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Volume 23, Issue 4 (10-2026)
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Ethics code: IR.BUMS.REC.1405.227
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Mohsenizadeh S M, Salehi H. From Bed Rest to Early Mobilization: Nursing Challenges in Older Adults After Major Abdominal Surgery: A Critical Narrative Review. Mod Care J 2026; 23 (4)
URL: http://mcj.bums.ac.ir/article-1-631-en.html
URL: http://mcj.bums.ac.ir/article-1-631-en.html
1- Assistant Professor of Nursing, Department of Nursing, Qaen Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
2- Instructor of Medical Surgical Nursing, Department of Nursing, Qaen Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran. ,hodasalehi@bums.ac.ir
2- Instructor of Medical Surgical Nursing, Department of Nursing, Qaen Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran. ,
Abstract: (114 Views)
Introduction: The growing population of older adults undergoing major abdominal surgery presents a significant challenge to postoperative care. Although evidence increasingly supports a shift from prolonged bed rest to early mobilization, implementation remains challenging in routine nursing practice.
Objectives: This critical narrative review aimed to analyze the transition from strict bed rest to active mobilization and identify nursing challenges in implementing early mobilization protocols in older adults following major abdominal surgery.
Methods: A critical narrative review was conducted following established principles for narrative reviews. PubMed, Scopus, Web of Science, and CINAHL were searched for studies published between January 2011 and December 2025 using terms related to early mobilization, older adults, major abdominal surgery, and nursing challenges. Of the 110 records screened at the title and abstract levels, 25 studies were included in the final synthesis. An iterative, concept-driven approach was used to identify recurring themes across quantitative, qualitative, and practice-based evidence. No formal quality appraisal was undertaken.
Results: Nursing challenges clustered into four domains: (1) physiological challenges, including frailty and lower adherence to mobilization protocols in emergency surgery; (2) psychological and cognitive challenges, including fear of falling and vulnerability to delirium; (3) structural challenges, particularly competition between mobilization and essential nursing tasks amid inadequate staffing; and (4) organizational challenges, including inconsistent protocols and implicit age bias. Nurse-led structured programs, such as MILES and the modified Hospital Elder Life Program (mHELP), showed potential benefits in selected outcomes. MILES supported individualized care and favorable recovery-related outcomes, while mHELP was associated with reduced delirium incidence. However, evidence remains limited to specific clinical settings.
Conclusion: Early mobilization after major abdominal surgery in older adults is shaped by patient vulnerability, clinical decision-making, team organization, and institutional culture. Therefore, nursing practice should move beyond simply encouraging activity toward individualized assessment, shared mobility goals, coordinated interdisciplinary care, and culturally responsive support.
Objectives: This critical narrative review aimed to analyze the transition from strict bed rest to active mobilization and identify nursing challenges in implementing early mobilization protocols in older adults following major abdominal surgery.
Methods: A critical narrative review was conducted following established principles for narrative reviews. PubMed, Scopus, Web of Science, and CINAHL were searched for studies published between January 2011 and December 2025 using terms related to early mobilization, older adults, major abdominal surgery, and nursing challenges. Of the 110 records screened at the title and abstract levels, 25 studies were included in the final synthesis. An iterative, concept-driven approach was used to identify recurring themes across quantitative, qualitative, and practice-based evidence. No formal quality appraisal was undertaken.
Results: Nursing challenges clustered into four domains: (1) physiological challenges, including frailty and lower adherence to mobilization protocols in emergency surgery; (2) psychological and cognitive challenges, including fear of falling and vulnerability to delirium; (3) structural challenges, particularly competition between mobilization and essential nursing tasks amid inadequate staffing; and (4) organizational challenges, including inconsistent protocols and implicit age bias. Nurse-led structured programs, such as MILES and the modified Hospital Elder Life Program (mHELP), showed potential benefits in selected outcomes. MILES supported individualized care and favorable recovery-related outcomes, while mHELP was associated with reduced delirium incidence. However, evidence remains limited to specific clinical settings.
Conclusion: Early mobilization after major abdominal surgery in older adults is shaped by patient vulnerability, clinical decision-making, team organization, and institutional culture. Therefore, nursing practice should move beyond simply encouraging activity toward individualized assessment, shared mobility goals, coordinated interdisciplinary care, and culturally responsive support.
Article Types: Review Article |
Subject:
Geriatrics
Received: 2026/05/23 | Accepted: 2026/09/19 | Published: 2026/10/18
Received: 2026/05/23 | Accepted: 2026/09/19 | Published: 2026/10/18
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