Research in Gerontological Nursing

Empirical Research 

Quality Mobility Care in Nursing Homes: A Model of Moderating and Mediating Factors to Guide Intervention Development

Janice Taylor, PhD, MGeron, BAppSc (Pty), Cert IV TAA; Jane Sims, PhD, MSc, BSc (Hons); Terry P. Haines, PhD, GCert (Health Economics), BPhysiotherapy (Hons)

Abstract

The current qualitative study aimed to understand factors in mobility care to inform practice improvements. Data were collected at three nursing homes in Melbourne, Australia, via interviews with 10 senior staff and 15 residents, focus groups with 18 direct care staff, and observations of 46 mobility events. Thematic and content analysis of data occurred. Findings included factors (a) intrinsic to residents, (b) intrinsic to staff, and (c) extrinsic to residents and staff, such as equipment and organizational factors. A model describing associations between factors and their roles as moderators and mediators of resident mobility was generated. Staff assistance, residents’ mobility effort, and equipment used during mobility were posited as complete or partial mediators of resident mobility outcomes. Barriers that may compromise the quality of mobility care in nursing homes emerged. The model provides direction for improvements in mobility care that integrate safety, mobility optimization, and person- and relationship-centered care. [Res Gerontol Nurs. 2014; 7(6):284–291.]

Dr. Taylor is Researcher, Monash University; Dr. Sims is Senior Research Fellow, Monash University; and Dr. Haines is Associate Professor, Allied Health Research Unit, Southern Health, and Director of Research, Southern Physiotherapy Clinical School, Monash University, Melbourne, Australia.

The authors have disclosed no potential conflicts of interest, financial or otherwise. Dr. Taylor was supported by an Australian Postgraduate Award and previously by a Primary Health Care Research Evaluation & Development Fellowship 2009, and Dr. Haines is supported by a National Health & Medical Research Council Career Development Award.

Address correspondence to Janice Taylor, PhD, MGeron, BAppSc (Pty), Cert IV TAA, Researcher, Faculty of Medicine, Nursing and Health Sciences, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia; e-mail: janice.taylor@monash.edu.

Received: March 24, 2014
Accepted: July 11, 2014
Posted Online: September 12, 2014

Abstract

The current qualitative study aimed to understand factors in mobility care to inform practice improvements. Data were collected at three nursing homes in Melbourne, Australia, via interviews with 10 senior staff and 15 residents, focus groups with 18 direct care staff, and observations of 46 mobility events. Thematic and content analysis of data occurred. Findings included factors (a) intrinsic to residents, (b) intrinsic to staff, and (c) extrinsic to residents and staff, such as equipment and organizational factors. A model describing associations between factors and their roles as moderators and mediators of resident mobility was generated. Staff assistance, residents’ mobility effort, and equipment used during mobility were posited as complete or partial mediators of resident mobility outcomes. Barriers that may compromise the quality of mobility care in nursing homes emerged. The model provides direction for improvements in mobility care that integrate safety, mobility optimization, and person- and relationship-centered care. [Res Gerontol Nurs. 2014; 7(6):284–291.]

Dr. Taylor is Researcher, Monash University; Dr. Sims is Senior Research Fellow, Monash University; and Dr. Haines is Associate Professor, Allied Health Research Unit, Southern Health, and Director of Research, Southern Physiotherapy Clinical School, Monash University, Melbourne, Australia.

The authors have disclosed no potential conflicts of interest, financial or otherwise. Dr. Taylor was supported by an Australian Postgraduate Award and previously by a Primary Health Care Research Evaluation & Development Fellowship 2009, and Dr. Haines is supported by a National Health & Medical Research Council Career Development Award.

Address correspondence to Janice Taylor, PhD, MGeron, BAppSc (Pty), Cert IV TAA, Researcher, Faculty of Medicine, Nursing and Health Sciences, Building 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia; e-mail: janice.taylor@monash.edu.

