Student Name:
Faculty Name:
PICO(T) Question: Use the PICOT question developed in Topic 3 Discussion Question 1 and refine it as needed based on feedback received.
| PICO(T) Question Template | ||
| P | Population | ICU-intubated Adults Patients |
| I | Intervention | Early mobility |
| C | Comparison | Standard mobility |
| O | Outcome | Duration of mechanical ventilation |
| T | Timeline | Time in the ICU |
| PICOT Question | ||
| In intubated Adult Patients (P), how does early mobility (I) compare to standard (C) affect the duration of mechanical ventilation (O) within their time in the ICU (T)? | ||
| Problem Statement | ||
| The problem statement is a scholarly statement that justifies or rationalizes that this is a problem. A problem statement must include literature for support and justification. In 150 words or less, provide a problem statement for your PICOT question. In many instances, critically ill patients who were intubated and required endotracheal intubation in the Intensive Care Unit (ICU) endured long periods of immobility as a result of sedation, mechanical ventilation, and critical illness. It results in muscle weakness, functional decline, and, in addition, ventilator-associated pneumonia and deep vein thrombosis. In spite of the growing facts that favour the effectiveness of early mobility interventions, the popularity of engaging in them is still lower. The absence of standardized protocols and the knowledge level of healthcare providers becomes an obstacle to effective mobilization. Closing this gap is crucial to achieving a better patient outcome, speeding up ICU length of stay, and ensuring rational resource use. Hence, a more in-depth study that centres on the effects of early mobility on quality and safety results in ICU intubated patients is necessitated. The problem statement responds to the research question of the impact of early mobility intervention on the quality of health care in critical care settings (Alaparthi et al., 2020). The -statement calls for the application of evidence-based practices to improve the care of patients in critical care settings. | ||
| Population | ||
| The population target helps narrow the scope of the project. In 150 words or less, describe the population of interest, including its functional and problem-solving capabilities. The target of this study is ventilated adult patients admitted to the ICU, ranging from the typical age of 18 years and above. Such patients are dealing with a number of health issues that, in many cases, are complicated with mechanical ventilation, such as respiratory failure, extensive illness, and postoperative period. Additionally, they may manifest an impaired respiratory system, reduced locomotion, and decreased capacity to perform activities of daily life (Lin et al., 2021). With that, problem-solving skills can be affected because of sedation, mental disturbance or specific circumstances of their condition. Considering their critical condition and the need for individualized treatment to curtail the complications acquired due to prolonged immobility and mechanical ventilation, these patients need comprehensive interventions and care. Early interventions for mobilization are aimed at addressing these issues, and hence, movement and rehabilitation are promoted even in the acute phase of an illness. Some expected benefits are ventilator-associated complications reduction, shorter duration of mechanical ventilation, and length of ICU stay. | ||
| Nursing Intervention | ||
| A nursing intervention is used to address the problem. In 150 words or less, describe the nursing intervention. Nursing intervention involves the implementation of early mobility protocols for intubated adults in the ICU. According to Schallom et al. (2020), this holistic approach consists of a variety of activities, including passive range of motion exercises, sitting on the edge of the bed, and progressive ambulation with help as tolerated. The nurses continually measure vital signs, oxygen saturation, and the patient’s response during the intervention, adapting the level of activity based on individual limitations and safety. In collaboration with a multidisciplinary team, nurses maintain a correct positioning, make good use of the equipment, including the ventilator tubing, and check patients’ stability during mobility sessions. The role of education is not to be underestimated since the nurse will advocate for patients and their families as far as the benefits, disadvantages, and techniques of early mobility are concerned. This intervention is planned to counteract the negative impact of immobility, facilitate rehabilitation, and increase the patient outcome indices in the ICU. | ||
| Comparison | ||
