Early patient mobility in the hospital environment has well-documented benefits (Adler & Malone, 2012; Morris et al., 2008; Needham, 2008; Perme & Chandrashekar, 2009; Schober & Thornton, 2013; Thomsen, Snow, Rodriguez, & Hopkins, 2008). Increases in provider workload require a collective team effort from all disciplines to help with safe patient mobility. However, it is difficult for health care educators to enable students to develop sustainable knowledge, skills, and attitudes in the fields of patient handling, care, treatment, and rehabilitation (Fogstad & Christiansen, 2011). It is crucial for students to practice their skills in those areas to increase their comfort levels to promote carry over into actual practice (Fogstad & Christiansen, 2011; Garbee et al., 2013).
In many hospital settings, physical therapists are the practitioners of choice for moving patients in and out of bed. However, with the increase in the general population requiring mobility services, it has become difficult for physical therapists to be available to all patients for all needed mobility activities. Much of the published evidence for interprofessional peer interaction includes the unequal representation of various disciplines and does not include the evaluation of outcomes related to physical therapy (PT) and nursing student interaction (Dufrene, 2012; Fogstad & Christiansen, 2011).
One of the few studies that examined the effects of peer learning between nursing students and PT students paired second-year PT students with first-year nursing students to help teach basic transfer skills to the nursing students (Fogstad & Christiansen, 2011). In that study, both groups reported a postintervention positive outcome and increased comfort levels with patient transfers. Not only was there an opportunity for interprofessional education, there was an opportunity for interprofessional communication. The study by von der Lancken and Levenhagen (2014) included an interprofessional experience, where PT students developed the objectives, lesson plan, handouts, and constructive feedback to teach mobility skills to undergraduate nursing students. The results of that study were positive, and the interprofessional experience was found to be a valuable addition to the curriculum (von der Lancken & Levenhagen, 2014).
The nursing faculty at the authors' university reported deficits in nursing students' mobility skills, which were reflected in licensing examination performance. As a result, the nursing faculty sought assistance from the PT department to enhance nursing students' mobility knowledge and skills. Doctoral PT students in their final year participated in a 4-hour interactive peer-assisted learning (PAL) laboratory experience with undergraduate nursing students. The teaching goals of the PAL experience included fall prevention and restraint management, bed mobility, passive range of motion, transfer training, gait training, and a review of assistive devices. Secondary objectives for both the nursing and PT students were to gain a better understanding of each group's roles and responsibilities within the hospital, to foster better interprofessional relationships in future clinical practice, and to use a PAL approach, which has been validated in both nursing and PT curriculums to reduce the demand on faculty, while improving the clinical experience (Ammon & Schroll, 1988; Stone, Cooper, & Cant, 2013). The American Nurses Association's Safe Patient Handling and Mobility: Interprofessional National Standards (2013) was used as a framework for teaching safe patient handling. According to those guidelines, role identity, collaboration, and team effectiveness need to be included in higher education (von der Lancken & Levenhagen, 2014). The PAL mobility laboratory meets the objectives set forth by the American Nurses Association. The university institutional review board approved the current study. Participation of human subjects did not occur until after informed consent was obtained.
Prior to the start of the laboratory, the nursing students completed a pretest questionnaire to assess baseline knowledge and confidence with basic patient mobility. The 63 nursing students and 31 PT students were then divided into 10 groups of approximately equal numbers of students, which included six nursing students and three PT students (the student-to-teacher ratio was 2:1). Demographic information was not collected. The laboratory was divided into 10 stations (Table 1). Groups rotated through each station every 20 minutes. PT students led the instruction and practice at all stations, with the exception of station #4, which was conducted by the nursing faculty. Two PT faculty members provided feedback and guidance as needed. After completing all 10 laboratory stations, the nursing students reviewed a case scenario that required them to apply their recently learned skills and knowledge focused on clinical decision making for appropriate assistive device use and transfer technique, as well as to determine when skilled PT services were warranted.
Nursing Mobility Laboratory Stations
The case scenario was about a 78-year-old man who was recently transferred from the intensive care unit to the acute care floor. He is medically stable but is deconditioned, with a reduction in the strength of muscles in multiple anatomic sites. He has active movement in all extremities and fair sitting balance. Vital signs taken at the bedside included the following: blood pressure, 140/90 mm HG; heart rate, 80 beats per minute; and respiratory rate, 18 breaths per minute (labored breath). Handouts summarizing each station skill were given to the nursing students as a reference guide. Following the completion of the mobility laboratory, the nursing students were asked to complete the same questionnaire as the pretest to assess posttest knowledge and confidence in patient mobility. The PT students were also administered a questionnaire following completion of the laboratory experience.
