Teaching Patient Mobility in the ICU Using a Simulated Patient
TimeThursday, April 152:00pm - 3:00pm EDT
LocationEducation and Simulation
Mobilizing intensive care patients is a priority across all specializations of critical care. The Society of Critical Care Medicine (SCCM) has provided guidelines regarding the early mobility of intensive care unit (ICU) patients that have been endorsed by the American Association of Critical Care Nurses (2015). Many states have also implemented programs to ensure the safety of caregivers moving patients. In the ICU, this activity involves the coordination of team members and specialized patient handling equipment. In order to establish competency, nurses are commonly trained within the unit using actual patients. The risks involved with mobilizing patients in this setting include device dislodgment, falls, and staff injury. The purpose of this inter-professional educational initiative was to provide a safe and realistic experience for new nursing staff to mobilize an ICU patient.
This program was designed for experienced nurses coming to the ICU and was held twice a year in the hospital's simulation center from 2016-2019. Nurses attended the session that was embedded in a multi-day ICU enculturation program. Each session consisted of a brief introduction to mobility assessment and three simulation scenarios. Scenarios were developed to portray a realistic clinical environment. They included incorporating several work system factors known to impact this process, such as communication and coordination among team members, challenges with ICU room size/layout, and technological challenges associated with the lifting equipment. In each scenario, a physical therapist played the patient's role with multiple devices attached, including an endotracheal tube, peripheral intravenous catheters, chest tubes and a urinary catheter. The physical therapist also portrayed different levels of dependence according to the nurses' assessment and organization. Each scenario was designed based on the patient's goal: (1: sitting at the edge of the bed; 2: standing; 3: walking to the doorway). The nurse participants were expected to utilize the appropriate lift equipment in each scenario. After completing the session, all three scenarios were debriefed by a nurse educator and the physical therapist. Debriefing aimed to identify opportunities to improve performance and discuss common challenges. They were also used to highlight potential systemic breakdowns that could compromise patient safety in the clinical environment.
One hundred seventy-five nurses participated in the program over the four-year evaluation period. In the debriefing sessions, the participants discussed how challenging it was to communicate with the intubated patient during the scenario. They consistently applied the simple assessment techniques in the introductory portion of the session to the simulation. Many describe these techniques as new knowledge and not content familiar to most nurses. Participants also debated patient safety and progress, considering the patient's proximity to the ventilator and bed. Each participant also completed an evaluation after completing the course. A majority of participants strongly agreed that their skills would help their current work responsibilities. Participants also rated the course as very good or excellent. Anecdotally, our educators have received feedback from the new nurses and their preceptors working on the floor that the scenarios helped provide a basis for patient preparation and the importance of teamwork.
Situational simulation training is essential for learning how to mobilize critically ill patients, especially when an adverse event can quickly result in inpatient or staff injury. It provides a learning environment where participants can safely make mistakes and learn from them. Interdisciplinary educational programs are valuable when staff is given the time to interact and pose questions to other disciplines, especially when they may not have time to interact to that degree in the patient care area. The simulation experience is elevated by including co-facilitators who have expertise in the subject matter and are willing to role-play. Doing so can present a more economical option for centers that may not have funding for professional actors. We have plans to evaluate the process of comparing pre-and post-session confidence ratings formally. We will continue to collect these confidence measurements as the participants practice on the floor and mobilize actual patients. Device dislodgements, patient falls, and staff injury will also be collected for the groups and compared to staff that has not received the training.