Early mobility in the critical care setting is almost an oxymoron and something that would have been impossible to consider not so long ago. In fact, it was pretty common practice to keep patients sedated in the ICU, then transfer them to a lower level of care as soon as they were able to sit in a chair or ambulate short distances. Today, however, evidence supporting practice strategies that are radically different from past practices are transforming how care is delivered to patients when they are most vulnerable as is described in our cover story.
The concept of early mobility moved quickly from theory to reality in my own family not so long ago when my mother-in-law, Mary, was hospitalized with what eventually was diagnosed as a urinary tract infection that morphed into septicemia. Mary is a fiercely independent woman who largely raised her sons single-handedly, manages her own finances and lives her life by her own rules. During her six-day hospitalization, Mary did not get out of bed; part of the reason, Im sure, was because she didnt feel well and consequently she refused to sit in a chair or walk to the bathroom. Instead, Mary huddled in her bed wrapped in blankets, communicating her displeasure with the hospital food, with the TV controls being out of reach and when staff didnt respond to her shouted demands. I suspect she was an exhausting patient.
The real story begins, however, upon her discharge from the hospital when it was discovered she no longer had the ability to stand or even take a couple of steps from bed to chair. She was extremely weak and shaky, and her legs simply would not hold her up. Because she was immobile for six short days, she had lost her ability to independently get from one place to another. That issue started a cascade of events that included four weeks in convalescent care, during which she received physical therapy to regain her strength and occupational therapy for accelerated memory loss.
When we finally were able to move her back to her residence, she had to be transferred from independent living to assisted living, and she was no longer able to handle her finances. She is a different woman than the one who went into the hospital for a UTI.
Because of this personal experience, I have profound respect for the nurses who are implementing early mobility programs in the acute care setting and, despite many challenges, in the critical care environment. Please know that you are making an enormous difference, not only in hospital outcomes, but also in the lives of patients and their families after discharge.