From left, Jillian Osborne, Rosana Lu, St. Claire Brunache, Sophie Salawu and Amy Bulger during PCA Grand Rounds in June

On Braunwald Tower 16AB, patient care assistants (PCAs) have found a simple, effective strategy to benefit older patients: walking and talking.

“Mobility can help patients achieve what matters most to them: going home, avoiding a nursing home and staying mobile to see family, friends and pets,” said St Claire Brunache, a PCA on the unit. “You can learn a lot about what matters to patients by walking and talking. Knowing what matters to patients can help guide their care.”

During a special PCA Grand Rounds in June, Brunache, along with colleagues Rosana Lu and Sophie Salawu, shared tips and guidance on caring for older adults, with a focus on mobility and “what matters” — ensuring that patients’ goals are aligned with those of their care team.

The benefits of mobility speak for themselves: reduced risk of falls, delirium, blood clots, pneumonia, and pressure injuries, along with an increase in strength and confidence in going home.

But it’s not always easy for patients to take those first steps to improve their mobility.

“The longer a patient is in bed, the more likely they are to lose independence,” said Salawu. “The patient’s ability to transfer and walk is related to their ability to function and do things like bathing, feeding and dressing on their own. It’s important to encourage patients together as a team to mobilize and participate in their care so they don’t lose their ability to function on their own when they leave the hospital.”

Lu shared a story about her approach to encourage a patient who often declined to get out of bed to walk. “I would keep trying and come back a few minutes later and say, ‘What about now?’” Lu said. “Eventually she would say she was ready. I tell my patients, ‘If you move, you are going to get better faster.’”

Pilot Focuses on PCA Role in Increasing Mobility

Lu, Salawu and Brunache played an important role in a grant-funded project led by Jillian Ng, PT, DPT, of Physical Therapy. In the project, PCAs on Tower 16AB served in a new mobility assistant role for four-hour shifts, five to seven days a week, over a four-month period. Their goal was to work closely with patients on mobility.

“Mobility is not just walking,” said Lu. “The mobility assistant would help some patients walk and others get into a chair and do some activities that helped them move.”

From left, Rosana Lu, St Claire Brunache, Jillian Osborne and Sophie Salawu at the NICHE Conference

Patients’ mobility status was assessed using the Johns Hopkins Highest Level of Mobility Scale, and staff collected data on length of stay and discharge disposition from 131 patients and 42 staff members. The data showed the mobility assistant role increased patient mobility and decreased the percentage of discharges to skilled nursing facilities. In addition, 92 percent of staff reported that the mobility assistant was helpful in improving patient mobility, with most staff agreeing the role encouraged a culture of mobility. The results were shared broadly via a poster presentation at the NICHE (Nurses Improving Care for Healthsystem Elders) Conference in New Orleans in 2023.

Though the mobility assistant role did not continue beyond the pilot, the PCA team incorporated key takeaways into everyday practice to keep the focus on patient mobility.

“Patients learn to trust us, and we’re giving them encouragement,” said Lu. “They need to be more independent and ready to go home. In the end, patients thank us for the attention we provide them with.”

Salawu agreed. She shared that the most rewarding part of the PCA role is seeing patients do well.

“Being able to be part of their care makes me feel good because I’m not just a PCA,” she said. “I’m someone who can make a difference in their life.”