Ambulation refers to the act of walking or moving from one place to another. In a healthcare setting, the term takes on a formalized meaning related to patient recovery and rehabilitation. It represents a deliberate, often prescribed activity that involves moving a patient outside of a seated or lying position. This structured movement is an integral part of the healing process across almost all areas of patient care, from post-surgical recovery to long-term rehabilitation. Prioritizing patient movement directly influences a person’s ability to regain independence and avoid complications associated with prolonged rest.
Defining Therapeutic Ambulation
Therapeutic ambulation is a specific, goal-oriented activity aimed at restoring or maintaining physical function. It is a prescribed intervention that involves a patient moving outside of their bed or chair, typically with supervision or physical assistance from a healthcare provider. This process is highly individualized, based on a patient’s specific condition and overall mobility assessment.
The nursing process begins with a careful mobility assessment to determine a patient’s baseline ability and safety needs. This includes evaluating the patient’s gait, which is the pattern of their walking, looking for elements like rhythm, balance, and posture. Tools like the Banner Mobility Assessment Tool (BMAT) or the Timed Get Up and Go Test are often used to objectively evaluate a person’s ability to safely move, guiding the level of assistance required for the care plan.
The Importance of Early Movement
Nurses prioritize early ambulation because immobility has rapid and widespread negative effects on the body’s systems. When a patient remains inactive for extended periods, the risk of developing a Deep Vein Thrombosis (DVT) increases significantly due to the pooling of blood in the lower extremities. Movement stimulates circulation, helping to prevent the formation of blood clots.
Early movement also plays a major role in respiratory function and prevents lung complications like atelectasis (partial collapse of a lung). Walking encourages deeper breathing and helps to clear secretions from the lungs, improving oxygen exchange and lowering the risk of pneumonia. Furthermore, ambulation helps maintain muscle tone and strength, combating muscle atrophy, and stimulates peristalsis, the muscle contractions that move waste through the digestive tract.
Techniques for Safe Patient Movement
Before any movement is attempted, the nurse conducts a pre-ambulation assessment, checking the patient’s vital signs, pain level, and overall cognitive readiness. This step confirms the patient can safely tolerate the activity and minimizes the risk of a fall or injury. The environment must also be secured by ensuring a clear pathway and that the patient has non-skid footwear firmly on their feet.
A standardized safety measure involves the patient “dangling,” which means sitting on the edge of the bed for a few minutes before attempting to stand. This allows the body to adjust to the change in position, helping to prevent orthostatic hypotension—a sudden drop in blood pressure that causes dizziness upon standing. During the actual transfer, a gait belt is secured snugly around the patient’s waist, over clothing, providing a firm point of contact for the nurse.
The nurse uses the gait belt to maintain control over the patient’s center of gravity, gripping the belt from behind with an underhand hold to ensure better leverage and proper body mechanics. The nurse stands to one side and slightly behind the patient, ready to support them if they begin to lose their balance. Should a patient begin to fall, the nurse is trained to use the belt to gently guide the patient down their own leg to the floor, protecting the patient’s head and preventing back injury to themselves.
Assistive Devices and Support Levels
The equipment used during ambulation is selected based on the patient’s specific needs for stability and weight bearing. Common assistive devices include canes, which offer a small base of support for minor balance issues, and walkers, which provide a wider, more stable frame for greater support. Crutches are used when a patient needs to completely or partially offload weight from one or both legs.
The degree of physical help a patient requires is classified into standard levels of assistance for clear communication among the care team:
- Independent: The patient can ambulate safely without any help.
- Stand-by Assist or Supervision: The nurse must be present for safety but does not physically touch the patient.
- Minimal Assistance: The patient performs 75% or more of the effort, while the nurse provides light guiding or stabilizing support.
- Moderate Assistance: The patient performs 50% to 74% of the effort.
- Maximum Assistance: The patient performs less than 50% of the work and often requires specialized equipment or the help of multiple staff members.