| In 150 words or less, compare the nursing intervention to what is currently in place at your practicum site/selected setting. Our practicum center’s standard approach to increased mobility for intubated adult ICU patients is largely confined to minimal movements, concentrating on resisting pressure ulcers and maintaining joint flexibility through passive exercises. Nevertheless, the application of scripted early mortality strategies is not widespread. In contrast to the systemic coordination of healthcare staff demonstrated above, existing systems do not seem to be sufficiently systematic for participating in the mobilization process on a large scale. Generally, nurses spending time stabilizing patients and maintaining machines such as ventilators may cause an escalation of immobility and, consequently, fewer chances for physical rehabilitation. Like the education and engagement of patients and families in the procedure of mobility, there is a lack of them. Mainly, this approach appeals to pragmatism, aiming to preserve order and steadiness instead of a forward-thinking approach. Applying data-supported early mobilization hosting approaches can help improve patient results because appropriate treatment of immobility problems could be prevented, and functional recovery could be promoted. | ||
| Outcome | ||
| An outcome is the result expected from the implemented action. In 150 words or less, describe the expected outcome for the selected intervention. The prediction of setting early mobility movement support for impaired adult ICU patients is a decline in mechanical ventilation duration. The recovery process provides the patient with an opportunity for active engagement in mobility exercises and progressive rehabilitation that works against the consequences of long-term immobility. Early mobilization ensures that the respiratory muscles stay in shape, prevents difficulties such as pneumonia and atelectasis, which are all associated with the use of ventilators, and accelerates the weaning process from mechanical ventilation (Alaparthi et al., 2020). With the provision of lung expansion and the facilitation of secretion clearance, patients can get disconnected from the weaning device more quickly. Moreover, this is important as it leads to better overall respiratory function and may discourage long-term reliance on ventilators. In summary, a decrease in the period of mechanical ventilation allows patients to recover faster through better comfort and better quality of life. Not only does this, but it also decreases the chances of developing ventilator-associated complications and shortening ICU lengths of stay. Reliance on ventilators. In summary, a decrease in the period of mechanical ventilation allows patients to recover faster through better comfort and better quality of life. Not only does this, but it also decreases the chances of developing ventilator-associated complications and shortening ICU lengths of stay. | ||
| Time Frame | ||
| Every project should have a specified time frame. In 150 words or less, describe the time frame for implementing the proposed intervention and evaluating the outcome. (Note: The capstone project will not be implemented on the practicum site. This is only a proposal.) The suggested intervention of early mobility protocols for adult patients who are intubated and in the ICU will be tested and assessed during the patient’s stay in the ICU. This timeframe equates to the patient’s admission from the moment of their admission until discharge or transfer to another unit. The intervention will be started immediately when the patient is stabilized and is thereby fit for mobilization with the aim of an early start of rehabilitating measures. The nursing staff will assimilate the early mobility protocols into the patient’s daily practice. It will keep evaluating and adjusting according to the improvement and the tolerance of the individual. In regard to the result of ventilator time reduction, which will be assessed through the course of the patient’s ICU stay with the monitoring of ventilator parameters and weaning progress, the follow-up will be regular. This timeframe is suitable for a rapid response and evaluation; therefore, it offers timely early mobilization when the patient still stays under critical care. | ||
References
Alaparthi, G. K., Gatty, A., Samuel, S. R., & Amaravadi, S. K. (2020). Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit. Critical Care Research and Practice, 2020, 1–14. https://doi.org/10.1155/2020/7840743
Lin, F. F., Liu, Y., Wu, Z., Li, J., Ding, Y., Li, C., Jiang, Z., Yang, J., Wang, K., Gao, J., Li, X., Xia, X., Liu, H., Li, X., Chen, X., Yang, L., Fang, X., Zhao, R., Chen, J., & Labeau, S. (2021). Pressure injury prevalence and risk factors in Chinese adult intensive care units: A multi‐centre prospective point prevalence study. International Wound Journal. https://doi.org/10.1111/iwj.13648
Schallom, M., Tymkew, H., Vyers, K., Prentice, D., Sona, C., Norris, T., & Arroyo, C. (2020). Implementation of an Interdisciplinary AACN Early Mobility Protocol. Critical Care Nurse, 40(4), e7–e17. https://doi.org/10.4037/ccn2020632
