Early Mobility Therapy: Advantages and Disadvantages

Introduction

Early mobilization therapy issue became an area of concern after researchers discovered the negative consequences of bed rest following sickness or trauma. These consequences can be versatile and dangerous for a patient’s health condition. The most prominent of them are cardiovascular deconditioning, increased risk of pressure ulcer development, muscle weakness and atrophy, neurological dysfunction. Thus, the given reasons are enough to support the need for developing an EBP project in this area (Patel, Pohlman, Hall, & Kress, 2014).

The nursing issue that has been chosen is the early mobility in the intensive care unit (ICU). Particularly, the advantages and the disadvantages of early mobility therapy compared to non-early mobility therapy for patients who are in intensive care will be analyzed. The reason for choosing this particular topic is that it is a significantly important issue in nursing practice. However, the amount of evidence that has studied the early mobilization of seriously ill patients is rather small.

A few randomized and controlled researches have been conducted including only several hundred patients which significantly limits the strength of the evidence. Therefore, since the early mobilization therapy is considered safe and feasible, it is important to pay more attention to it (Schaller et al., 2016). Thus, this assignment consists of the following sections: Introduction, The Connection between FNP and Early Mobility Therapy, Nursing Issue, PICO Question, and Research Literature Support, Conclusion, and References.

The Connection between FNP and Early Mobility Therapy

The specialty track that has been chosen is the Family Nurse Practitioner (FNP). FNPs are advanced practice nurses who work autonomously or in cooperation with other healthcare professionals to provide family-focused care. They provide a wide range of healthcare services for particular family units on a long-term basis. FNPs’ objective is to promote health, prevent diseases, treat patients, and counsel them across the lifespan. The role of an FNP in early mobility therapy in the ICU is significant. FNPs look after patients when they are in intensive care. In this regard, they can help implement early mobility therapy during the treatment of their patients (Bernhardt, 2017).

Thus, depending on the type of illness or injury, FNPs can determine whether to use early or non-early mobility therapy on their patients. Although in general, early mobility therapy helps prevent negative consequences caused by bed rest, in certain cases, it can lead to the relapse of a disease or the opening of an undertreated wound. Therefore, FNPs’ purpose is to decide whether this therapy will harm a patient in a particular case or improve patient’s health, accelerate the healing process, and help avoid pernicious consequences connected with the non-early mobility therapy (Clark, Lowman, Griffin, Matthews, & Reiff, 2013).

Nursing Issue

The nursing issue on which this project is focused is the early mobility program in the ICU. There has recently been an increase in the movement to begin research that focuses on the physical therapy utilization within the ICU establishment and the outcomes of the early intervention program with patients within this establishment. Progressive or early mobilization includes a system of movements that increase the activity of a patient beginning with the passive set of movements and ending with the independent ambulation. After the implementation of early mobility therapy, patients will begin a special movement therapy in 24-48 hours after the mechanical ventilation (Schaller et al., 2016).

The early mobility therapy had been implemented until recently. For several years, many types of research were conducted to identify the advantages and disadvantages of this therapy. Eventually, a couple of years ago, some hospitals started to implement it. Thus, as for the frequency of the occurrence of this therapy, it is not frequent, as it is a new therapy, but those who have started to use it demonstrate chiefly the positive results (Reade & Finfer, 2014).

The initiation of the therapy begins after the establishment of the clearance from a physician or a medical team responsible for the ICU patients (approximately a week) and after the occupational therapy and/or the physical therapy has been consulted. Currently, numerous attempts are being made to launch more trials of the early mobility therapy for the ICU patients in combination with the interruption of sedation during the therapy time.

In this regard, this therapy becomes more frequent, and it may soon be fully introduced in nursing practice (Engel, Tatebe, Alonzo, Mustille, & Rivera, 2013). Additionally, the implementation of the early mobilization protocol requires a multidisciplinary approach that includes collaboration between physicians, nurses, respiratory therapists, rehabilitation therapists, and administrators. Thus, this issue will engage all stakeholders, including improvement team leaders, senior leaders, and frontline staff who will be involved in the process of its implementation (Schaller et al., 2016).

