Table 2:
Reciprocal translation table, which depicts synthesis of themes across studies and the primary study themes identified by primary study authors.
| Derived analysis: themes and subthemes | Identified in paper # (Corresponding to Table 1) and page(s) | Primary study themes | Socioecological Model Levels and Interactions |
|---|---|---|---|
| 1. Patient, family, and clinician expectations shape roles in in-hospital mobility. | |||
| Ageism among clinicians lowers expectations around mobility | 2 (pg 218), 3 (pg 310), 6 (pg 231–232), 8 (pg 5), 10 (pg 6) | Walking a tight rope, Marginalization and oppression of older people, lack of patient motivation, stereotypical thinking | Clinician, Patient-Clinician interaction, Clinician-society |
| Clinician uncertainty about prior level of function lowers mobility expectations | 1 (pg 385), 2 (pg 219), 5 (pg 1243) | Constraints to function promotion, Barriers to independence, Attributing responsibility to others | Clinician, clinician-patient interaction, hospital-clinician interaction |
| Management-level expectations drive clinician mobility behaviors | 2 (pg 220), 5 (pg 1244) | Changing actions without changing responsibility | Unit-clinician interaction |
| Many patients take a passive role in their mobility | 1 (pg 383, 386), 2 (pg 218), 3 (pg 308), 6 (pg 231), 8(pg 5), 10 (pg 8), 11 (pg 717), | Barriers to independence, marginalization of older people, better not worse, barriers to exercise | Patient, Clinician-patient interaction, Patient-society |
| Mobility helps patients regain autonomy | 8 (pg 5), 11 (pg 716) | Improved well-being, fundamental feelings | Patient, patient-caregiver/clinician interaction |
| Patient, family, and clinician preconceived notions influence mobility. | 2 (pg 219), 4 (pg 94), 6 (pg 232), 7 (pg 13), 8 (pg 4), 10 (pg 8), 11 (pg 715) | Walking a tight rope, the hospital environment, patient and family-based barriers, meeting the patients’ expectations, stereotyping the older person | Provider-patient and clinician-patient interaction |
| Patients have differential expectations for who provides mobility interventions | 7 (pg 12), 10 (pg 8) | Taking joint responsibility | Patient-clinician interaction |
| The caregiver paradox: optimal care involves promoting mobility, but clinicians may do more for the patient than needed. | 4 (pg 94), 7 (pg 10), 8 (pg 5), 10 (pg 8) | Adoption of ‘sick role’ behaviors, the hospital environment | Clinician, clinician-patient Interaction |
| 2. Stakeholders’ role in mobility depends on hospital environment, infrastructure, culture and resources. | |||
| Among clinicians, competing priorities put mobility low on the task list. | 1 (pg 385), 2 (pg 219), 3 (pg 308), 4 (pg 95), 5 (pg 1243), 6 (pg 232), 8 (pg 4–5), 10 (pg 4–5) | Constraints to function promotion, if only we had time, need for assistance and lack of staff, the hospital environment, attributing responsibility to others, hospital-based barriers, physical activity depends on the external environments | Clinician, unit, hospital, healthcare system; clinician-unit interaction, Unit-hospital interaction, hospital-healthcare system interaction |
| The rhythm of workflow may facilitate mobility, but it is easily disrupted. | 4 (pg 94), 5 (1244), 7 (pg 14), 10 (pg 6) | Integration of physical activity into daily work, adjusting to resource limitations | Clinician-unit interaction, unit-hospital interaction |
| Physical environment of a hospital often hinders realization of professional role surrounding mobility. | 1 (pg 385), 2 (pg 218), 3 (pg 308), 8 (pg 4), 7 (pg 8–9), 10 (pg 6), 11 (pg 716) | Constraints to function promotion, enabling environment, institutional barriers, Medical devices, hospital environment, materialities, physical activity depends on external environment | Clinician-unit interaction, Unit, Hospital |
| Clinicians use motivational strategies to engage patients in mobility. | 1 (pg 384), 2 (pg 219), 4 (pg 94), 5 (pg 1244), 7 (pg 12), 8 (pg 4), 10 (pg 4, pg 7) | Coaching and caring, strong basic nursing care, meaning of inpatient physical activity and rest, professional roles, motivating patients, in the hands of nurses | Clinician, clinician-patient interaction |
| Resilient, experienced clinicians will take charge of mobility-related tasks even in uncertain circumstances | 2 (pg 219), 4 (pg 95), 5 (pg 1242), 7 (pg 11), 10 (pg 4–5), | Constraints to function promotion, nurses claiming responsibility, in the hands of nurses | Clinician-unit interaction, clinician-hospital interaction |
| A culture of fear around falls deters patient mobility | 1 (pg 385), 2 (pg 218, 220), 3 (pg 309), 4 (pg 95), 5 (pg 1243), 11 (pg 717) | Walking a tight rope, barriers to independence, fear of injury, fear of a patient falling, hospital-based barriers, waiting for risk to change | Patient, caregiver, clinician, unit, hospital, patient-clinician interaction, clinician-unit interaction, hospital-healthcare system interaction, society |
| 3. Teamwork creates successful in-hospital mobility, but lack of coordination and cooperation leads to delay in mobilizing. | |||
| A team approach involving patients, families, and clinicians facilitates stakeholder roles surrounding mobility | 4 (pg 63–64), 5 (1243–1244), 8 (pg 6), 10 (pg 7) | Striving for a mutual understanding of patients’ physical activity, healthcare professional-based facilitators, claiming responsibility | Provider and Caregiver-unit interaction |
| Language around mobility differs by stakeholders | 7 (pg 10), 8 (pg 4) | Meaning of inpatient physical activity and rest, professional roles | Patient, Caregiver/clinician |
| PTs and OTs are experts in complex factors around mobility | 4 (pg 94), 7 (9–10), 8 (pg 5), 9 (pg 910), 10 (pg 7), | The hospital environment, application of specialized PT knowledge, engaging a multidisciplinary team approach | Clinician, clinician-unit interaction, clinician-hospital interaction |
| Nurses and patients may wait for PT or physician clearance before mobilizing. | 2 (pg 219), 5 (pg 1243), 7 (pg 10), | Constraints to function promotion, professional roles, attributing responsibility to others | Clinician interaction, clinician-unit interaction, clinician-hospital interaction |
| There is disagreement around who is responsible for mobility tasks. | 2 (pg 219), 5 (1243), 7 (pg 10–11), 9 (pg 910) | Constraints to function promotion, attributing responsibility, professional roles | Clinician, Clinician-unit interaction, clinician-hospital interaction |