Enhancing Compliance to the Seated Portion of a Hospital Mobility Bundle to Improve Safety: A Mixed Method Case Study

Purpose:
The goal of this study was to examine the relationship among consistent, standardized, and reproducible use of safe patient handling equipment in the acute care setting and impacts upon: employee (nursing) injury-reduction, patient falls-prevention, and patient-pressure ulcer prevention.

Background/Significance:
Nursing is frequently challenged with maintaining patients seated out of bed and upright in chairs. Boosting, safety, and preventing hospital-acquired conditions prove to be ongoing and ever-challenging variables with the seated patient. This study evaluated nurse perceptions in an acute care setting regarding applicability, utilization, and efficiency for employing a seated positioning system device for safely sitting patients upright and boosting them in chairs with minimal provider injury.

Methods:
A mixed method case study design was implemented. Nursing focus group interviews were conducted both pre- (N = 38) and post-pilot (N = 36) implementation of use of a seated positioning system device. Similarly, for purposes of robustness and rigor of the study, collection of post-pilot survey data (N = 39) was conducted to aid in triangulation of data. Thematic emergence analysis (to saturation) of qualitative data and correlation statistical analysis of quantitative data were applied to each respective data set. Data triangulation was then utilized among the pre- and post-focus group data and inferential statistical data analyses to suggest comprehensive strength of the overall results.

Results:
Results suggested nurses were more compliant in following organizational safety and safe patient handling protocols when using a standardized seated positioning device in practice. Additionally, it was suggested use of such a device aided in falls and pressure ulcer prevention [r(37) > .80; p = 0.00, for each respective item correlation]. Furthermore, nurses preferred use of such a device over traditional and varied efforts of pulling patients upright in chairs: noting less effort and fewer staff were required to accomplish the same tasks (all eight survey items scored favorably with at least 68% of respondents). Data triangulation among the three data sets also supported positive findings.

Conclusions and Implications for Practice:
Using technology as an alternative opportunity for promoting safety and preventing hospital-acquired conditions of injury for the seated patient can efficiently impact safe patient handling, repositioning, and mobility protocol compliance for nurses in the acute care setting.