MICA · CARE LEARNING NOTES
Observe, keep care safe and communicate
Mobilisation aims to maintain ability and comfort while preventing falls and pressure injury. Plan it with the patient according to clinical condition, prescribed restrictions and the team’s competencies.
Assess actual ability
Ask how the person usually moves and what has changed: pain, weakness, dizziness, fatigue, confusion or fear of falling. Identify usual aids, previous falls and sensory needs. Assessment must lead to appropriate support rather than being limited to a risk score. NICE falls recommendations apply to people aged 65 or over and those aged 50 to 64 with an increased risk factor.
[1]Prepare the environment and assistance
Explain the planned movement, obtain agreement and enable the patient to participate to the extent possible. Check footwear, lighting, obstacles, furniture stability and the chosen mobility aid. Arrange sufficient appropriately trained staff for the transfer without improvised pulling. Plan around catheters, infusions and oxygen; short tubing or an unsecured brake can turn an ordinary move into a hazardous event.
[1][2]Adapt effort and pressure relief
Progression, walking aids and exercises follow the individual plan, with rehabilitation input when needed. Avoid default immobility while respecting justified medical restrictions. For someone at risk of pressure injury, arrange individual, documented and tolerated pressure redistribution and repositioning. A specialist support surface does not replace assessment of skin, pain and ability to reposition.
[1][2]Before standing, check pain, dizziness, devices, footwear and required assistance. Independence recorded yesterday does not guarantee it today. Support patient participation without pulling their arms or improvising unsafe handling. Poor tolerance requires stopping movement, safe positioning and reassessment.
- Hand over the assistance actually required and symptoms on standing.
Recognise poor tolerance
Stop exertion, support the person safely and obtain assessment if faintness, chest pain, unusual breathlessness, sudden weakness or new instability occurs. After a fall, assess for injury and follow the assessment pathway before attempting an improvised lift. Hand over circumstances, symptoms and actual assistance needs. Review the mobilisation plan after clinical change instead of assuming yesterday’s successful approach remains suitable.
[1][2]A learning situation
FICTIONAL SITUATION · REFLECTION WITHOUT A SCORE
Fictional situation: a usually independent patient becomes dizzy while sitting at the edge of the bed. They insist on walking to the toilet alone.
Should walking continue to preserve independence?
Read the reasoning
First support the patient safely and stop the unassisted attempt to stand. Assess symptoms and involve the responsible professional to identify the cause and adapt assistance. Offer an option that respects toileting needs and privacy. Independence is supported by proportionate, reviewed assistance rather than exposure to a foreseeable fall.
References and scope
- Falls: assessment and prevention in older people and in people 50 and over at higher risk — NG249 recommendations ↗
- Pressure ulcers: prevention and management — CG179 recommendations ↗
Original documentary teaching summary for adult care. Procedures and medicines depend on professional competence, prescription and institutional procedures. International references do not establish an Algerian protocol. Independent human scientific review remains to be confirmed.