Implementation of a Progressive Mobilization Program in a Medical-Surgical Intensive Care Unit

Abstract

BACKGROUND Current literature supports implementation of progressive mobility protocols in intensive care units. Education can help nurses overcome barriers to mobility and increase knowledge about the positive effects of mobility. OBJECTIVE To evaluate the effect of education for a progressive mobilization program for intensive care nurses on knowledge and performance. METHODS A pretest-posttest evaluation was conducted for 41 nurses, and a chart review was performed before and after implementation of the educational intervention to evaluate changes in knowledge and mobilization. RESULTS Scores after the educational intervention were significantly higher than scores before the intervention (t = 2.02; P < .001). Overall mobilization (P = .04) and dangling (P = .01) increased significantly after the education. No significant increases occurred in ambulating or getting patients up to a chair. CONCLUSIONS Mobilization education was effective and increased nurses' knowledge about the benefits of mobility for critically ill patients. The educational program also affected how nurses performed mobility interventions. Although provision of education had positive effects on patients' mobility, leadership and coaching are still important components in implementing change. (Critical Care Nurse. 2015;35[5]:28-42) ©2015 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ccn2015469 R esearch on early and progressive mobility is currently challenging the traditional standard of care that patients who are critically ill and treated with mechanical ventilation must remain bedfast for days or weeks. 1 Survival of critically ill patients has improved since the mid-1990s, but many of these patients experience long-term disabilities 2 and require rehabilitation after discharge from the intensive care unit (ICU). 1 In the ICU, the focus of care has been the short-term goal of survival, with little attention given to the functional and cognitive impairment of patients.1 One study 3 revealed that the quality of life of ICU patients was largely reduced 6 years after ICU admission; approximately half of the patients still had health problems, including cognitive dysfunction and problems with mobility. The traditional ICU standard of care for patients treated with mechanical ventilation has included deep sedation and prolonged immobility. RN, MSN, CCRN, 10 Firestone Dr, Arden, NC 28704 (e-mail: april.messer@msj .org).To purchase electronic or print reprints, contact the American Association of CriticalCare Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org. culture shift in ICU care to include strategies to mobilize ICU patients, 1,2,5,6 many ICUs in the United States have not changed their practice to include mobility of patients. 2,7,8 Nurses are often the key providers of mobility for patients who are critically ill. Barriers to mobility in the ICU include, but are not limited to, clinicians' fear and lack...

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