Table 1:

Description of studies included in the qualitative metasynthesis.

Reference number	Authors	Study Purpose	Country	Study Design	Methods	Participants	Summary of Findings
1	Boltz et al. (2010)	To examine older adults perspectives on physical function during and after a hospital stay	USA	Descriptive	-Focus groups with semi-structured interviews	24 older adults who had recently experienced a hospitalization	-Participants expected to go home feeling better than when initially hospitalized, but experienced a profound loss of physical function over the course of the hospital stay. -Participants experienced significant barriers to independence, but felt as though strong nursing care facilitated improvement.
2	Boltz et al. (2011)	To examine organizational factors that influence physical function in hospitalized older adults from the perspectives of nursing staff.	USA	Descriptive	-Focus groups with semi-structured interviews	55 nurses, nurse supervisors, and personal care assistants from two hospitals	-Nursing staff identified both facilitators and barriers to improving physical function for hospitalized older adults. -Participants identified how older adults are particularly vulnerable to loss of physical function. -Nurses saw promotion of physical function as integral to their professional role.
3	Brown et al. (2007)	To compare barriers to mobility identified by patients, physicians, and nurses in the hospital setting	USA	Grounded theory	-One on one semi-structured interviews -Content analysis was used to determine perceived barriers to mobility	10 patients (age 75 or older), 10 nurses, and 9 resident physicians	-All three groups identified barriers such as symptoms (i.e. weakness, pain, fatigue), having an intravenous line or urinary catheter, and concern about falling. -Lack of staff was noted by most nurses and physicians and some patients. -Clinicians identified low patient motivation as a potential barrier, but patients did not.
4	Chan et al. (2018)	To describe nurses’ perception of facilitators and barriers to older adult’s participation in physical activity during a hospital stay from an Asian context	Singapore	Phenomonology	-Focus group interviews with semi-structured interview guide, reflexivitiy employed throughout the study, theoretical thematic analysis	30 registered or enrolled nurses from various general wards in a single hospital	-Physical activity was a fundamental aspect of nursing -Facilitators included premorbid functional state, a multidisciplinary approach, family support system -Barriers included adoption of ‘sick role’ behavior, prolonged bed rest, pain and unfamiliar medical devices, fear of falls, safety culture around falls and language differences
5	Doherty-King & Bowers (2012)	To explore nurses’ expectations around the responsibility for ambulating patients, as well as how this impacts their decision whether to ambulate	USA	Grounded dimensional analysis (grounded theory combined with dimensional analysis)	-Structured focus groups	25 registered nurses on medical or surgical units from two hospitals	-Some nurses claimed that ambulation of patients was their own responsibility -Nurses who claimed responsibility tended to focus on patient independence and psychosocial well-being, interdisciplinary collaboration, determining appropriateness of activity orders, and adjusting to resource availability -others believed that it was the responsibility of other clinicians
6	Higgins et al. (2007)	To examine the negative attitudes of nurses towards older adults in their care	Australia	-descriptive qualitative study	-In-depth interviews -Nurses were provided scenarios that demonstrated both positive and negative aspects of care	-9 nurses participated in this secondary study	-Nurses perceive older adults to be more difficult to work with than other patients -Lack of time for care leads to difficulty caring for this population -Stereotyping older patients was common
7	Kirk et al. (2019)	To explore how social contextual circumstances impact the mobility of older adults, and how it alters healthcare clinicians decisions whether to mobilize a patient	Denmark	Ethnographic field study	-Study authors followed participants and observed how they talked about mobility, interacted with patients, and how surrounding shaped their actions using an observation guide -Go-along interviews were also conducted	61 Health professional (PTs, RNs, Nursing assistants) and 18 physicians from six departments in three public hospitals	-Professional roles appeared to be the most important factor for making decisions about mobility. Time pressure contributes to lack of mobility - Environment played a major role in lack of mobility -Encouraging patients was crucial for mobilization -Patients expected nurses to be too busy with other tasks -Mobility improved when connected with ‘transfer value’ (i.e. goals connected to home)
8	Koenders et al. (2018)	To understand attitudes, beliefs, thoughts and experiences related to physical activity from the perspectives of patients and healthcare clinicians	Norway	Interpretive Phenomono-logical study,	One on one semi-structured interviews, compared patients to health care clinicians	42 total participants: 18 patients in cardiac care unit, cardiology, orthopedics or traumatology; 24 clinicians (nurses, nursing assistants, PTs, 1 physician assistant and 1 physician)	-Patients/clinicians commonly described physical activity as purposeful activity to achieve a goal -Physical and mental rest is needed to balance physical activity -The hospital environment was not conducive to physical activity -Ability to participate in physical activity was associated with feelings of freedom and autonomy
9	Masley et al. (2011)	To determine the role of PTs in the acute care setting and describe clinical reasoning processes	USA	Grounded-theory	Semi-structured interviews, used a constant comparative process to determine common themes, which lead to theoretical model	18 PTs in three academic medical centers	-PTs collect and analyze medical information to determine appropriateness of therapy, apply specialized PT knowledge in mobility, movement dysfunction, and safety in a complex environment -PTs have patients do as much as they can on their own without physical help -PTs communicate with other professions, patients, and families
10	Ohlsson-Nevo et al. (2019)	To describe how nurses perceive and facilitate physical activity for hospitalized older adults	Sweden	Exploratory/ descriptive	Semi-structured focus group interviews, interaction analysis	29 nursing staff in three hospitals	-Patients depend on nursing staff for mobility, although nursing staff does not always have time to help -Nurses see physical activity as a fundamental part of their professional role -Understanding patient expectations facilitates physical activity performance -A team approach involving the patient, family, and multiple healthcare professionals facilitates physical activity
11	So & Pierluissi (2012)	To describe the expectations, facilitators, and barrier around exercise in the hospital	USA	Framework theory/ framework method (familiarization, identifying thematic framework, indexing, charting, mapping and interpretation)	Semi-structured interviews at besides about attitudes/expectations regarding in-hospital exercise	28 English or Spanish-speaking hospitalized older adults,	-Exercise was equated with walking for most participants -Few participants expected to be exercising -Motivating factors: avoiding negative effects of bed rest, promoting a sense of well-being, being asked to exercise -Barriers included symptoms, institutional barriers, fear of injury