Executive Summary: Progressive Mobility Project

Critically ill patients that require mechanical ventilation are at risk of developing secondary infections that may increase length of stay and possibly even morbidity. This fragile patient population requires special attention and meticulous adherence to established nursing standards of care. These standards of care are founded on evidenced based practices. It is important that nurses receive education about why these standards are in place and what consequences can result due to not following the established care protocols.

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

lifting for staff to be trained and to ensure that they use the right method. If employees have

Considered as top priority and central to the recovery plan of the unit, the operations of the unit have to be re-hauled, with higher emphasis on delivery of quality practices in preventing and controlling healthcare infection. The high risk areas of infection have to be curtailed with close monitoring, supervision of routine procedures of treatment. Exacting pressure has to be maintained to ensure there is no laxity among staff and all disposables are handled as per procedure and industry benchmarks achieved to the closet segment. Patient fall instances have to be contained by revisiting the existing physical layout of the unit, followed by examination and ad-hoc monitoring of the unit for obstacles in the path of patients. The budgetary allocations have to be handled with sagacity as nursing professional enhancement courses are primary in the current situation. The optimization of allocation of the limited budget would be prioritized with a maximum allocation provided to functions which would lead to immediate solutions for the unit to rebound as a top unit within the organization. The clinical goals would include (1) Holistic care of the highest quality standards (2) Patient-centric service delivery with optimized inter-professional cooperation. (3) Efficient and profitable management of resources (4) optimize healthcare integration scope.

The AICU is full and the discharge planner is under pressure from his supervisor to free up beds, which are needed for other critical patients (Belhaven University, 2015). The hospital’s business office requests if the patient can be discharged from AICU due to the cost being the responsibility of the hospital, in the amount of $9,000 per day, or if the family will agree to disconnect the ventilator. Unfortunately, “the attending physician is new on the

Balance, strength, and mobility are used in day to day for activity of daily living that are used by both independent and dependent adults. Mobility is defined as “the

I value your capstone project. I work in long-term acute care with clients who are on the vent with compromised pulmonary and cardiovascular problems, and I agree with you that there is limited evidence- based intervention to guide clinicians who work in acute care. It is imperative that OTs take the leadership role and train nurses and CNAs on the importance of bed mobility and transfers to eradicate problems with decreased functional mobility with bedsores and severe sacral wounds secondary to prolonged bed rest.. In addition, lack of physical activity and prolonged bed rest have significant consequences on musculoskeletal, cardiovascular, respiratory, (Parry & Puthucheary, 2015).

VAP is one of the common hospitals acquired infections, which got significant importance in following evidence based practice to prevent it. The authors of this study used a retrospective single center observational cohort study, done in the ICU at Scott and White Hospital, Temple, Texas. The study took almost two years for its completion. The research team implemented the ventilator bundle about 258 patients in mechanical ventilator. The limitations of the study were its retrospective nature, single center study and the database does not have metrics for severity, such as Acute Physiology and Chronic Health Evaluation (APACHE) score.

Nurses are accountable for delivering safe pressure ulcer prevention for patients who are at risk. Pressure ulcers can cause considerable amount of pain and distress in patients with nutritional deficiencies and can also cause high healthcare expenses due to extended hospital stay. Marlene Varga defines a pressure ulcer as “a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear” (Varga, 2015, p. 26). Significant to nursing practice, evidence-based pressure ulcer protocols are incorporated through research and clinical capability with the intention of aiding practitioners to make evaluations in accordance with current practices and studies (Chaves, Grypdonck, & Defloor, 2010). In hospitalized patients with nutritional imbalances, how would repositioning and turning the patient compared to the use of redistribution or patient positioning system devices manage existing pressure ulcers and prevent new ones from forming?

In addition to not fully understanding or recognizing the need for increased ICU intensivists and critical care nurses may be unfamiliar and uncomfortable with the technology. Because the hospital or health system pays all of the operating and staffing expenses of the eICU, cash layouts for an eICU system may be deemed an unnecessary and expensive venture, at least in the short-run. Despite these concerns, as many as 100 hospitals nationwide have implemented eICU programs, while others are considering expanding these programs to other high-risk areas of the hospital, such as step-down

Caring for adults with impaired physical mobility is a risk fact for many people with acute and chronic disease. There are negative consequences to all body systems when immobile which leads to deconditioning and loss of functions. Nurses use interventions to help prevent these deconditioning and function

The ambulation of hospitalized patients is very pertinent to alleviating many cases of impaired mobility and also greater lengths of hospital stays for patients in Intensive and Intermediate Care settings. This study was done in attempts to understand and determine the importance of implementing a nurse based mobility protocol, to increase the percentage of patients being able to ambulate during the first 72 hours of their hospital stay. This experiment was carried out in a large community hospital, using patients from a 16-bed adult medical/surgical intensive care unit and a 26-bed adult intermediate care unit. Guided by the nursing assessment of mobility potential, a mobility order set was developed and implemented on each unit. Depending on the assessment, nurses were able to get a second opinion by consulting an occupational therapist or physical therapist. Daily reports were collected to determine each patient’s ambulatory needs and status compared to their activity levels. “The results after this 6 month study showed the importance of implementing mobility. Prior to implementation 6.2% (12 of 193) of the ICU patients and 15.5 (54 of 349) of IMCU patients, ambulated during the first 72 hours of their hospitalization. After implementation there were great improvement in mobility to 20.2% (86 of 426) and 71.8% (257 of 358), respectively” (Drolet, 2013, p.1).

In ICU patients at risk for pneumonia and delirium, how does the implementation of bundled care (ie; awake/off vent, delirium monitoring and management and early mobility) compared to conventional ICU care decrease the rate of pneumonia and length of stay within the first 72 hours of hospitalization?

I felt after getting to know my client and the details of his health experience I would focus my healing initiatives around increasing his strength and mobility, managing adequate oxygenation and support around decreasing stress while he was in hospital. My ideas around increasing strength and mobility would be talk with Physio about exercises he could do for his upper body. My client spent a great deal of time in his bed and was limited on his mobility for his lower body. I felt that increasing the strength of his upper body, this would help him be more independent in repositioning in bed, as well as improving (would help decrease fall risk) his transfers to and from him w/c and bed. Hourly deep breathing and coughing would ensure he keeps

Additionally, nurses also encourage sick individuals to use toilet facilities in its place of bedpan (Southwell-Keely & Vandervord, 2012). I saw some patients after lower extremities surgery gets reluctant to mobilize or start loosing mobility when they are in pain. So, it is very necessary for a nurse to encourage early patient mobility. However, I think physiotherapist is the best specialist to attend post-operative patients to encourage independence and aid with mobility but I hardly saw any physiotherapist on my ward during my placement weeks. The nurses are doing all the work to encourage, educate and aid patients with their mobility needs. I had chat with my buddy nurse about the topic and she explained to me that early ambulation is a secure intervention for patients who were earlier independent, are physically and intellectually stable. Ambulation is safe to initiate after 4-48hours pot-op post anesthetic recoveries with appropriate dressing and splinting (Nedelec, Serghiou, Niszczak, McMahon, & Healey,