Impaired wheelchair mobility

Domain 4. Activity-rest
Class 2. Activity-exercise
Diagnostic Code: 00089
Nanda label: Impaired wheelchair mobility
Diagnostic focus: Mobility

Nursing diagnosis of impaired wheelchair mobility is defined as an altered ability to propel self and other objects by use of a wheelchair. This can occur due to physical injury, age-related declines, or any number of situational factors that can lead to reduced physical abilities. Nurses play a valuable role in identifying and treating the underlying causes of impairments in wheelchair mobility, as well as providing nursing care that can help improve mobility and reduce further deterioration.

NANDA Nursing Diagnosis Definition

This nursing diagnosis is classified by NANDA International as a health promotion and maintenance diagnosis. It defines impaired wheel chair mobility as “an individual’s inability to use a wheelchair for the purpose of self-propulsion” that results from “an injury, disease, disability, or impairment which impairs their conformance to recommended wheel chair usage guidelines”.

Defining Characteristics

The subjective defining characteristics of impaired wheelchair mobility are: Self-report of inability to use a wheelchair for the intended purpose; Difficulty propelling a wheel chair due to physical impairments; Pain associated with wheelchair propulsion activities; and/or Physical fatigue associated with wheelchair usage.

Objective defining characteristics include: Inability to use the wheel chair independently; Difficulties traversing certain terrains or obstacles; Changes or deteriorations in the physical abilities necessary for wheel chair mobility; and/or Reduced range of motion associated with wheel chair usage.

Related Factors

There are a number of factors that can contribute to impaired wheelchair mobility, including: Age-related declines in physical abilities; A history of physical injuries or traumas; Progressive cognitive or physical impairments; Neurological disorders; Musculoskeletal impairments; and/or Poor balance and coordination.

At Risk Population

Individuals who are at risk for impaired wheelchair mobility are those who are elderly, have a history of physical or mental impairments, live in a long-term care facility, or are otherwise unable to use a wheel chair according to recommended usage guidelines.

Associated Conditions

Given that impaired wheelchair mobility may be caused or aggravated by a host of conditions, it is important to identify and screen for any associated conditions prior to treatment. Examples of related conditions that must be evaluated include: Arthritis; Osteoporosis; Rheumatoid arthritis; Multiple sclerosis; Parkinson’s disease; Diabetes; Spinal cord injuries; and/or Stroke.

Suggestions for Use

Prior to working with an individual with impaired wheelchair mobility, nurses should do a complete assessment of the patient’s condition that includes medical history, physical exam, and evaluation of the patient’s current level of functioning. Assessment should also include any psychological, social, and/or cultural issues that could be influencing the patient’s circumstances.

Once the assessment is complete, the nurse should devise a plan of care that addresses the physical, psychological, and socio-cultural needs of the patient. The plan should include nursing interventions that work to improve mobility and provide the patient with the necessary tools and support to manage impairment and maximize independence.

Suggested Alternative NANDA Nursing Diagnoses

If the patient has specific risks and/or impediments that put them at risk of further impairments, there are additional NANDA diagnoses that can provide further information on these concerns:

• Intermittent Mobility Alteration: When patients experience differences in their capability to use a wheelchair on one or more occasions.
• Mobility Alteration Related To Cognitive Impairment: When cognitive issues such as dementia or memory loss impede the patient’s ability to use the wheelchair.
• Mobility Alteration Related To Muscle Weakness: When muscle weakness results in difficulty using the wheelchair.
• Mobility Alteration Related To An Injury Or Illness: When an injury or illness causes an impairment in the patient’s mobility.
• Mobility Alteration Related To Physical Limitations Or Disability: When physical limitations and/or disability impede the patient’s ability to use the wheelchair.

Usage Tips

When assessing a patient with impaired wheelchair mobility, it is important to be mindful of the underlying causes of the problem. If any of the factors listed above are indicated, it is important to take steps to address them as part of the nursing plan. Additionally, nurses should strive to continually reassess and adjust the plan of care in order to ensure the most appropriate and effective interventions are provided for each individual.

