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2.24.2008
Hospital Stays Can Be Reduced By Physical Therapy In ICU
The results of the first study to show the effectiveness of early physical therapy in a medical intensive care unit (ICU) were presented yesterday (Oct. 23) by a researcher from Wake Forest University Baptist Medical Center at the national meeting of the American College of Chest Physicians in Chicago.
The length of stay for a group of respiratory-failure patients who received mobility therapy within 48 hours of the insertion of a breathing tube was reduced by an average of three days compared to the stay for patients who did not receive the therapy. This reduced length of stay included a reduction of time in the ICU of more than a day.
Initial therapy -- called passive range of motion -- was provided by nursing assistants who flexed the joints of the patients' upper and lower limbs three times a day, seven days a week. As patients progressed, they received more advanced physical therapy from a physical therapist. The therapy proved safe, and there was also no addition to hospital costs because the salaries of the employees who provided mobility therapy were offset by reduced lengths of stay in the hospital, according to Peter Morris, M.D., lead investigator and associate professor in the Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases.
Immobility and the resulting loss of physical conditioning are common problems for patients with respiratory failure, which means they cannot breathe without the assistance of a ventilator, said Morris. However, little data exist on whether early mobility therapy for ICU patients is associated with improved outcomes or cost benefits.
"Although there are data for efficacy of exercise for emphysema patients and for congestive heart failure patients in the outpatient setting, this was the first time for ICU administration of exercise as a therapeutic agent," said Morris. "The project confirms that it is safe to administer early mobility to ICU patients and that it is of benefit."
Phase I of a planned two-phase study was designed to address this lack of data by conducting a structured project, or protocol, over 24 consecutive months from 2004 to 2006 in which respiratory-failure patients admitted to the Medical Center's ICUs were assigned to one of two groups: 165 to a protocol group, which received early therapy from a mobility team (a critical care nurse, a nursing assistant and a physical therapist), and 165 to a control group, which received usual care. Some of those patients who received usual care also received therapy, although not as early or as frequently as those in the protocol group. Once patients were transferred to a regular nursing unit, both groups received usual care.
In addition to shorter hospital stays, the protocol patients also progressed more quickly to active physical therapy, were out of bed earlier and experienced no adverse events during an ICU therapy session.
Morris said further studies are needed in order to clarify the optimum number and duration of exercise sessions. Phase II of the study at the Medical Center will look at a broader range of ICU patients, both more and less ill, and will continue through hospital discharge. In addition, a study funded by the Medical Center's Claude D. Pepper Older Americans Independence Center will examine the effect of early mobility therapy for the elderly, who may be more at risk than younger patients for ICU-related arm and leg weakness.
Morris will make additional presentations on the study in February at the 37th Critical Care Congress of the Society of Critical Care Medicine, and in May at the 2008 International Conference of the American Thoracic Society.
Phase I of the early mobility therapy study was conducted by a team from both N.C. Baptist Hospital and Wake Forest University School of Medicine representing hospital administration, nursing leadership, the Division of Public Health Sciences, physical therapy, and the Section on Pulmonary Care. The study was funded primarily by Baptist Hospital.
The Medical Center's ICUs are one of 10 sites for the adult respiratory distress syndrome (ARDS) network of the National Institutes of Health, which is the critical care research network for the United States.
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Article adapted by Medical News Today from original press release.
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Wake Forest University Baptist Medical Center is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University Health Sciences, which operates the university's School of Medicine. U.S. News & World Report ranks Wake Forest University School of Medicine 18th in family medicine, 20th in geriatrics, 25th in primary care and 41st in research among the nation's medical schools. It ranks 35th in research funding by the National Institutes of Health. Almost 150 members of the medical school faculty are listed in Best Doctors in America.
Source: Karen Richardson
Wake Forest University Baptist Medical Center
The future of nursing; overcoming obstacles today for a better tomorrow
A recent Press Ganey survey conducted at Fox Chase Cancer Center in Philadelphia, Pa. reported that patients rated their overall care in the 99th percentile. "Fox Chase continues to be recognized for demonstrating clinical competency and providing excellent care to patients," said director of nursing, Anne Jadwin, RN, MSN, AOCN, CNA. "Our challenge now is maintaining very high standards while managing the changes created by an aging nursing population coupled with the shortage.
All across the county, nurses are growing older and the supply of new nurses is not enough to fill positions left by retirees and the increasing demand for professional nurses." At the 29th Annual Oncology Nursing Society, Jadwin shares first hand struggles and successes of implementing a certified nursing assistant (CNA) program and why the process is worth the bumpy ride for the future of nursing.
"The average age of a hospital nurse is 45," explains Jadwin. "After years of providing care, this age group is starting to feel the physical stresses of the job. Adding the certified nursing assistant position is not a means of replacing current experienced nurses, but aiding them and further introducing the profession of oncology nursing."
