The influence of protection, palliation and costs on mobility optimization of residents in nursing homes: A thematic analysis of discourse

Background: With the aging of the population, increasing numbers of older people live in nursing homes. Discourse such as policies and standards highlight the need to optimize the mobility independence of residents. This is expected to occur in a way that is safe for residents and staff whilst meeting the residents' needs. The influence of discourse on health care delivery can be poorly understood, being at times hidden or taken for granted. The aim of this study was to uncover discourse relevant to resident mobility optimization to enable the origins and reasoning behind existing and intersecting policy and practice to be critically appraised. Design: Narrative literature review and thematic analysis with a focus on discourse were employed for this study. Data sources: Databases (CINAHL and Ovid Medline) and websites of relevant professional and governmental bodies were accessed. Method: A literature search centered on retrieval of texts focused on discourses that influenced goals to optimize resident mobility. Database searches for texts covered the period from 1994 to 2011. Iterative thematic analysis focussed on the texts' socio-cultural context and influence. Findings: Four discourses emerged that potentially influence goals to optimize resident mobility: safe manual handling; falls prevention; palliative care; and costs and funding constraints to individualized care. These discourses may influence mobility care in the direction of more routinized, passive and dependency support approaches. A common overarching theme was that of collaboration and communication. Conclusion: Discourses such as safe manual handling, falls prevention, palliative care and cost constraints to individualized care can negatively impact on the goal to optimize the mobility of residents in nursing homes. Inter-professional approaches where staff work collaboratively and communicate well may counter such influences and ensure individualized care that focuses more effectively on resident mobility. (C) 2012 Elsevier Ltd. All rights reserved.