Video Case Study - Activity and Movement

Nurse Alex works on an intermediate care unit and is caring for Joan, a 45-year-old female who is being treated following a car crash two weeks ago. Since then, Joan has been experiencing significant weakness in the lower extremities, difficulty bearing weight, and difficulty changing position independently while in bed. Nurse Alex goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Joan's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Alex recognizes important cues. He notices Joan is unable to bear weight, has adequate upper extremity strength and requires maximum assistance to transfer from bed to the chair and bedside commode. He reviews the electronic health record, or EHR, where he notes that a transfer board is recommended for Joan based on her initial evaluation by the physical therapist.

Next, Nurse Alex analyzes these cues and determines Joan will need his support to reduce the impacts of immobility.

Nurse Alex prioritizes the hypothesis of impaired mobility and generates solutions to address Joan's impaired mobility that will include promoting safety and increasing her level of functioning. He establishes the expected outcome that after intervening, Joan will safely transfer from the bed to a chair using a transfer board with a one-person assist.

Nurse Alex then takes action to implement the generated solutions. First, he institutes fall precautions to promote safety. Before proceeding, Nurse Alex ensures the bed and chair are locked and in proper position, that the chair is slightly lower than the height of the mattress, and that all obstacles are removed. He will also ensure Joan's pain is controlled and her vital signs are stable prior to attempting to use the transfer board. He recalls that Joan has only used the transfer board once with physical therapy and plans to reorient Joan to the proper technique to using the transfer board.

Nurse Alex: Hi Joan, ready to transfer to the chair?

Joan: I don't know, I still need so much help moving around.

Nurse Alex: It's important to try to maintain mobility, even if it's just transferring from bed to chair. I will be here to help you transfer using this transfer board. Do you remember how to use it?

Joan: I think so.

Nurse Alex: Okay, let's review. First, I will assist you with sitting on the edge of the bed positioning both of your feet on the floor. Then, I will apply the gait belt around your waist. This will help me guide your body as you transfer. You will shift your weight onto your left hip as I gently place the board under your right hip, until about a third of the board is underneath you. Then, with my help, you will use your arms to push across the board and onto the chair. Remember to lean slightly forward as you slide across. Ready?

Joan: Okay! I'll give it a try.

Nurse Alex then evaluates the outcome of his actions. Joan successfully transferred to the chair, and she stated she was beginning to feel confident using the transfer board. Based on the outcomes established by Nurse Alex, Joan met the goal of transferring from bed to chair using a transfer board with a one-person assist.

Then, Nurse Alex suggests that Joan continue to do active range of motion exercises in her upper extremities, even while in bed, to improve muscle strength and help with use of the transfer board.

Before leaving the room, Nurse Alex ensures that Joan's call light and personal possessions are in reach, that the bed alarm is on, and he reminds her to use her call light before trying to get out of bed on her own.

Alright, as a quick recap… Nurse Alex recognized and analyzed cues related to Joan's impaired mobility and prioritized hypotheses and generated solutions to address this problem. Nurse Alex then implemented measures and took actions to improve mobility such as use of a transfer board and evaluated her outcomes and compared them to the expected outcome.