Department of Nursing Science, University of Turku, Turku, Finland.
Wellbeing Services County of Southwest Finland, Turku University Hospital, Turku, Finland.
J Clin Nurs. 2023 Dec;32(23-24):8078-8094. doi: 10.1111/jocn.16866. Epub 2023 Sep 12.
AIM(S): The aim of this research study is to collaboratively generate insights in the current institutional long-term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults.
This research constitutes a qualitative study with a critical approach.
Data were collected using photo-elicitation in four long-term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together.
Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so.
To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Increased attention to the support of activity and mobility could benefit older adults in institutional long-term care. Physical activity promotion should be incorporated as an integral part of nursing practice.
Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data.
(ADDRESSING): What problem did the study address? ○Older adults have recurrently been reported as living inactive lives in institutional long-term care. ○There is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research-practice gap in terms of implementing activity- and mobility-promoting environments. ○Older adults and staff members are important in developing practice and change-oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long-term care. What were the main findings? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. ○Improvements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources for activity support would benefit older adults' activity and mobility. Where and on whom will the research have an impact? ○Increasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity. ○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. ○Policymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care.
The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).
目的（AIM）：本研究旨在共同探讨当前老年人长期机构护理环境中的活动和移动问题，并提出可能用于提高老年人活动水平和改善其移动能力的解决方案。
设计（DESIGN）：本研究采用批判方法进行定性研究。
方法（METHODS）：2022 年春季，在芬兰的四个长期护理机构中，采用照片诱发法收集数据。老年人参加了个人数据收集会议，其中包括拍照和讨论。工作人员单独拍摄照片，然后根据照片参加小组讨论。使用反思性主题分析对所有数据进行综合分析。
结果（RESULTS）：10 名老年人和 12 名工作人员参与了研究。确定了四个主题：（1）设施应根据使用者进行设计和配备；（2）在机构环境中移动；（3）被动是一种常态；（4）护士应采取不同的行动并拥有相应的资源。
结论（CONCLUSION）：为了提高老年人的活动水平和改善其移动能力，需要在设施设计、行动自由机会、户外活动、日常生活活动、锻炼、护士激发老年人的作用以及资源等方面进行改进。
对专业和/或患者护理的影响（IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE）：增加对活动和移动的支持可能使机构长期护理中的老年人受益。应将促进身体活动纳入护理实践的重要组成部分。
患者或公众的贡献（PATIENT OR PUBLIC CONTRIBUTION）：在计划研究时咨询了单位主管。老年人和护士为数据收集和解释做出了贡献。
影响（IMPACT）：（解决的问题）：本研究解决了哪些问题？老年人在机构长期护理中经常被报道过着不活跃的生活。有证据表明环境与老年人的活动和移动之间存在关联，但在实施促进活动和移动的环境方面似乎存在研究与实践之间的差距。老年人和工作人员在制定实践和以变化为导向的知识方面非常重要，这些知识可以用于提高机构长期护理中老年人的活动水平和改善其移动能力。主要发现是什么？建议进行各种环境改进，以提高机构长期护理环境中老年人的活动水平和改善其移动能力。设施设计、行动自由机会、户外活动、日常生活活动、锻炼、护士激发老年人的作用以及资源方面的改进将使老年人受益于活动和移动。这项研究将在哪里以及对谁产生影响？为了提高老年人的活动水平，护士在机构护理中需要更好地促进活动并提供移动支持。除了重视活动的护理和组织文化外，还应组织足够的教育和资源来促进活动。在设施规划、建设和翻新阶段都需要考虑促进活动和移动的环境方面。决策者和护理组织者在做出有关护理组织决策时，应考虑不同机构居住环境的危害和益处的证据。
报告方法（REPORTING METHOD）：本研究使用《定性研究的统一报告标准》（COREQ）进行报告。
