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I want to share a success story that was sent to me from an ICU nurse.
"I would like to let you know about some of the superstars that have recently provided assistance with patient mobility.
...I was caring for a ventilated trauma patient in the ICU. ...JT was instrumental in pushing for this patient’s mobility. Because I was busy transfusing multiple blood products to my other patient, JT called the trauma surgeon and received orders to end bedrest activity. She also placed the patient’s bed in chair position. His level of sedation was actively being decreased and neurological status was evaluated over my shift. On the following day, we received an order for Precedex. The plan was to eliminate Propofol, maintain pain medication at the lowest dose possible (while still keeping him comfortable, yet functional), and get the patient to the chair. Now, I need you to know what my honest thoughts were. I really did NOT want to get this patient out of bed. I was absolutely afraid that we would accidentally pull out the ET tube, one or both of the chest tubes, nasogastric tube, urinary catheter, or any of his much needed peripheral IVs. I was also skeptical about the patient’s likelihood of tolerating the move. He had shaken his head ‘no’ in response to turns (despite communication about how, what, and why it must occur). He became agitated many of the times I attempted to perform care. He was also being restrained because he had reached toward his ET tube on a several occasions despite frequent orientation (and many other things I tried to prevent restraint use). I can honestly tell you that my anxiety over moving the patient to the chair would have definitely slowed any attempts to get the patient out of bed. Despite the absolutely clear reasons to engage in early mobility, the time, equipment, planning, and ancillary coordination required can take a considerable amount of time and effort. I must make you aware that the biggest contributor of this patient’s mobility was due to the encouragement and support of JT. She notified (the) physical therapist, of the need to get the patient to the chair. She encouraged me many, MANY times prior to and during the transfer. Most importantly, she assisted us with the transfer. Because she was present, she realized that RT needed to be there for assistance when I didn’t (I told you I was anxious…). She helped ensure chest tube protection and patient safety. Once the patient was safely to the chair, she stayed to promote mobility in the chair (explaining marching and leg extension exercises to the patient). Finally, she offered kudos and thanks to me. Placing this ventilated patient into the chair would not happened as fast as it did without her. Furthermore, I was more confident, less anxious, and better able to anticipate things for the patient’s return to bed. I was able to coordinate staff and plan things inside the room prior to their arrival. JT's presence during the transfer out of bed was THE absolute most important part of the process. Despite her transition to another role in the ICU, she has worked as a staff nurse on more than one occasion when we needed help. Maintaining bedside competency does so much in gaining staff trust. It makes a difference in doing something because ‘the research/boss/lead/manager says so’ and doing something because it’s best practice and having the adequate training/coaching to do so. JT is someone I respect and emulate.
I would also like to thank the rest of the team that helped during this process. ...physical therapy was very supportive in transferring the patient. He came right away after JT notification, discussed timing with me, and notified lift coach. During the transfer, he ensured proper positioning and safety of the patient with multiple fractures. Physical therapy has more recently begun working with ICU patients and staff. He has a quieter personality, but when it comes to the physical/mechanical safety of a patient in regards to movement, he does not hesitate to speak up and guide us. He is a great member of our team.
...(The) lift coach, was available for each transfer. He came quickly per physical therapy's request for the first transfer, and on time, as requested for the trip back to bed. The Lift Coach handled the lift, and coordinated the patient’s actual movement in the sling. Lift Coach anticipates our supply needs and will even gather linens while patiently waiting for us to get things in order for any repositioning. We are so lucky to have such a calm, intelligent, approachable person in our SPHM Team.
Another RN was present as resource during the transfer back to bed. He came into the room to help without being asked. I am grateful for his initiative and calm demeanor.
Finally (the) respiratory therapist helped to ensure safety of the endotracheal tube. He is also a newer member to our team. He was calm and continually accepted advice and requests from other staff during both transfers.
I hope that you recognize each of these individuals for their role in the mobility of this patient. They have certainly influenced my practice and confidence in regard to mobility. With the support of people like this, we will continue to progress with our early mobility program and future practice changes...
