Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie Hardin Pierce

Clinical Mentor

Dr. Elizabeth Burckardt

Committee Member

Dr. Sheila Melander

Abstract

Purpose: This practice inquiry project was designed to evaluate current mobility practice and identify associations between mobility practice and specific patient characteristics in a cardiovascular intensive care unit.

Population and Setting: The sample consisted of electronic medical records of adult patients that required mechanical ventilation in a 16-bed cardiovascular intensive care unit in a private, urban hospital in Southern U.S. Of the selected participants, 48 were male and 52 were female with an average age of 64.49 (SD=14.58).

Inclusion Criteria: Inclusion criteria for this study were patients who 1) were aged 18 and older; 2) were mechanically ventilated for greater than six hours; 3) had a Richmond Agitation Sedation Scale score of -1 to +1 while mechanically ventilated; and 4) had physician orders for progressive mobility activities.

Design and Methods: This study uses a retrospective descriptive design to analyze mobility data from 100 randomly selected electronic medical records of mechanically ventilated patients receiving care between January and October 2015.

Results: Of the 100 randomly selected patients included in this study, one patient was mobilized while mechanically ventilated with the following mobility interventions: passive range-of-motion, active range-of-motion, sitting on side of bed, standing at side 64 of bed, and ambulating. This patient, compared to the sample demographics, had an average BMI, slightly more comorbidites and invasive catheters, and no infusing vasoactive medications. Due to a lack of mobility data, analysis to determine the association between mobility practice and specific patient characteristics could not be performed. Also, of the 100 patients in this study, 74 patients received a physical therapy consultation and of those 74 consulted, 64 patients received an evaluation. The average number of days between physical therapy consultation and evaluation was 4.57 days (SD=6.00). Patients did not receive a physical therapy evaluation while intubated.

Conclusion: The results of this study reveal that, despite best known evidence, early mobility interventions are not commonly practiced for mechanically ventilated patients in this cardiovascular intensive care unit. An early mobility protocol, designed to cater to the specific demographic and clinical variables of this particular patient population, is proposed at the end of this study.

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