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Does Nursing Support Early Mobility in the ICU?

Marla R. Robinson, MSc, OTR/L, BCPR, BT-C, FAOTA, Cheryl Esbrook, OTR/L, BCPR

July 27, 2015

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Question

Does nursing support early mobility in the ICU?

Answer

At our institution, we have been very fortunate that therapy services has built a very solid rapport with our nursing staff to the point almost, where the nurses totally trust us.  However, I will say that when we did start doing some of this research, and even now after we have completed it, we do meet situations where you get some pushback from nursing.  What helps this is establishing our own risk benefit.  You walk in the room and determine if the patient will benefit from what you are doing today, or is this something that could wait a day.  From there, we can use our own thoughts to educate the nurse as to why it is important and help the patient to understand why it is important.  Do we ever meet nursing resistance?  Yes.  I do think a lot of it is fear.  It is scary to have a patient who is awake moving about with all the equipment, despite being very sick.  The more we can educate nursing and physicians on this topic, it will only help us to be more successful with implementation of these ideas. 

Marla adds:  I have worked in ICUs my entire career and it had a lot to do with the competence of your staff.  Developing clinical competencies that are validated by other therapists who are practicing in those areas, or if you are going to be using a portable ventilator, coordinating that with your respiratory therapy team to be able to have them involved so they feel comfortable with you utilizing equipment that is not always traditionally been part of a therapy realm will also enhance that collaboration.  The other thing to do is start going to rounds and speak about what you are doing with the patients.  That develops a lot of collaboration and rapport with everyone on the multidisciplinary team. 


marla r robinson

Marla R. Robinson, MSc, OTR/L, BCPR, BT-C, FAOTA

Marla Robinson is the assistant director of inpatient therapy at the University of Chicago Medical Center.  She oversees the day-to-day operations for inpatient acute pediatric and adult acute care hospitals.  Her clinical work is with pediatric and adult acute care burn rehabilitation. She has research interests in burn rehabilitation.  She served on the development committee for the Burn Therapist Certification for the American Burn Association and was part of the first cohort of Burn Therapists-Certified. Marla has served on the Illinois Occupational Therapy Licensure Board as chair and as co-chair of the Chicago Area Council of OT Directors.  Marla has served AOTA in many capacities.  She served on the AOTA Board for Advanced and Specialty Certification as a member and chair, Chair of the Commission of Continuing Competence and Professional Development, AOTA representative for National Quality Forum for Patient-Reported Outcomes, AOTA representative for the Joint Commission Professional Technical Advisory Committee for Hospitals, AOTA representative for Society of Critical Care Medicine Task Force Long Term Consequences of PICs, Fellowship Site Reviewer, Chair of the Taskforce on Mentoring and as co-chair of the Chicago Area Council of OT Directors. 

Marla speaks nationally on burn rehabilitation and OTs role in preventing hospital readmissions.  She is passionate about continuing competence and ongoing professional development for occupational therapy practitioners.  She has authored book chapters on continuing competence, leading and managing in healthcare systems, and acute care management of gastrointestinal issues.


cheryl esbrook

Cheryl Esbrook, OTR/L, BCPR

Cheryl Esbrook earned a degree in Occupational Therapy from Western Michigan University.  She has been practicing as an occupational therapist at the University of Chicago Medical Center focusing her treatment and research on the critical care patient populations in both the medical and surgical ICUs for 11 years.  She is also the coordinator of the occupational therapy fieldwork program for students at the University of Chicago as well as the first occupational therapy residency program in acute care.  She is involved with local occupational therapy programs to increase knowledge of the OT role in critical care.  Cheryl has presented at national and international conferences including the American Physical Therapy Association, the American Occupational Therapy Association, NTI, the American Thoracic Society and the Society for Critical Care Medicine.  Cheryl has made research contributions to the field of early mobility in the ICU with published articles in The Lancet and Critical Care Medicine.  Cheryl is an advocate and mentor for increasing OT presence in the ICUs participating in international roundtable programs and presenting associated topics to occupational therapy programs.  Her current emphasis is on developing methods to assess therapist competency in the ICU and increasing assessment of delirium and cognition in patients experiencing critical illness. She recently received her Board Certification in Physical Rehabilitation from AOTA.


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