Case study - Immobility: Nursing

Nurse Alex works on an intermediate care unit and is caring for Joan, a 45-year-old female who is being treated following a car crash two weeks ago. Since then, Joan has been experiencing significant weakness in the lower extremities, difficulty bearing weight, and changing position independently while in bed. Nurse Alex goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Joan's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Alex recognizes important cues. He notices Joan is unable to bear weight, has adequate upper extremity strength and requires maximum assistance to transfer from bed to the chair and bedside commode.  

He reviews the electronic health record, or EHR, where he notes that a transfer board is recommended for Joan based on her initial evaluation by the physical therapist.  

Next, Nurse Alex analyzes these cues and determines Joan will need his support to reduce the impacts of immobility.

Nurse Alex prioritizes the hypothesis of impaired mobility and generates solutions to address Joan’s impaired mobility that will include promoting safety and increasing her level of functioning. He establishes the expected outcome that after intervening, Joan will safely transfer from the bed to a chair using a transfer board with a one-person assist.

Nurse Alex then takes action to implement the generated solutions. First, he institutes fall precautions to promote safety.  

Before proceeding, Nurse Alex ensures the bed and chair are locked and in proper position, that the chair is slightly lower than the height of the mattress, and that all obstacles are removed.  

He will also ensure Joan’s pain is controlled and her vital signs are stable prior to attempting to use the transfer board.

He recalls that Joan has only used the transfer board once with physical therapy and plans to reorient Joan to the proper technique to using the transfer board. 

Nurse Alex: Hi Joan, ready to transfer to the chair?  

Joan: I don’t know, I still need so much help moving around. 

Nurse Alex: It’s important to try to maintain mobility, even if it’s just transferring from bed to chair. I will be here to help you transfer using this transfer board. Do you remember how to use it?