Received: March 24, 2014
Accepted: July 11, 2014
Posted Online: September 12, 2014

A focus on the quality of aged-care services in developed countries is increasing as their populations age (Leone, 2010). The quality of mobility care for residents in nursing homes also deserves attention. Mobility contributes to residents’ health through prevention of depression (Atkins, Naismith, Luscombe, & Hickie, 2013) and pressure ulcers (Brillhart, 2005). It also contributes to residents’ functional ability (Forster et al., 2009), quality of life, and wellness (Bourret, Bernick, Cott, & Kontos, 2002; Taylor, Sims, & Haines, 2013a). Therefore, staff must promote residents’ mobility efforts (Bourret et al., 2002 ; Brown Wilson, 2009). Recommendations for safe manual handling exist (de Castro, Hagan, & Nelson, 2006); however, resident frailty and disability, as well as the increasing number of residents with dementia, pose greater manual handling challenges (Wångblad, Ekblad, Wijk, & Ivanoff, 2009; Wilson, 2000).

The literature highlights barriers to both safe manual handling and mobility optimization, including time pressures; lack of equipment; lack of management support; and poor staff knowledge, skills, and attitudes (Bowers, Lauring, & Jacobson, 2001; Koppelaar, Knibbe, Miedema, & Burdof, 2009). Communication and collaboration are advocated to address such barriers (Kneafsey, 2007; Taylor, Sims, & Haines, 2012). Furthermore, person- and relationship-centered approaches to care may also have a positive influence on the quality of mobility care (Brown Wilson, 2009 ; Passalacqua & Harwood, 2012). However, mobility care is a complex phenomenon, of which safe manual handling, mobility optimization, and relationships are key aspects.

The current study aimed to comprehensively explore factors influencing the quality of mobility care by integrating the factors related to the three key aspects of safety, mobility optimization, and relationship, rather than treating them distinctly. In line with realistic evaluation, an explanatory and representational model of moderating and mediating factors was developed from the findings. Realistic evaluation is recommended for evaluations of interventions in complex settings. Such evaluations are dependent not only on outcomes, but also on evaluation of mechanisms and contexts (Kazi, 2003). Kazi (2003) suggests that the starting point for realist evaluation is a proposition on how the mechanisms of an intervention, introduced amongst pre-existing contexts, can generate outcomes. The current article provided a model of moderating and mediating factors to achieve such an understanding.

Moderating factors affect the strength and direction of associations between independent and dependent variables and can have a positive, neutral, or negative influence. Mediating factors are the pathway through which independent variables act in relation to a dependent variable. They specify how associations between such variables occur (Baron & Kenny, 1986; Bennett, 2000). For example, resident mobility capacity most likely predicts resident mobility efforts, which mediate subsequent mobility outcomes. However, factors such as resident motivation to move, staff mobility-enhancing skills, and organizational factors may have a moderating influence on mobility outcomes. The model in the current article may therefore facilitate testing of future mobility care practice improvements.

Method

Design

The current study was part of a focused ethnography exploring mobility care in three nursing homes in Melbourne, Australia, from July 2010 to October 2012. The value of focused and applied ethnography, where the focus is on a particular issue within a limited time, is increasingly being recognized in health care research (Savage, 2006; Willis & Anderson, 2010), especially when quality of care and safety are of interest (Dixon-Woods, 2003).

Participants

The first author (J.T.) gained access to facilities through collegial networks and the public domain. A purposive sample of residents and staff for interview was identified with the assistance of managers and nursing staff. A convenience sample of staff for focus groups was recruited by displaying notices on boards and through manager announcements at staff meetings. Letters of invitation were issued to all potential participants, and consent was obtained.

Procedure

The first author conducted semistructured interviews with residents and senior staff, as well as focus groups with direct care staff. Question schedules designed to elicit participant perspectives on mobility care were used to guide interviews and the focus groups (, available in the online version of this article). Questions were derived from the researcher’s (J.T.) experience as a physiotherapist in nursing homes and her theoretical orientation to the research question, as well as with reference to similar schedules used in previous studies (Bourret et al., 2002; Ouellet & Rush, 1996; Rush & Ouellet, 1998). Data collection continued until data saturation was achieved. The first author also conducted unobtrusive observations of residents and staff during mobility events in public areas of the facilities at times of peak activity. These events were resident transfers on and off chairs and wheelchairs, as well as assisted walking. Observations were recorded using a tool adapted for the purpose (, available in the online version of this article) from a previously developed instrument (Kjellberg, Lagerström, & Hagberg, 2003). Triangulation of data occurred, and care staff were provided with an opportunity to confirm findings from resident and senior staff interviews and observations during focus groups. The study methodology was positively appraised using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong, Sainsbury, & Craig, 2007). Ethics approval was obtained for the study from a human research ethics committee.

