Exercise Physiologists: Key to Providing Early Mobilization in the Intensive Care Unit.

BACKGROUND: Patient immobility and a lack of physical activity in the intensive care unit results in a myriad of negative patient and hospital outcomes. OBJECTIVE: To report research findings related to the use of exercise physiologists in promoting and providing aggressive and progressive early mobilization within the intensive care unit. METHODS: This observational cohort study used the researcher-generated 12-point Activity Mobilization Evaluation Scale and delirium prevention bundle in 3 medical-surgical intensive care units to track patients' progress with mobilization. RESULTS: On average, most of the 216 patients in the study population realized a 1.6-point change (P < .001) in activity level with intervention by an exercise physiologist. Almost all of the study population (97%) maintained or increased the level of activity after receiving a minimum of 1 session with an exercise physiologist (mean, 3.5 sessions per day) during the 3-month study period. CONCLUSION: The introduction of exercise physiologists in the intensive care units proved to be a novel, safe, and effective strategy that maintained or increased the activity level of 97% of study patients.

Description of Nurse Scientists in a Large Health Care System.

Replicating a research study that described the work of nurse scientists in children's hospitals, the purpose of the study was to describe the role, activities, and outcomes of nurse scientists employed in a national health care organization. The characteristics of nurses filling the nurse scientist role in clinical settings and outcomes associated with the role have not been extensively described. The setting of this study is ideal since the organization includes facilities of various sizes located in rural, urban, and suburban areas in 18 states. Names and contact information of nurse scientists were obtained from nurse executives at each of the 110 affiliated organizations. Nurse scientists completed an anonymous survey. The primary role of the nurse scientists is to facilitate the work of others. Recommendations to strengthen the research infrastructure are provided.

Feasibility and Effectiveness of a Delirium Prevention Bundle in Critically Ill Patients.

BACKGROUND: Strategies for preventing delirium include early identification and avoiding or modifying patient, environmental, and iatrogenic factors. Minimal research exists on a prescriptive delirium prevention bundle that details elements or strategies for each bundle component. Even less research has been focused on nurse-driven interventions or components. OBJECTIVE: To evaluate the effectiveness of a delirium prevention bundle in decreasing delirium incidence in 2 medical-surgical intensive care units in a large Texas medical center. METHODS: Researchers used the Confusion Assessment Method for the Intensive Care Unit to assess delirium incidence by using a controlled interventional cohort design with 447 delirium-negative critically ill patients. Bundle components consist of sedation cessation, pain management, sensory stimulation, early mobilization, and sleep promotion. RESULTS: The intervention, analyzed by using a logistic regression model, reduced the odds of delirium by 78% (odds ratio, 0.22; P = .001). CONCLUSIONS: The delirium prevention bundle was effective in reducing the incidence of delirium in critically ill medical-surgical patients. Further validation studies are under way.

The experience of family members of ICU patients who require extensive monitoring: a qualitative study.

A mixed methods study using family research with a phenomenological approach (n = 5 families) was conducted to explore family members' perceptions about the extensive monitoring technology used on their critically ill family member after cardiac surgery, as experienced when family members initially visited the patient in the cardiovascular intensive care unit. Five relevant themes emerged: overwhelmed by all of the machines; feelings of uncertainty; methods of coping; meaning of the numbers on the machines; and need for education.