Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit

Abstract

Background: Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit. Local Problem: Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning. Methods: Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale. Interventions: A new self-proning nursing protocol was implemented outside the intensive care unit. Results: Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol. Conclusions: Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.

A Prospective, Descriptive Study on Awake Self-prone in Hospitalized COVID-19 Patients

“…Similar to our research, in 1 report, PT team members provided quality, focused interactions, support, and tools needed to successfully perform the intervention. 29 , 30 No other studies were found that used a multidisciplinary approach to proning.…”

Implementation and Assessment of a Proning Protocol for Nonintubated Patients With COVID-19

“…The differences in nursing attitudes about the benefits proning are documented in a separate article which shows significant variation between units. 38 This underlines a need for more uniform and ongoing education to promote awareness among both nurses and physicians.…”

Nurse-led implementation of awake prone positioning

“…March 2020 data from the Jiangsu Province in China demonstrated lower mortality and decreased intubation rates with and ventilation is improved. [4][5][6]16 PP may also facilitate postural drainage and secretion clearance. 6 Given combined benefits and improved oxygenation, engaging patients in APP serves as a low-risk intervention, supporting the management of patients on the medical floor while helping reduce the risk of intubation.…”

“…[4][5][6]16 PP may also facilitate postural drainage and secretion clearance. 6 Given combined benefits and improved oxygenation, engaging patients in APP serves as a low-risk intervention, supporting the management of patients on the medical floor while helping reduce the risk of intubation. [4][5][6]17 In May 2020, nonventilated patients with COVID-19 ARDS were admitted to a designated 22-bed acute care medical unit at a 596-bed Level I trauma center and community teaching hospital in southcentral Pennsylvania.…”

“…Shallow respirations pose a further risk for atelectasis. Ventral weight in the supine position compresses the lungs, causing atelectasis of the dorsal lung and hyperventilation of the ventral lung 4-6. Dorsal alveoli become preferentially perfused secondary to the gravitational gradient in vascular pressures, leading to high perfusion with poor ventilation, further disrupting blood oxygenation 4,5,16…”