Data Analysis

Interviews and focus groups were transcribed and coded using NVivo 9.0 software. The first author analyzed interview and focus group data using qualitative thematic analysis and analyzed observations using content analysis (Liamputtong & Serry, 2013). Categories were linked to an emerging theory regarding associations between factors, as well as their roles as moderators and mediators. Credibility of coding, categories, and analysis were established through peer review by the coauthors (J.S., T.P.H.) throughout the study.

Results

Characteristics of the facilities are shown in Table 1. Residents received, on average, 5 to 17 minutes of physiotherapy per week; physiotherapy was provided to residents with the greatest need and involved assessments, reviews, problem solving, and staff support. Facility A’s physiotherapist also provided physiotherapeutic treatment modalities for pain management. Interviews were conducted with 15 residents with various mobility levels (Table 2) and 10 senior staff, including four managers, four nurses, and three physiotherapists. Eighteen direct care staff participated in focus groups (Table 2).

Facility Characteristics

Table 1:

Facility Characteristics

Resident and Focus Group Participant
Characteristics

Table 2:

Resident and Focus Group Participant Characteristics

Approximately 16 hours of observation of 46 mobility events occurred across the three facilities. The main categories to emerge from the data were intrinsic factors related to residents and staff, as well as factors extrinsic to staff and residents. These factors informed the development of a model of moderating and mediating factors posited to influence resident mobility, with three complete or partial mediators of resident mobility outcomes (i.e., resident mobility effort, staff assistance, and equipment use) (Figure). Independent variables within the model were resident values and beliefs regarding mobility, resident mobility capacity, staff mobility care knowledge and skills, and equipment availability. Descriptions of factors and their moderating and mediating characteristics follow, with some supporting quotes.

A model of hypothesized moderators and mediators influencing resident mobility outcomes. Mediating factors are motivation to
move, mobility efforts, staff assistance, and equipment use. Moderating factors are attitudes toward mobility and mobility loss, motivation to move,
cognitive factors, staff attributes and attitudes, organizational factors, policies, systems, staff training, leadership and supervision, culture, resource
allocation–staff, and resource allocation–equipment. Independent variables are values and beliefs, mobility capacity, mobility care knowledge and skills,
and equipment available. Outcome variable is mobility outcome.

Figure.

A model of hypothesized moderators and mediators influencing resident mobility outcomes. Mediating factors are motivation to move, mobility efforts, staff assistance, and equipment use. Moderating factors are attitudes toward mobility and mobility loss, motivation to move, cognitive factors, staff attributes and attitudes, organizational factors, policies, systems, staff training, leadership and supervision, culture, resource allocation–staff, and resource allocation–equipment. Independent variables are values and beliefs, mobility capacity, mobility care knowledge and skills, and equipment available. Outcome variable is mobility outcome.

Resident Intrinsic Factors

Residents valued mobility and independence and often demonstrated motivation to make an effort to move within the limits of their capacity. One resident stated, “I try to do as absolutely much as I can myself.”

Facilities determined residents’ mobility care needs through assessment, during which residents’ values, beliefs, motivation, and preferences were considered. Staff had to account for residents’ pain, mood, and mobility fluctuations, which could influence residents’ cooperation and motivation to move. Staff reported that manual handling decisions were difficult at times, due to resident behaviors associated with dementia. One staff member said, “The residents that have dementia are often a little more resistive to being transferred in ways that are safest for staff, lifting equipment, that sort of thing.”

Such challenges during mobility care were also evident during observations.

Model Implications. Values and beliefs and mobility capacity are represented as independent variables. Residents’ attitudes are shown as having a moderating influence on their motivation to move. Motivation to move then mediates between these factors and residents’ mobility effort. In turn, mobility effort acts as a mediator of mobility outcomes. Cognitive factors indicate that residents’ cognition has a moderating influence on their physical mobility effort.

Staff Intrinsic Factors

Senior staff highlighted the need for care staff compliance with safe manual handling and mobility optimization. Care staff aimed to optimize residents’ mobility and consider their wishes. One staff member said, “If they can walk a bit, I assist them if they want assistance. Always ask them if they want assistance to stand up or if they’re still mobile.”

Another staff member stated, “Every resident is unique. I mean I wouldn’t approach one person the same way as I would another.”

However, staff at all levels acknowledged that assistants may not always consider resident needs during mobility events or comply with safe manual handling procedures. One supervising nurse suggested that staff did not think to encourage residents to move: “A lot of people forget that residents can roll over and so on, and they don’t invite them to do so.”