Thus, this project will attempt to present evidence on the advantages and the disadvantages of early mobility therapy in the ICU in contrast to non-early mobility therapy. The rationale for choosing this particular nursing issue is that it is important and relevant now and requires much attention and effort on the side of all the stakeholders to be successfully implemented in nursing practice. Additionally, due to the lack of practical evidence of the positives and negatives of early mobilization therapy, it is crucial to conduct further research on this issue to accelerate its overall implementation. Moreover, this therapy has already proved to be safe and efficacious (Bernhardt, 2017).

PICO Question

Currently, the problem of the implementation of early mobility therapy in the ICU is relevant. Many types of research have been made since the first attempts to introduce this new program. Recent literature supports the need for this program, stating that it will help avoid the undesirable effects that can be caused by long bed rest and improve patient’s health (Reade & Finfer, 2014). Based on the identified need for the early mobility therapy development in the ICU and the current relevance of the identified nursing issue the following PICO question is created to guide this project: Will a severely ill or injured patient have an ameliorated functional state and a decreased stay in hospital with the realization of the early mobilization therapy compared to the non-early mobilization therapy?

Literature Search Strategy

Six sources were used to analyze the identified nursing issue. The main criterion for the search was the scholarly or peer-reviewed articles published from 2013 to the present day relating to the chosen nursing issue. Since the identified nursing issue is vital, relevant, and widespread today, all the six sources were found using only Google Scholar thereby making the search in other reliable databases and libraries unnecessary.

Additionally, only two of the provided resources are from the same journal. Others are from different journals related to nursing and medicine. All the sources analyze the nursing issue from slightly different perspectives thereby making this research more voluminous and multisided. Thus, the rationale for using these particular studies is that they have one common purpose that relates to the chosen nursing issue, namely, to ascertain whether the patients who were previously admitted to surgical ICU and randomized to the early mobilization program, would reach a higher mobilization level, compared to patients who received the standard mobilization therapy.

Conclusion

Early mobilization therapy has already demonstrated its efficaciousness for patients in the ICU. Additionally, current research has supported the need for widespread implementation of this therapy. According to the results of the experiments on the implementation of the early mobility program, it was proved that it helps avoid undesirable consequences for patients in the ICU which can be dangerous and sometimes life-threatening. Thus, the expected outcomes for this project proposal will be positive, as, in general, the early mobility therapy has proved to be effective and gives positive results.

As for the role of the FNPs in early mobility therapy, it is crucial, as considering a particular case, they must decide whether this therapy will harm a patient or improve their overall health and the healing process, and help avoid severe consequences connected with the non-early mobility therapy.

From this assignment, I have learned more about the early mobility therapy, the types of research that have been conducted regarding this issue, the benefits of this therapy, and the necessity for its widespread implementation. Additionally, I have determined the role of the FNPs in the implementation of early mobility therapy and found out the importance of this nursing issue.

References

Bernhardt, J. (2017). Early mobilisation and rehabilitation in the intensive care unit – Ready for implementation? Annals of Translational Medicine, 5(3), 57-59. Web.

Clark, D. E., Lowman, J. D., Griffin, R. L., Matthews, H. M., & Reiff, D. A. (2013). Effectiveness of an early mobilization protocol in a trauma and burns the intensive care unit: A retrospective cohort study. Physical Therapy, 93(2), 186-196. Web.

Engel, H. J., Tatebe, S., Alonzo, P. B., Mustille, R. L., & Rivera, M. J. (2013). Physical therapist–established the intensive care unit early mobilization program: Quality improvement project for critical care at the University of California San Francisco Medical Center. Physical Therapy, 93(7), 975-985. Web.

Patel, B. K., Pohlman, A. S., Hall, J. B., & Kress, J. P. (2014). Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated. CHEST Journal, 146(3), 583-589. Web.

Reade, M. C., & Finfer, S. (2014). Sedation and delirium in the intensive care unit. New England Journal of Medicine, 370(5), 444-454. Web.

Schaller, S. J., Anstey, M., Blobner, M., Edrich, T., Grabitz, S. D., Gradwohl-Matis, I.,… Lee, J. (2016). Early, goal-directed mobilisation in the surgical the intensive care unit: A randomised controlled trial. The Lancet, 388(10052), 1377-1388. Web.