"I would like to let you know about some of the superstars that have recently provided assistance with patient mobility.
...I was caring for a ventilated trauma patient in the ICU. ...JT was instrumental in pushing for this patient’s mobility. Because I was busy transfusing multiple blood products to my other patient, JT called the trauma surgeon and received orders to end bedrest activity. She also placed the patient’s bed in chair position. His level of sedation was actively being decreased and neurological status was evaluated over my shift. On the following day, we received an order for Precedex. The plan was to eliminate Propofol, maintain pain medication at the lowest dose possible (while still keeping him comfortable, yet functional), and get the patient to the chair. Now, I need you to know what my honest thoughts were. I really did NOT want to get this patient out of bed. I was absolutely afraid that we would accidentally pull out the ET tube, one or both of the chest tubes, nasogastric tube, urinary catheter, or any of his much needed peripheral IVs. I was also skeptical about the patient’s likelihood of tolerating the move. He had shaken his head ‘no’ in response to turns (despite communication about how, what, and why it must occur). He became agitated many of the times I attempted to perform care. He was also being restrained because he had reached toward his ET tube on a several occasions despite frequent orientation (and many other things I tried to prevent restraint use). I can honestly tell you that my anxiety over moving the patient to the chair would have definitely slowed any attempts to get the patient out of bed. Despite the absolutely clear reasons to engage in early mobility, the time, equipment, planning, and ancillary coordination required can take a considerable amount of time and effort. I must make you aware that the biggest contributor of this patient’s mobility was due to the encouragement and support of JT. She notified (the) physical therapist, of the need to get the patient to the chair. She encouraged me many, MANY times prior to and during the transfer. Most importantly, she assisted us with the transfer. Because she was present, she realized that RT needed to be there for assistance when I didn’t (I told you I was anxious…). She helped ensure chest tube protection and patient safety. Once the patient was safely to the chair, she stayed to promote mobility in the chair (explaining marching and leg extension exercises to the patient). Finally, she offered kudos and thanks to me. Placing this ventilated patient into the chair would not happened as fast as it did without her. Furthermore, I was more confident, less anxious, and better able to anticipate things for the patient’s return to bed. I was able to coordinate staff and plan things inside the room prior to their arrival. JT's presence during the transfer out of bed was THE absolute most important part of the process. Despite her transition to another role in the ICU, she has worked as a staff nurse on more than one occasion when we needed help. Maintaining bedside competency does so much in gaining staff trust. It makes a difference in doing something because ‘the research/boss/lead/manager says so’ and doing something because it’s best practice and having the adequate training/coaching to do so. JT is someone I respect and emulate.
I would also like to thank the rest of the team that helped during this process. ...physical therapy was very supportive in transferring the patient. He came right away after JT notification, discussed timing with me, and notified lift coach. During the transfer, he ensured proper positioning and safety of the patient with multiple fractures. Physical therapy has more recently begun working with ICU patients and staff. He has a quieter personality, but when it comes to the physical/mechanical safety of a patient in regards to movement, he does not hesitate to speak up and guide us. He is a great member of our team.
...(The) lift coach, was available for each transfer. He came quickly per physical therapy's request for the first transfer, and on time, as requested for the trip back to bed. The Lift Coach handled the lift, and coordinated the patient’s actual movement in the sling. Lift Coach anticipates our supply needs and will even gather linens while patiently waiting for us to get things in order for any repositioning. We are so lucky to have such a calm, intelligent, approachable person in our SPHM Team.
Another RN was present as resource during the transfer back to bed. He came into the room to help without being asked. I am grateful for his initiative and calm demeanor.
Finally (the) respiratory therapist helped to ensure safety of the endotracheal tube. He is also a newer member to our team. He was calm and continually accepted advice and requests from other staff during both transfers.
I hope that you recognize each of these individuals for their role in the mobility of this patient. They have certainly influenced my practice and confidence in regard to mobility. With the support of people like this, we will continue to progress with our early mobility program and future practice changes...
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