Impaired bed mobility

Domain 4. Activity-rest
Class 2. Activity-exercise
Diagnostic Code: 00091
Nanda label: Impaired bed mobility
Diagnostic focus: Mobility

Bed mobility is an essential skill for older individuals, providing them with the ability to take care of their daily needs. It can be difficult or even impossible for many older patients to move independently in bed. As such, they may require the help of a healthcare professional. Even if the patient is able to move in bed, they can experience discomfort or physical limitations that still necessitate assistance. Nurses often play a major role in supporting the patient’s bed mobility and in helping them mix independence with the right level of oversight and guidance.

NANDA Nursing Diagnosis Definition

The NANDA Nursing Diagnosis definition of “impaired bed mobility” is a complete lack of movement or an inability to perform effective mobilization while in bed. This lack of mobility can cause potential injury, reduced physical functioning, or decreased independence associated with relaxing and repositioning oneself in bed. Additionally, any attempts to increase mobility can significantly amplify the risk of further injuries, such as fractures, due to the fragility of elderly individuals.

Defining Characteristics

Subjective Components of Impaired Bed Mobility:

• Pain or discomfort: The patient may feel pain or discomfort as a result of inactivity or difficulty moving in bed.
• Depression: Low moods, lack of motivation, and other psychological symptoms due to limited mobility.
• Fear of falling: Fear of sliding out of bed or otherwise getting injured.

Objective Components of Impaired Bed Mobility:

• Movement deficits: Difficulty shifting into different positions or remaining inactive.
• Postural instability: Difficulty remaining balanced and upright.
• Muscle weakness: Reduced strength and impaired ability to support one’s body weight.

Related Factors

There are several related factors that can lead to impaired bed mobility:

• Friction: Friction can create difficulty transferring from one position or lying surface to another due to sticking or fear of sliding.
• Multiply hospitalizations: Recuperation times can lead to weakened muscles and joints, making bed mobility more challenging.
• Gravity: Gravity affects our ability to move and shift in bed.
• Physical disabilities: Physical conditions such as arthritis can interfere with the natural ability to move freely in bed.
• Diagnosis: Medical conditions can change a patient’s mobility and ability to move in bed.
• Medication: The side-effects of certain medications can decrease one’s capacity to move in bed independently.

At Risk Populations

The following populations are at higher risk for developing impaired bed mobility:

• Older adults: Age-related changes can result in the optimization of activities, including the ability to move freely in bed.
• Immobile patients: Patients who are bedridden, or those with minimal mobility, cannot move in bed as easily as a more mobile patient.
• Patients with neurological deficits: Neurological conditions may limit the patient’s awareness of posture, balance, position, and ability to transfer from one position to another.
• Patients with limited cognitive abilities: Patients may not have the ability to understand when to move or the need to move, leading to decreases in safety in bed and the potential for falling.

Associated Conditions

Impaired bed mobility often results in multiple associated conditions:

• Pressure ulcers: Unnecessary pressure on the skin can cause sores due to prolonged inactivity.
• Infection: Unable to keep oneself clean adds to the risk of infection and increases the possibility of further complications.
• Dehydration: Difficulty getting up to use the bathroom can lead to dehydration.
• Falls: Lack of proper movement and balance makes falls more likely.
• Malnutrition: Difficulty getting up to eat can cause malnutrition.
• Confusion or disorientation: Moving from one position in bed to another without guidance can cause confusion or disorientation.

Suggestions for Use

When it comes to nursing diagnosis of impaired bed mobility, nurses must provide both prevention and solutions. The nurse should be aware of at-risk populations and the associated conditions. To prevent issues, the nurse can provide supervised exercises, assistive devices, and continued education. Solutions to existing problems include physically changing positions in bed, reducing friction, and providing guidance and reassurance.

Suggested Alternative NANDA Nursing Diagnosis

In a few cases, “impaired bed mobility” may not be the most appropriate nursing diagnosis for the patient. In these cases, alternative NANDA Nursing Diagnosis may be used instead:

• Impaired Physical Mobility: relating to decreased capability of moving from one location to another.
• Mobility Crisis-Risk for Inactivity: relating to the risk of increased immobility due to stress, environmental changes, pain, etc.
• Impaired Transfer Ability: relating to the patient's reduced ability to safely move to another location or area.

