Background: Older adults are at risk for losing their ability to ambulate independently during hospitalization due to multiple barriers that limit walking. “MOVIN” (Mobilizing Older adult patients Via a systems-based INtervention), a multicomponent nurse-led mobility intervention, achieved promising pilot results and was funded as a clinical trial in July 2020. The study aimed to implement MOVIN and monitor the change in nurse behaviors and unit culture before, during and after the 14-week intervention period. The challenge was to maintain the integrity of the intervention in the face of many COVID-19 challenges.

Methods: A cluster randomized controlled trial design was used to implement the MOVIN components (psychomotor training, mobility resources, communication tools, ambulation pathways, and support for developing a culture of ambulation) over 14 weeks at the first of four inpatient nursing units. Unit #1 is a 24-bed adult moderate acuity cardiac unit in a large urban Magnet quaternary medical center in Wisconsin. Evaluation focused on patient, nurse, and process outcomes.

Findings: The researchers and interdisciplinary clinical launch team met every two weeks to plan the implementation in compliance with COVID-19 restrictions. Baseline assessments were gathered, and the intervention was launched in July 2021 with implementation of all components. Weekly electronic reports based on clinical documentation were generated to provide feedback on ambulation outcomes (distance and frequency of patient walking) and confirm progress toward goals. The unit effectively navigated many COVID-19 obstacles including staff turnover, shortages and high patient volumes by adjusting orientation, pivoting communication strategies, focusing on “fun” activities when mileage goals were achieved, and setting a unit performance goal to sustain culture of mobility. At one year, the unit increased and maintained high-values for percentage of patients ambulated by nursing (average 82 %, up 20% above baseline) with ambulation distances, averaging 14 miles per week, up 300% from baseline.

Implications for D&I Research: MOVIN is a promising system-based intervention that supports unit culture change and promotes nurse-initiated patient ambulation. The intervention had an impact on the percentage of patients ambulated and the distance. Real-world testing required vigilant maneuvering around obstacles to ensure the integrity of the intervention and sustain the effectiveness over time despite the pandemic.