Observations reinforced that staff often provided assistance to residents by taking control rather than using mobility enhancing strategies, which could result in staff imposing dependence on residents. It was reported that staff did not always take the time to find other staff to help, find necessary equipment, or read care plans. Senior staff attributed such noncompliance to intrinsic factors, such as care staff ’s lack of knowledge and attitude, as well as time pressures. A physiotherapist suggested that lack of time may be perceived rather than actual, stating:

I think occasionally they [staff ] might get a bit tired or rushed. I think with this facility, the feeling of being rushed would be more self-imposed; the facility doesn’t push the staff to be really fast or quick.

Model Implications. Staff mobility care knowledge and skill are represented as an independent variable. Staff attributes and attitudes are portrayed as a factor that moderates how staff put their knowledge and skill into practice. Staff assistance is a factor that mediates resident mobility. At times, staff assistance may have a dual role as a mediator and moderator; physical assistance by staff mediates a mobility outcome, whereas staff encouragement of residents to move is a moderating influence on residents’ mobility efforts.

Factors Extrinsic to Staff and Residents

Policies and Systems. Staff practices related to safe manual handling and resident mobility optimization were guided by facility policies. Systems existed for planning, communication, and continuous improvement. Mobility care plans were based on assessment and review of residents’ mobility conducted by physiotherapists. Care plans reflected a need for control of ad-hoc mobility care that could occur due to the multiplicity of care staff opinions, attitudes, and modes of practice. The emphasis was on all staff being aware of current mobility care plans and changes. Verbal hand overs at the beginning of shifts provided time for communication regarding residents’ status and care. Another method of structured communication was written progress notes.

Model implications. Facility policies and systems are shown as having a moderating influence on staff ’s mobility assistance.

Organizational Culture. Risk management approaches to prevent resident and staff injuries were evident. Organizational risk tolerance levels varied. Staff were concerned about resident falls and that resident mobility could be discouraged due to falls risks. One staff member said, “If they are a falls risk, maybe they’re not encouraged to walk as much for fear of falling.”

Challenges, such as the need for staff to collaborate and coordinate their effort and the use of equipment at times of high demand, were described. It was considered important for physiotherapists to work closely with nursing staff. Physiotherapists were generally considered to be an integral part of the team, providing clarity regarding manual handling care plans. However, some nurses believed physiotherapists may be unaware of nursing issues that could impact residents’ mobility assessments.

Model implications. Cultural factors, such as risk management approaches and teamwork, are portrayed as having a moderating influence on staff assistive performance.

Staff Training. Continuous improvement via staff training occurred. Competency assessment and training were part of staff orientation; new staff were assigned to work alongside regular staff. Some care staff complained that newly qualified staff were not well trained and that orientation of new staff was not always adequate. Manual handling updates were considered important by all levels of staff, especially when staff were found to be noncompliant. Some on-the-job peer support occurred.

Model implications. Staff training is shown as having a moderating influence between staff ’s knowledge and skills in mobility care and their assistive performance. Although pre-employment training may have an important influence on staff skills, organizational training and orientation are the moderating factors that aim to address gaps in skills and knowledge of employees.

Leadership and Supervision. Nurses in charge of units in nursing homes took daily responsibility for resident care, as well as staff support and performance. However, nurses relied on physiotherapists and peer leaders for support in their role due to a lack of time for direct observation of staff behavior. One nurse said:

It’s casual; it’s not a formal thing. Often [the physiotherapist] will say, “I don’t believe what I saw in there, you know, what was going on behind the screen. What were they doing with that sling when it’s written in the care plan it should be this?” And that will alert me that somebody’s you know…because I can’t always be behind every curtain.

Timely feedback given to staff who were noncompliant with optimal mobility care was considered important. One facility had staff who were accredited manual handling trainers and provided this kind of support. The facility manager commented:

So these accredited trainers will deal with manual handling issues on a daily basis as required or if there’s been an issue raised and a staff member has had an issue with manual handling, they’ll take them aside and spend some time with them on the floor and do a refresher with them.

Nurses, physiotherapists, and peer leaders were considered able to provide support, advice, and instruction to other staff and act as role models. As one manager said:

But we have a very good rapport with our physio[therapist] here, so she communicates very clearly with the staff, with the nurse unit manager. So we have this sort of loop where they communicate to the staff and then communicate back to the [physiotherapist].