Usage Tips

In order to assess the patient’s bed mobility accurately and effectively, nurses should take the following tips into consideration when utilizing the diagnosis of “impaired bed mobility”:

• Always assess the patient’s current abilities first before planning any interventions.
• Help the patient understand the importance of increased mobility by explaining why it is important for their physical and emotional health.
• Encourage the patient to move in bed according to their comfort and abilities, rather than simply holding their body still.
• Implement assistive devices, such as transfer belts or CANes, when deemed necessary for support.
• Provide the patient with one-on-one guidance and support during assisted mobility.

NOC Outcomes

The NOC Outcomes listed to assess patient care related to an impaired bed mobility diagnosis are as follows:

• Transfer Ability: Ability to safely move parts of the body to areas within and beyond the body’s base of support.
• Bed Mobility: Ability to use trunk and extremity movements to assume, maintain and change the body’s position in bed.
• Body Positioning: Ability to adjust and maintain the body’s position so that it does not come into contact with surfaces or objects other than those being used for support.
• Postural Stability: Ability to maintain an upright position with or without support.

Evaluation Objectives and Criteria

The evaluation objectives and criteria for impaired bed mobility are as follows:

• Transfer Ability: Patient can move parts of the body to areas within and beyond the body’s base of support without assistance.
• Bed Mobility: Patient is able to assume, maintain, and change the body’s position in bed using trunk and extremity movements.
• Body Positioning: Patient can adjust and maintain the body’s position so that it does not come into contact with surfaces or objects other than those being used for support.
• Postural Stability: Patient can maintain an upright position with or without support.

NIC Interventions

The NIC Interventions that nurses can implement to better address impaired bed mobility diagnoses are as follows:

• Bed Mobility Training: Implementing strength and endurance training to improve the patient’s ability to move in bed.
• Assistive Devices: Utilizing assistive devices such as a belt to help the patient move in bed more easily.
• Body Mechanics: Teaching the patient how to use their body to move in bed more effectively.
• Guided Imagery: Guiding the patient through visualization techniques to enable them to move more easily in bed.
• Positioning: Helping to move the patient for comfort through bed repositioning.

Nursing Activities

In order to assess patient care related to impaired bed mobility diagnosis, nurses should take the following activities:

• Assess the patient’s medical history and current medical condition.
• Observe the patient’s current ability while in bed.
• Gather resources, such as assistive devices, to help the patient move in bed more effectively.
• Encourage the patient to engage in strengthening, stretching, and range-of-motion exercises.
• Offer guidance and support to help the patient move in bed.
• Observe the patient while they are trying to move in bed and monitor their breathing patterns and vital signs.

Conclusion

Impaired bed mobility is a common issue in elderly individuals, particularly those who require additional assistance or aid for daily living. Knowing the cause and associated conditions of impaired bed mobility is essential for nurses in order to ensure the best possible outcome for the patient. Nurses should always be mindful of the at-risk populations and the signs and symptoms associated with the diagnosis. Utilizing the NANDA Nursing Diagnosis definition and related interventions may help nurses differentiate between risk factors and models of care to promote safe, competent, and comfortable mobility in bed.

FAQs

• Q1: What is impaired bed mobility?
  A1: Impaired bed mobility is a complete lack of movement or an inability to perform effective mobilization while in bed. This lack of mobility can cause potential injury, reduced physical functioning, or decreased independence associated with relaxing and repositioning oneself in bed.
• Q2: What are some associated conditions with impaired bed mobility?
  A2: Associated conditions that can arise as a result of impaired bed mobility include pressure ulcers, infections, dehydration, falls, malnutrition, and confusion or disorientation.
• Q3: Are there any alternative NANDA Nursing Diagnosis to impaired bed mobility?
  A3: Yes, alternative NANDA Nursing Diagnosis that may be used in place of “impaired bed mobility” include impaired physical mobility, mobility crisis-risk for inactivity, and impaired transfer ability.
• Q4: What kind of nursing activities should nurses take with patients suffering from impaired bed mobility?
  A4: Nursing activities should include, but are not limited to, assessing the patient’s medical history and current medical condition, observing the patient’s current ability while in bed, gathering resources to help the patient move in bed more effectively, encouraging the patient to engage in strengthening, stretching, and range-of-motion exercises, offering guidance and support to help the patient move in bed, and observing the patient while they are trying to move in bed.
• Q5: What type of evaluation should be used for impaired bed mobility?
  A5: The evaluation objectives and criteria for impaired bed mobility should be geared towards assessing transfer ability, bed mobility, body positioning, and postural stability.