DNP Scholarly Projects


Background: The older adult population is growing, and these individuals often have health challenges that require complex nursing care. On an older adult unit in Tennessee, a 4Ms (What Matters, Medication, Mentation, and Mobility) Age-Friendly care initiative was implemented to improve care and outcomes. Early data showed inconsistent nursing engagement with 4Ms initiatives and qualitative data on engagement factors was needed to increase nursing support and improve patient outcomes. Purpose: Therefore, this scholarly project explored factors influencing nursing staff engagement with the 4Ms initiative on an older adult unit. Methods: Nurses and care partners (n = 14) from the older adult unit participated in qualitative, individual, semi-structured interviews. Responses were analyzed using descriptive analytics, open coding, and thematic development. CFIR (Consolidated Framework for Implementation Research) and 4Ms framework supported the project. Results: Themes identified: patient complexity, culture, 4Ms barriers, and 4Ms facilitators. Mobility and Mentation were often highlighted by nursing staff as Ms affected by patient complexity such as communication, increased time, and risk; however, culture remained positive. Some barriers identified were communication and risk of Mobility, difficulty with outside staff engagement, and staffing. Some 4Ms facilitators identified were integration into care, access to tools, and impact on patient care. Conclusion: Nursing experiences with 4Ms was better understood and opportunities to improve nurse engagement were identified. Next steps include development of undergraduate nursing clinical rotations pairing nursing students with an older adult patient to support staff and increase 4Ms competency, training nursing staff to use mobility scores to reduce perceived risk and increase confidence in Mobility, and training travel nurses on 4Ms to improve care and engagement.


Spring 4-16-2023

First Advisor

Dr. Kathryn L. Dambrino

Scholarly Project Team Member

Dr. Steven Busby

Scholarly Project Team Member

Dr. Sarah A. Welch

Scholarly Project Team Member

Dr. Maria C. Duggan


Nursing, School of


Health Sciences & Nursing, Gordon E. Inman College of

Document Type

Scholarly Project


Doctorate of Nursing Practice (DNP)

Degree Level


Degree Grantor

Belmont University


age-friendly care; 4Ms; older adult; nurse; care partner

Included in

Nursing Commons