Care staff also supported each other, and one staff member stated, “following [experienced staff ]…what they do so you can get into a routine…following their lead and getting pointers.”

Model implications. Leadership and supervision are represented as moderating factors in the model.

Staff Resource Allocation. Adequate resident-to-staff ratios and sufficient time to provide care were considered important. Staff familiarity with residents helped with communication and consistency of care but depended on staff stability. One manager pointed out that the need to use casual or agency staff challenged stability and development of familiarity, stating, “If you don’t have too many strangers, not many agency, if you have your own staff, they do pick up the differences.”

Model implications. Resource allocation–staff is portrayed as having a moderating influence on staff assistance.

Equipment. The prescribing, sourcing, and ordering of equipment was usually the physiotherapist’s task. Equipment provision depended on costs and was either the responsibility of the facility or negotiated with families.

Residents indicated dependence on equipment to assist them in mobility. On resident, indicating her walker, said, “I couldn’t do without that.”

The height and design of chairs and wheelchairs had an impact on the level of staff assistance required during transfers. Resident mobility also depended on manual handling equipment. Care staff were expected to (a) know what equipment had been prescribed for each resident, (b) understand what equipment was appropriate to a situation, and (c) ensure it was used safely and effectively. The onus was on staff to ensure equipment for mobility or manual handling was correct and in good working order. One staff member said, “If you’re using equipment to lift [residents], you have to make sure that nothing’s broken.”

Model implications. Equipment available within a facility is represented as an independent variable in the model. The factor resource allocation–equipment is portrayed as having a moderating influence on equipment use and encompasses the range of organizational factors discussed above. Policies, systems, and staff training may also have a moderating influence on equipment availability. The role of staff assistance as a moderator of not only resident mobility effort but also of equipment use is represented in the model. Equipment use represents the third factor that can be a complete or partial mediator of mobility outcomes.

Discussion

Barriers and facilitators of quality mobility care have been defined in the current study as moderators and mediators to facilitate more robust and contextually relevant intervention development and evaluation in the future (Baron & Kenny, 1986; van Bokhoven, Kok, & van der Weijden, 2003). Residents’ contribution to their mobility has been explored elsewhere (Taylor et al., 2013a). This discussion focuses on staff assistance as a key factor in ensuring safe and quality mobility care. The influence of staff assistance on resident mobility is strong—not only is it a mediating factor, but it can also have a moderating influence on resident mobility efforts and equipment use.

Resident- related factors, such as cognitive impairment, have been cited as possible barriers to safe manual handling ( Koppelaar, Knibbe, Miedema, & Burdorf, 2011; Koppelaar et al., 2009). However, when considering mobility care, the focus should go beyond safe manual handling alone. Attention should also be paid to staff influence on resident mobility efforts, which is dependent on the use of mobility enhancing strategies and person-centered approaches to care ( Bourret et al., 2002; Taylor et al., 2013a). Although the current study found that care staff espouse a concern for residents’ wishes and understand the need for flexibility to improve resident choices and control during mobility care, care staff ’s behavior did not always reflect this understanding. Resident choice and control are important aspects of person-centered care (Passalacqua & Harwood, 2012) and may have a positive moderating influence on resident mobility efforts. Staff considerations of residents’ autonomy and control may be particularly important when residents have cognitive impairment (Wångblad et al., 2009).

The authors of the current article found that many organizational factors influenced mobility care. The current study supported that organizational learning, leadership, and training played major roles in practice development (Berta et al., 2010; Nolan et al., 2008). Organizational moderating factors, such as staff time, equipment allocation, and staff support, were highlighted and have been cited elsewhere as barriers to safe manual handling (Koppelaar et al., 2009, 2011). The current study supported other studies that pointed to the need for staffing stability and rostering systems designed to support resident–staff relationships and familiarity ( Brown Wilson, 2009).

Relationship-centered nursing home cultures have been proposed to better support staff and help them be less time and task oriented (Brown Wilson, 2009; Nolan, Davies, Ryan, & Keady, 2008); an enriched relationship-centered environment that enhances resident–staff relationships and supports person-centered approaches to mobility care may be more likely to help residents retain desired function and autonomy during mobility events ( Taylor, Sims, & Haines, 2013b). Furthermore, staff safety, well-being, and sense of job satisfaction may improve when staff are well supported and resident mobility is optimized.

