The Nurse’s Role in Early Mobility with Heidi Engel, PT, DPT
Today, ICU patients seem to become sicker and more sedated. Sedation medications, such as Propofol, have become more accessible and can be hung up and left on a drip all day. Heidi Engel, PT, DPT argues that less sedation and more mobilization should be thought of as important as taking medications. In this episode, we discuss how nurses can play a crucial role in mobilizing our patients both in the ICU and on the floor.
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Benefits of Early Mobilization:
- Prevent pneumonia
- Prevent blood clots
- Prevent bowel obstructions
- Prevent severe muscle wasting
- Prevent delirium
- Prevent shoulder/back pain
- Prevent calf weakness
- Decrease length of hospital stay
When to Initiate Mobility?
- 48 hours is target for initiating mobility because it only takes 48 hrs to start developing diaphragm weakness
We must advocate for our patients who develop anxiety regarding getting out of bed
- When a patient is hospitalized and constantly horizontal in a bed, it is associated as their safe space
- Patients become terrified of leaving their comfort zone
- Nurse should anticipate the fears, anxieties and how much the patient has adapted to their bed
Strategies for coaching patients through anxiety
- Inform patient of session’s measurable goal: “today, we are going to walk out of the room into the hallway and sit at the bench by the window”
- Think of the patient as a whole, with questions such as:
- How frail are they?
- How many comorbidities do they have?
- How old are they?
- How much anxiety disorder?
- Do they have at baseline?
- How can we how can we recruit their family members to help cheer them on?
- Or do their family induce more anxiety?
What are some chair and standing exercises RNs can lead with our patients while we’re in the room?
- Weight bering exercise to stretch heel cords to prevent calf wasting
- Toe taps in chair
- Ankle Pumps
- Coughing and deep breathing/ incentive spirometer
- Squats and arm raises may be completed while standing and holding onto assistive device or chair,
GOAL: We want to normalize activities and being out of bed as much as possible. Getting out of bed is imperative for maintaining mental and physical health
Example of Early Mobility Initiative Success
Inner Mountain Health in in Salt Lake City is an institution that is very aggressive about early mobilization. They have the longest running, most vigorous, mobility program in the country. Patients, ventilated or not, are out of bed and walking twice a day, while getting uninterrupted sleep throughout certain nightly hours. A very high percentage of their ICU patients are able to leave sooner and go straight home after their hospital stay. Here are articles that explain how an initiative encouraged early mobility for a shorter hospital stay.
Last Notes:
- Mobility should not be viewed as just a PT project.
- It is an interprofessional, multidisciplinary, critical care project. It is always composed of TEAMWORK.
- The benefits early mobilization will involve improved core strength and returning to normal routines/independence
