Ward-Based Walking Therapy in a Tertiary Inpatient Rehabilitation Ward: a Nurse Led Initiative

Abstract

Ward-Based walking therapy in a tertiary Inpatient Rehabilitation Ward: A Nurse Led Initiative.

Wang Shan

Nurse Educator
Tan Tock Seng Hospital, Singapore

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Background: Restoring the functional mobility has been one the ultimate Rehabilitation goal for all stroke and spinal cord injury patients. Very often, the physiotherapists or the therapy assistants played the primary roles in facilitating patients’ therapy. Recently, in order to enhance the rate of functional recovery of the patients, the Rehabilitation nurses have initiated the engagement of the patients in walking therapy especially during the weekends. As illustrated by Doherty, B. & Bowers, J.(2013), nurses have been identified as the professional most capable of promoting walking independence in the hospital setting. However, the nurses do not often walk their patients much.

Aim: To explore empowering nurses to led in walking therapy for stroke and spinal cord injury patients in a tertiary Rehabilitation Centre in Singapore so as to improve the functional outcome of the patients.

Method: It is a descriptive study. Patients with stroke and spinal cord injury with a Functional Independence Measure (FIM) Score of 4 or more were recruited for the initiative. Registered Nurses were identified to be the trainers by the assigned physiotherapist. The training for the Trainers entails 4 hours of theory session and 4 sessions (1.5 hours each) for hands on practicum to assess on their competencies. Following that, the nurse trainers will then start to train the identified nurses. The trained nurses will then facilitate a maximum of 3 patients per day for a 10 minutes walking session each covering a distance of 600m to 1km during the weekends. Self Efficacy scale was used to gather nurses’ confidence level and patients’ satisfaction score was also collated.

Results: A total of 6 Nurse Trainers and 36 nurses were trained in walking therapy in Rehabilitation ward. Three trained nurses were assigned to walk about 9 patients per sessions. With each session, there was an increase of about 3 hours of therapy time for the patients per week. For a month, there was an increase of at least 12 hours of therapy time for them. As for the patients’ survey, they have generally feedback that their walking performance had improvement positively and they have more time to be actively engaged in walking therapy then just lying on the beds. 85% of them feedback that they are very satisfied with the initiative. The incidence of fall in the wards has also not increased since the initiative. Lastly, the nurses have also shared that there is an immense increased in their level of confidence while they walk the patients as they are now more accounted for promoting patients’ independent functions.

Conclusion: Ward-Based walking therapy program improved the chances of walking activity for patient undergone rehabilitation. It is possible to carry out the convenience of walking in the ward will combine with the consistent availability of trained rehab nurses to engage patients in the extra walking practice.