Refusals, safety concerns impeded nurses' efforts to mobilize intubated patients

New study finds mobility practices nonexistent for ICU patients deemed ready to begin out-of-bed activities.

By Carol Davis, HealthLeaders Media

Critical care nurses frequently did not mobilize intubated patients receiving mechanical ventilation because the patient was uncooperative, according to a new study published in American Journal of Critical Care.

Competing demands from other patients or concerns about patient safety or potential adverse events also kept nurses from mobilizing intubated patients, according to Nurses’ Perceptions of Barriers to Out-of-Bed Activities Among Patients Receiving Mechanical Ventilation, which explores the mobility practices of critical care nurses in a 56-bed medical intensive care unit (MICU) at Yale New Haven Hospital in Connecticut.

If a unit has no designated mobility team, efforts to get patients out of bed are integrated into nurses’ individual patient care responsibilities. Although all 105 patients examined in the study met early mobility criteria within eight to 173 hours after intubation, none were mobilized for out-of-bed activities.

For the study, the definition of mobility was narrowed to nurse-initiated interventions that helped patients get out of bed to stand, sit in a chair, or walk.

Bed rest for patients can lead to rapid deconditioning and muscle atrophy, according to the study, Early Mobilization and Rehabilitation in the ICU: Moving Back to the Future.

In mechanically ventilated patients, bed rest can decrease skeletal muscles by 12.5% over the first week in the ICU, that report said, and for every day of additional bed rest in the ICU, they can lose 3-11% of their muscle strength.

In this newest study, patients were deemed ready to begin mobility activities within an average of 41.5 hours after oral endotracheal intubation. The authors believe the study is the first to report how soon patients were in stable-enough condition after intubation to begin mobility based on a defined set of parameters.

"Creating a unit culture that embraces early mobility practices requires collaboration, education, and a commitment that patients who can do out-of-bed activities are actually mobilized," said co-author Dawn Cooper, MS, RN, CCRN, CCNS, a clinical nurse specialist at the York Street Campus of Yale New Haven Hospital.

"Most nurses in our study reported that they never or rarely got intubated patients receiving mechanical ventilation out of bed, and clinicians infrequently entered mobility orders for these patients," she said.

Though patients, medical issues, and patient safety concerns provided the most barriers to mobility, the environment of care posed very few barriers; nurses rarely mentioned that lack of help from other nursing staff, physical therapists, or respiratory therapists, or lack of a clinician’s activity order impeded mobility, the study said.

Most nurses indicated they had received training on portable lift equipment, but just 58% reported feeling comfortable using it. Six rooms in the unit have a ceiling lift, but only 17% of the nurses reported being trained on its use and only 12% felt comfortable or very comfortable using it.

Units should review their mobility criteria and protocols for patients with complicated medical conditions, the authors recommend, take inventory of the factors unique to their unit that create barriers to early mobilization, and then apply an interdisciplinary protocol-driven mobility program to overcome those barriers.

Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand. This story first ran on HealthLeaders Media.