Nurses' Behaviours and Implementation Factors Towards Promoting Mobility Among Hospitalized Older Adults in China: A Mixed Method Study

Abstract

<p><b>Aims</b>: To describe the status of nurses' behaviours towards promoting mobility among hospitalized older adults in China, and to explore modifiable enablers and barriers for nurses.<br></p><p><b>Design</b>: A sequential- explanatory mixed method design was used to collect data from nurses in three tertiary teaching hospitals in Hunan Province, China.<br></p><p><b>Methods</b>: Quantitative data were collected using the Nurses' Behaviour Towards Promoting Mobility Scale, which covers eight dimensions: physical fitness assessment, exercise guidance, daily activities guidance, joint movement assistance, physical therapists' consultation, environment arrangement, mobilization assistance and cognition stimulation. Qualitative data were collected through in-depth individual interviews, with questions developed based on the quantitative findings. Descriptive statistics, one-way ANOVA and multiple linear regression were used to analyse the quantitative data. Interview transcripts were analysed thematically and mapped to the capability, opportunity, motivation and behaviour (COM- B) model. Quantitative and qualitative findings were integrated using a joint display approach.<br></p><p><b>Results</b>: The overall level of nurses' mobility promotion behaviours was moderate (156.15 ± 23.94), with scoring rates varying across dimensions (50.69%–81.69%). Nurses' behaviours were significantly associated with their working positions and departments. Further, the qualitative data revealed six barriers including ‘insufficient competence’, ‘lack of standardized protocols’, ‘fear of adverse events’, ‘unclear nurse role’, ‘lack of time’, and ‘limited environment and equipment’, and four facilitators, such as ‘practice-based training’, ‘incentive policies’, ‘family involvement’ and ‘organizational expectations’. The quantitative and qualitative findings were convergent, dissonant, complementary or silent.<br></p><p><b>Conclusion</b>: Nurses' behaviours towards promoting mobility were suboptimal and influenced by multiple barriers and enablers related to the COM-B model. These findings need to be considered when developing targeted nurse-driven mobility promotion interventions to improve the functional abilities of hospitalized older adults.<br></p><p><b>Implications for the Profession and/or Patient Care</b>: This study emphasizes the necessity of improving nurses' behaviours in promoting older inpatients' mobility. Adequate practice-based training is essential to enhance nurses' capability in this area. Additionally, fostering a sense of responsibility and implementing an incentive policy could boost motivation. At the organizational level, clear protocols and standardized procedures, together with supportive ward environments, may increase opportunities for implementation. Involving family members in mobility promotion care might be an alternative way considering nurses' heavy workload and time limitations.<br></p><p><b>Reporting Method</b>: The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for the quantitative component, the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for the qualitative component, and the Good Reporting of A Mixed Methods Study (GRAMMS) guideline for the reporting of mixed methods.<br></p><p><b>Patient or Public Contribution</b>: Nurses participated in the quantitative study and qualitative interviews that informed this study.<br></p>