Analysis of the pretest–posttest by Wilcoxon sign ranked test (Table 2) revealed that the nursing students demonstrated significant improvement (p < .001) in questionnaire performance aimed at evaluating overall knowledge of safe patient mobility. The nursing students also showed improved confidence in instructing patients and others in mobility skills (p < .001). Ninety-two percent of the nursing students and 82% of the PT students reported that the PAL was either extremely successful or very successful at enhancing learning (Tables 2–3). When reviewing the case scenario, 90% of the nursing students identified appropriately the need for PT services for getting patients out of bed for the first time. Nursing students' reasons to support the decision warranting the need for skilled PT services for early mobility included the age of the patient, generalized deconditioning, impaired mobility, and labored breathing. Nursing and PT students also displayed better understanding of nursing and PT roles and responsibilities and how they can better interact in the future.
Nursing Students' Mobility Laboratory Pretest and Posttest Results
Physical Therapy (PT) Students' Mobility Laboratory Posttest Results
The mobility activity described in this article provided the opportunity to cross-train future nursing professionals not only to help with increasing safe mobility for those patients who do not require skilled PT services but to also recognize when PT services are warranted, thus meeting the first overarching objective for the laboratory.
The PAL model for learning has been previously examined in the application of learning musculoskeletal PT skills and athletic training skills (Burke, Fayaz, Graham, Matthew, & Field, 2007; Henning, Weidner, & Jones, 2006), with results indicating that PAL is a useful adjunct to training. The results of the current study and the study by Fogstad and Christiansen (2011) support that the PAL approach to learning is also successful in training at the acute care–hospital level. The interprofessional teaching project by von der Lancken and Levenhagen (2014) included a collaborative effort of several disciplines to teach patient mobility techniques for safe patient mobility. That study was part of a four-course, 9-credit hour interprofessional education program, with the goal of preparing students to “not approach care as individual experts but as expert teams” (von der Lancken & Levenhagen, 2014, p. 708) The interprofessional teaching project by von der Lancken and Levenhagen involved more contact hours and addressed the potential need for increased time for interprofessional collaboration within the current authors' curriculum, given the success of the program investigated by von der Lancken and Levenhagen. Despite reports of the various interprofessional activities conducted (Fogstad & Christiansen, 2011), a need exists for longitudinal studies that examine outcomes after students enter the professional world.
A second objective of the current PAL laboratory activity was to improve understanding of the various roles and responsibilities of the two disciplines within the hospital environment. Although the groups reported a better understanding of each profession's roles and responsibilities and how they can better interact in the future, anonymous feedback gathered from the PT student questionnaire included, “the nursing mobility laboratory was very successful in helping to review the material, but I don't have a good understanding on what nursing's role is in patient care.” As a result of such feedback, future PAL laboratory experiences will have the nursing and PT students switch roles, allowing the nursing students to be the primary instructors on nursing-specific topics, such as nutrition and hygiene. A primary focus for the nursing faculty was improvement in performance in the national licensure examination components that focus on patient mobility knowledge. Future research should assess the changes in board examination performance as a result of the current and future PAL strategies.
The current study aimed to examine the outcomes of a PAL mobility laboratory that went beyond basic transfer skills. The PT students were able to provide knowledge about and practice of mobility skills needed in the hospital environment, including bed mobility, fall prevention, gait training on a variety of surfaces with appropriate assistive devices, and range of motion. The PT students learned those basic mobility skills in the second semester of their nine-semester program, and the mobility laboratory provided an opportunity for the PT students to revisit those skills in the seventh semester, promoting the concept that “to teach is to learn twice” (Fogstad & Christiansen, 2011, p. 25).
Of note, the posttest survey instrument for the nursing students and the PT students was administered 4 days after the mobility laboratory. The delay in data collection may have had an impact on the results. On the other hand, the delay in taking the posttest could have resulted in an improvement of the results by decreasing the recency effect. In addition, although the faculty members involved in the study (A.K.L., M.A.N.) made every effort to protect the rights and welfare of the students and maintain confidentiality of all data, inherit bias of wanting to answer what the teachers wanted to hear could have influenced the student responses, as the students were part of academic courses. However, all data were evaluated and studied after the completion of the semester.