Despite challenges to practice improvement due to the complexity of mobility care, improvements in staff assistive performance are urgently needed, as the nature of staff assistance has ramifications for the quality of resident mobility and staff and resident safety. Staff need to encourage residents’ mobility efforts, thus contributing to resident independence ( Taylor et al., 2013a). Staff must also ensure the correct use of mobility equipment, which is in good working order. In short, staff must be competent in safe manual handling, mobility optimization, and person-centered approaches to mobility care. A relationship-centered facility culture may also be required to support staff provision of such care. The current article provides a model that allows practical and realistic consideration of the factors most likely to have the greatest impact on mobility care practice improvement efforts.

Strengths and Limitations

The current study was qualitative and cannot be generalized. However, it provided theoretical insights that can be tested by future research. Data saturation and peer review were used to test coding categories and minimize bias. Checking of emergent interpretations of data occurred in focus groups. Triangulation of multiple studies helped with formulation of the model.

Implications and Conclusion

The current article highlighted the moderating and mediating factors that may be relevant to improvements in mobility care aimed at integrating safety, resident mobility optimization, person-centered approaches to care, and a relationship-centered culture. Person-centered care may improve the quality of staff assistance and consequent resident mobility outcomes. Facility cultures based on relationship-centered care may enhance staff assistive performance by providing an enriched environment focused on collaborative leadership and staffing stability to enhance staff familiarity with residents.

The model presented in the current article highlighted associations between moderating and mediating factors related to resident mobility. It has provided a basis from which mobility care practice improvements can be developed and tested. Feasibility studies that focus on care staff training in person-centered mobility care and the use of mobility-enhancing strategies are warranted. Strategies to enhance relationship-centered cultures, such as dedicated staffing and transformational leadership, should also be considered. Future studies may focus on ambulatory residents and how to maintain their transfer and walking ability, and/or on residents requiring mechanical assistance to transfer, and how to ensure safe and person-centered staff interactions. Further research such as this would indicate optimal practice and organizational changes needed to ensure quality mobility care in the future.

