In your inpatient unit, you are caring for a patient who is still weak from surgery. Upon reviewing physician orders, you see the patient is to get up and walk two laps in the hall. Tell me how you would proceed.
The interviewer is attempting to determine if the candidate would assess the patient's ability to participate in physical activity before getting her up to walk around the hall of the inpatient unit. Patient falls is one of the biggest patient safety concerns for hospitals, and it is the onus of the nursing staff to ensure they protect their patients from falls in all situations, even when there is a physician order stating otherwise. To effectively answer this question, the candidate should indicate that they would assess the patient's ability to participate in the physical activity, and if they, in fact, the patient was too weak, they would contact the physician for alternative orders. A more successful answer to this question would include a specific example from the candidate's nursing career where they prevented a patient fall by assessing their ability to participate in physical activity.
"If the patient was still weak from their surgical procedure, I would assess their ability to get up and walk, to ensure they are not at risk for a fall. This is something I deal with often at my current job as an inpatient nurse. Just recently, I was caring for a patient who had been admitted for a serious infection. When the patient seemed to be getting better, the physician ordered that he get up and walk, and he did well the first couple of days. However, on the third day, he was feeling worse, and when it was time for his walk, instead of just getting him up, I assessed his condition and found that getting him up for a walk would put him at risk. Upon calling the physician and updating him on the patient's condition, he came to check on him, and found that the patient needed emergency surgery as the infection had returned. Not only did my diligence prevent the patient from becoming injured, it also helped alert the physician of an emergent issue."
"When I worked on the post-op cardiac unit, we were constantly assessing if patients could safely walk around the unit with just a nurse to support them. Ambulating after surgery is very important to increase strength and decrease the chance of pneumonia, blood clots, and other complications. However, if a patient isn't ready to walk, even with a gait belt or a walker, they could risk falling and sustaining serious injury. In this case, I would assess the patient and see if he can safely walk 2 laps in the hall. If his assessment shows that he can walk 2 laps in the hall, I would walk with him. If the assessment did not show that he could safely do this yet, I would contact the physician, explain the scenario, and request an order for a physical therapist to come to evaluate and work with the patient."
Community answers are written by other candidates practicing this set. Reading how others frame the same question is one of the fastest ways to sharpen your own.
Anonymous Answer
I would asses the patient. If through my assessment the patient was not capable of doing physical activity, I would call the physician for further instructions.
Cindy's Feedback
Good start. Consider using the question to demonstrate more examples of good judgment. What would you do if the patient showed signs of weakness? Would you approach the patient how he/she is feeling?
Anonymous Answer
I would ensure that the patient is feeling strong enough to walk the laps by talking to them about it. Assess their ability prior to starting. I would then help them sit up and dangle their feet at the side of the bed to make sure and avoid any orthostatic hypotension. I would make sure that their non-slip socks are on and make sure that they aren't feeling dizzy. Once they are ready I would help them up and use any assistive devices as needed and walk with them.
Chad's Feedback
You make it clear that assessing the patient's ability to participate in physical activity is the top priority. Good job! Be sure to also discuss the steps you would take if the patient was too weak to proceed. If possible, include a specific example of a time you prevented a patient fall by assessing a patient's ability to participate in physical activity and use the STAR method to frame your response.
Anonymous Answer
Start slow and use mobility aids they normally use, ensure have non-slip socks or well-fitting shoes on, sit at the side of the bed for a few minutes ask if dizzy? Address pain prior to mobilizing but make sure meds won't make them drowsy or uncoordinated. Even tho it's ordered if it's unsafe to walk them then don't put myself or the patient at risk. Notify doc if failed walk test and next steps. Maybe need PT to mobilize the first time.
Cindy's Feedback
Great answer! It shows your knowledge and care. Good job.
Anonymous Answer
I would start by assessing how alert and oriented they are and make sure their pain is treated to their goal number before getting up. I would watch how they sit up and let them sit for a minute to prevent dizziness. Then I would apply nonslip socks, and a gait belt, and have another person with me, especially if it's their first time ambulating after surgery. If they show signs of fatigue or dizziness, I would sit them down safely. If I notice a decline in their ability compared to a previous day, I would let the MD and PT know.
Stephanie's Feedback
This is a very thorough and well-balanced response. It sounds like you have a great plan of action in place, should you be faced with this scenario!
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