NOC Outcomes

In order to evaluate the effectiveness of the primary nursing interventions, nurses should consider the following nursing outcomes classification (NOC):

• Mobility: Appropriate Self-Care: When patients are able to engage in daily activities with minimum assistance and maintain an optimal level of independence in terms of personal care and mobility.
• Mobility Enhancing Strategies: When patients are able to use appropriate strategies and techniques to move safely and increase their overall mobility levels.
• Mobility: Sleep/Rest: When patients are able to achieve appropriate sleep/rest patterns that minimize physical activity and maximize restorative periods.
• Mobility: Transferring: When patients are able to transition themselves in and out of a wheelchair with minimal assistance.
• Mobility: Wheelchair: When patients are able to safely and independently operate a wheelchair to move from one place to another.

Evaluation Objectives and Criteria

When evaluating the effectiveness of nursing interventions for improved wheelchair mobility, nurses should consider the following objectives and criteria:

• Physiological: The patient should be able to maintain a safe level of mobility independently, without experiencing physical fatigue, pain, or other physical discomforts.
• Psychological: The patient should be feeling confident and secure in their ability to use a wheelchair for daily living activities.
• Social/Cultural: The patient should be actively participating in family and social activities, displaying adequate communication skills, and demonstrating healthy decision-making abilities.

NIC Interventions

Nurses may provide the following nursing interventions to promote and improve wheelchair mobility:

• Assess the patient's physical abilities, cognitive functions, and emotional impact to improved mobility.
• Provide instruction and assistance to the patient regarding proper wheelchair use, positioning, and maneuvering.
• Monitor and record the patient's progress towards desired mobility levels.
• Create an individualized exercise program to improve mobility, utilizing activities and equipment that are appropriate for the patient's needs.
• Encourage the patient to make adaptations and modifications to increase their level of independence with respect to use of the wheelchair.
• Educate the patient and/or caregivers about general safety concerns and risks associated with wheelchair use.
• Establish and monitor goals that meet the patient’s needs with respect to mobility, independence, and quality of life.

Nursing Activities

In order to ensure that nursing interventions for improved wheelchair mobility are successful, nurses should engage in the following activities:

• Periodically assess the patient's physical abilities and functional mobility levels.
• Develop an individualized plan of care that addresses the patient's specific needs.
• Administer medications, treatments, and procedures as prescribed by the physician/nurse practitioner.
• Monitor and modify the plan of care to ensure effectiveness, safety, and efficiency.
• Provide patient education on proper use of the wheelchair to improve mobility and function.
• Collaborate with other healthcare team members to ensure the patient's treatment and mobility requirements are being met.
• Develop a support system for the patient and family focusing on lifestyle and functional mobility changes.

Conclusion

Impaired wheelchair mobility can be a debilitating condition, and it is important for nurses to understand the factors that contribute to it and how to best address it. An individualized care plan should be developed for each patient to ensure the most appropriate and effective interventions are provided. By assessing the patient and developing an individualized plan of care, nurses can help ensure the most positive outcomes for improved mobility.

FAQs

• Q. What is impaired wheelchair mobility?
  A. Impaired wheelchair mobility is an alteration in the ability to use a wheelchair, as a result of physical injury, age-related decline, or a number of other situational factors that reduce physical abilities.
• Q. How do nurses assess a patient with impaired wheelchair mobility?
  A. Prior to developing a plan of care for a patient with impaired wheelchair mobility, nurses must complete an assessment that includes medical history, physical examination, evaluation of the patient's current level of functioning, and consideration of any psychological, social, and/or cultural issues that could be influencing the patient’s circumstances.
• Q. What kind of nursing interventions are used to improve wheelchair mobility?
  A. Nurses can provide a range of interventions designed to improve wheelchair mobility, including assessment, instruction, monitoring and recording of progress, exercise programs, modification, safety education, and collaboration with other healthcare team members to ensure the patient’s treatment and mobility needs are met.
• Q. What is the role of the NOC Outcomes when assessing a patient with impaired wheelchair mobility?
  A. The NOC Outcomes provide a useful framework for evaluating the effectiveness of nursing interventions in improving wheelchair mobility. The outcomes include Mobility: Appropriate Self-Care, Mobility Enhancing Strategies, Mobility: Sleep/Rest, Mobility: Transferring, and Mobility: Wheelchair.
• Q. Which associated conditions should be considered when treating impaired wheelchair mobility?
  A. Medical conditions that should be evaluated during assessment for impaired wheelchair mobility include arthritis, osteoporosis, rheumatoid arthritis, multiple sclerosis, Parkinson’s disease, diabetes, spinal cord injury, and stroke.