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Appendix A:
Resident interview questions
Independence and Capacity
  • What does being mobile mean to you?
  • When you think about being mobile, or able to get about, what comes to mind?
  • What prevents you from being as mobile as you wish/able to get about as much as you wish? How does that make you feel?
  • How has your mobility changed? What abilities do you feel you have lost?
  • Is there anything you want to do that you can’t?
  • What do you have difficulty doing?
  • Do you think you could move more than you do? How? (capacity versus actuation)
Assistance
  • Do staff assist you with transfers/getting in or out of bed/getting in or out of chairs/in the shower?
  • How does it feel when they do?
  • How do you think you would feel if you needed assistance?
Equipment
  • What equipment do you have that assists you…bed, bathroom, chairs, walkers…? How does it help?
  • Are there any chairs you have difficulty getting out of or avoid for some reason?
Mobility
  • How do you get up and sit down from your chair?
  • How do you get off the bed?
  • Do you ever have difficulty or need assistance? Have you in the past?
Physiotherapy
  • Have you had any experience with physiotherapy?
  • What was it?
  • Did it help? How?
  • What is your understanding of physiotherapy?
Manager interview questions
Questions - Logistics:
  • How many beds do you have in this facility?
  • How many staff do you employ?
  • What are the staff to resident ratios in the morning/afternoon/evening/at night?
  • Do you have a physiotherapist here?
  • How many physiotherapy hours are provided?
  • Do you have an OH&S officer?
  • How many manual handling Work Cover claims did you have last year?
Questions - Policy & procedure:
  • What is your facility manual handling policy?
  • What does this mean?
  • Do you promote No Lift as described in the Worksafe transferring people safely document? e.g. are staff allowed to use “walk belts”?
  • Do you have regular OH&S meetings?
  • How often do they take place?
  • Is manual handling a standard item on the agenda?
Questions - Manual handling training:
  • Please tell me about your manual handling training program
  • Are all staff trained in safe manual handling?
  • How often does each staff member have to attend training?
  • Who does the training?
  • How is the training funded?
  • How long does the training session run?
  • How is the session conducted?
  • Are staff tested for safe manual handling competencies?
  • How does this occur?
  • What happens if they are deemed not competent?
  • Do you have one or more people in the facility you regard as safe manual handling champions? OR Do you have staff within the facility who specifically promote safe manual handling?
  • How many safe manual handling champions do you have?
  • Are they in formal or informal roles?
Questions - Safe manual handling training-practice gaps:
  • How effective do you feel the training program is?
  • Do you see any barriers to practicing safe manual handling in your facility?
  • If yes, What are they?
  • If no, ask clarifying question, So does this means you feel confident that staff always carry out manual handling tasks in the safest and best way possible?
  • Please comment on how you would like to see manual handling training improved?
  • Please comment on how you would like to see manual handling practices improved?
Questions – Resident mobility:
  • Please tell me about your program to optimize resident mobility.
  • Do you see any barriers to optimizing resident mobility?
  • If yes, What are they?
  • If no, Does this means you feel confident that staff always assist residents to get on and off beds and in and out of chairs in the safest and best way possible?
  • How do you ensure resident mobility care plans are implemented?
  • What is the role of the physiotherapist in relation to resident mobility?
  • What is the role of the physiotherapist in relation to carer safety?
  • Does No Lift impact on resident mobility in any way?
Facility clinical coordinator & physiotherapist interview questions
Questions - Policy & procedure:
  • What is your facility manual handling policy?
  • What does this mean?
  • Do you promote No Lift as described in the Worksafe transferring people safely document? e.g. are staff allowed to use “walk belts”?
Questions - Manual handling training:
  • Please tell me about the facility manual handling training program?
  • Are all staff trained in safe manual handling?
  • How often does each staff member have to attend training?
  • Who does the training?
  • How is the training funded?
  • How long does the training session run?
  • How is the session conducted?
  • Are staff tested for safe manual handling competencies?
  • How does this occur?
  • What happens if they are deemed not competent?
  • Do you have one or more people in the facility you regard as safe manual handling champions?
  • OR Do you have staff within the facility who specifically promote safe manual handling?
  • How many safe manual handling champions do you have?
  • Are they in formal or informal roles?
Questions - Safe manual handling training-practice gaps:
  • How effective do you feel the training program is?
  • Do you see any barriers to practicing safe manual handling in your facility?
  • If yes, What are they?
  • If no, Does this means you feel confident that staff always carry out manual handling tasks in the safest and best way possible?
  • Please comment on how you would like to see manual handling training improved?
  • Please comment on how you would like to see manual handling practices improved?
Questions – Resident mobility:
  • Please tell me about the facility program to optimize resident mobility.
  • Do you see any barriers to optimizing resident mobility?
  • If yes, What are they?
  • If no, Does this means you feel confident that staff always assist residents to get on and off beds and in and out of chairs in the safest and best way possible?
  • How do you ensure resident mobility care plans are implemented?
  • What is the role of the physiotherapist in relation to resident mobility?
  • What is the role of the physiotherapist in relation to carer safety?
  • Does No Lift impact on resident mobility in any way?
Focus Group Questions
Staff role in mobility optimization
  • What is your role in keeping residents mobile?
  • How do you give residents opportunities to be mobile?
  • How do you think you best help residents with their mobility and transfers?
Safety
  • How does assisting them with their mobility impact on safety for them?
  • How does assisting them with their mobility impact on safety for you?
  • What is it that impacts most on your safety when assisting residents to move?
Dementia
  • How do you find assisting residents that are confused/have dementia to move?
Relationship
  • How does your relationship with residents impact on how you help them move?
Organization – culture
  • What is it about working here (or elsewhere) that makes it easy for you to provide quality care?
  • What is it about working here (or elsewhere) that makes it hard for you to provide quality care?
  • How do other care staff influence your mobility care?
  • How does the way other staff perform when providing mobility care affect you?
  • How do you think routines/time affect your ability to provide mobility care?
Organization – care plans
  • How do mobility care plans assist you with your work?
  • How do know what a resident’s mobility care plan is?
Organization – supervision
  • How do you find senior nurses influence your mobility care?
  • How do you find physiotherapists influence your mobility care?
Organization – training
  • How could your ability to safely mobilize residents be improved?
  • What forms of education or training would improve staff’s mobility care practice?
Equipment
  • What role does equipment play in keeping residents mobile?
General
  • What is it that impacts most on resident mobility?
Appendix B: Transfer Observation Instrument

Appendix B:

Transfer Observation Instrument

Appendix B: Transfer Observation Instrument

10.3928/19404921-20140731-01

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