Overall changes recommended by the authors for future PAL mobility laboratory exercises include scheduling two shorter sessions instead of one 4-hour session to maximize student attention and retention of information. Second, a whole-group debriefing after the laboratory would allow an opportunity for the students to discuss the cases as a group, as well as to review the key concepts learned in the laboratory. Third, the authors would like to include more opportunities for the nursing students to teach PT students about nursing care issues so that each of the students have the opportunity to be both student and teacher. Finally, the authors recommend a thorough faculty debriefing after the exercise to ensure that all faculty are engaged, and all faculty involved should be encouraged to discuss ways to improve the interprofessional experience.
The success of the preliminary interprofessional PAL exercise described in this article shows great promise for future nursing and PT collaborations. Approximately 161 nursing programs nationwide also have PT programs on campus; therefore, it is feasible that this interprofessional PAL laboratory experience can be incorporated in other programs to promote better educational experiences for students, foster long-lasting interprofessional respect, and provide a novel foundation on which safe and efficient patient handling can be based.
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- American Nurses Association. (2013). Safe patient handling and mobility: Interprofessional national standards. Silver Spring, MD: Author.
- Ammon, K.J. & Schroll, N.M. (1988). The junior student as peer leader. Nursing Outlook, 36, 85–86.
- Burke, J., Fayaz, S., Graham, K., Matthew, R. & Field, M. (2007). Peer-assisted learning in the acquisition of clinical skills: A supplementary approach to musculoskeletal system training. Medical Teacher, 29, 577–582. doi:10.1080/01421590701469867 [CrossRef]
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Nursing Mobility Laboratory Stations
|1||Fall prevention, fall risk assessment, and restraint management|
|2||Bed mobility basics (rolling, supine to sit, scooting, body mechanics basics)|
|3||Passive range of motion for the upper extremity, lower extremity, and cervical spine|
|4||Dependent hospital bed to stretcher transfer (led by nursing faculty)|
|5||Assisting patients with ambulation: Axillary and forearm crutch training|
|6||Assisting patients with ambulation: Standard walker, rolling walker, and hemiwalker|
|7||Assisting patients with ambulation: Single-point cane and quad cane (i.e., cane with four feet)|
|8||Navigating stairs and curbs with various assistive devices|
|9||Dependent transfer: Manual Hoyer lift|
|10||Assisted transfers: Slide board, squat pivot, stand pivot transfers|
Nursing Students' Mobility Laboratory Pretest and Posttest Results
|Measure||Pretest||Posttest||p||Z||Pearson's Correlation Coefficient (r)|
|n||Mean ± SD (Range [%])||n||Mean ± SD (Range [%])|
|Mobility laboratory test performance||56||60.05 ± 14.16 (20–87)||56||79.71 ± 11.90 (53–100)||<.001*||5.14||.69|
|Confidence instructing patients and others||59||2.15 ± 0.96 (1–4)||59||2.95 ± 0.75 (1–4)||<.001*||6.58||.86|
|How successful was the mobility laboratory in performing its intended task of enhanced learning?a||92% of the nursing students reported the activity to be extremely to very successful (47% extremely successful, 45% very successful, 5% moderately successful, 3% not answered).|
Physical Therapy (PT) Students' Mobility Laboratory Posttest Results
|I feel confident that I can safely transfer a patient after participating in the mobility laboratory. (Likert scale: strongly agree, agree, neutral, disagree, strongly disagree.)||89% of PT students responded strongly agree to agree (71% [n = 20] strongly agree, 18% [n = 5] agree, 7% [n = 2] neutral, 4% [n = 1] not answered).|
|This nursing mobility laboratory experience will help to foster better understanding and improve interprofessional relationships between PT and nursing staff in my future clinical practice. (Likert scale: strongly agree, agree, neutral, disagree, strongly disagree.)||83% of PT students responded strongly agree to agree (54% [n = 15] strongly agree, 29% [n = 8] agree, 14% [n = 4] neutral, 4% [n = 1] not answered).|
|How successful was the mobility laboratory in performing its intended task of enhanced learning? (Likert scale: extremely successful, very successful, moderately successful, slightly successful, not at all successful.)||82% of PT students responded extremely successful to very successful (39% [n = 11] extremely successful, 43% [n = 12] very successful, 14% [n = 4] moderately successful, 4% [n = 1] not answered).|