At Fox Chase, newly hired CNAs are required to complete a three-day oncology course with curriculum designed by clinical nurse specialists. Topics covered include patients' rights, communication, end-of-life and restorative care, reporting of signs and symptoms, and behavioral expectations. Certified nursing assistants are also required to obtain CPR certification and complete competency-based skills checklists.
"We wrongly assumed that just because our nurses provide outstanding care to patients, that they would also be great teachers for CNAs. It wasn't until we went through this process that we figured out that we needed to help re-educate our experienced nurses," said Jadwin. Delegation in-services for RNs and behavioral interviewing skills workshops for clinical managers were established, as well as a review of job descriptions and department care delivery model philosophy.
Fox Chase is not the only institution that underestimated the difficulty of implementing CNA positions in a primary nursing model," said Jadwin. "Through constant modification, the CNA turnover rate has decreased by over 20 percent since its implementation in 2001," continued Jadwin. In addition to the three-day oncology course, certified nursing assistants are offered career development assistance, on-site conferences, tuition reimbursement and recognition in the departmental newslette
In the future, Jadwin plans to continue to monitor Press Ganey patient satisfaction surveys and RN and CNA turnover and vacancy statistics, evaluate trends in staff satisfaction data, and support diversity leadership programs.
"When properly utilized, unlicensed competent personnel can enhance unit efficiency and patient care outcomes," concluded Jadwin.
Jadwin is among the staff of Fox Chase nurses who, in 2000, were recognized for excellence with the Magnet Award. At Fox Chase, nurses not only specialize in oncology, but further concentrate within a particular field allowing them to provide the most up-to-date treatment.
Co-presenting with Jadwin is JoAnn Mick, RN, MSN, MBA, AOCN, CNAA, of MD Anderson Cancer Center at the University of Texas.
Fox Chase Cancer Center was founded in 1904 in Philadelphia, Pa. as the nation's first cancer hospital. In 1974, Fox Chase became one of the first institutions designated as a National Cancer Institute Comprehensive Cancer Center. Fox Chase conducts basic, clinical, population and translational research; programs of prevention, detection and treatment of cancer; and community outreach. For more information about Fox Chase activities, visit the Center's web site at www.fccc.edu or call 1-888-FOX CHASE.
Contact: Colleen Kirsch
colleen.kirsch@fccc.edu
215-728-7784
Fox Chase Cancer Center
Locked Door Psychiatric Units Have More Disadvantages Than Advantages Say Staff
The disadvantages of locking the front doors of psychiatric units outnumber the advantages by more than two to one, according to a study published in the latest Journal of Clinical Nursing.
Researchers from Uppsala University in Sweden interviewed 40 mental health nurses and nursing assistants working on seven Swedish psychiatric inpatient wards with locked entrance doors.
The majority of patients in their care (45 per cent) had been diagnosed with mood disorders, 33 per cent had anxiety, personality or other disorders and 22 per cent had schizophrenia and psychotic disorders.
Eight advantages and 18 disadvantages were cited by the staff and most of these concerned patients' experiences.
"Enabling staff to control patients was felt to be an advantage by 85 per cent of staff, providing patients with secure and efficient care by 73 per cent and protection against the outside world by 68 per cent" says lead author Kristina Haglund.
"We know where the patients are" commented one member of staff, while another said that "it gives patients a sense of security when the ward is locked." Another said that family members were relieved to "know that the patient is safe and secure."
But there were twice as many disadvantages to contend with.
"The most common disadvantage, mentioned by 83 per cent of respondents, was that controlling the door was an uncomfortable and time-consuming task for staff, which could interrupt ongoing duties or contact with patients" adds Kristina Haglund.
"75 per cent felt that having a locked door could reduce patients' self-confidence and feeling of personal responsibility. "48 per cent also expressed worries that it created a non-caring environment and could make patients feel that they had to depend on staff to open the door."
One member of staff expressed concern that rattling keys could "intensity the "prison" atmosphere" and others worried that it added "to the feeling of illness", caused "agitation" or made patients "passive". Staff also talked about difficult issues relating to voluntary patients who didn't need to be locked in.
Locked doors also made staff question their role. "At the same time that you are caring for a patient you must be a sort of guard too" said one respondent. Other staff said it made them feel "shut-in".
There was also practical concern that locked doors could be a hindrance in an emergency.
Just over half of the staff surveyed (53 per cent) had also worked on an open door psychiatric unit. The majority (70 per cent) were female and the average age of the 20 registered nurses was 52 - five years older than the 20 mental health nurse assistants.
The registered nurses had been working in their current role for an average of 10 years, compared with eight years for the nurse assistants.
39 of the 40 participants mentioned both advantages and disadvantages during their taped interviews, which averaged 20 minutes and were carried out by an interviewer with extensive experience of working in mental health care.
One participant - a mental health nursing assistant - mentioned only disadvantages.
Both groups cited an almost equal number of advantages, but registered nurses mentioned more than 27 per cent more disadvantages.
Another survey carried out in the same year as this research found that three-quarters of Swedish psychiatric units were locked.
"It's clear from our research that staff have mixed feelings about locked door psychiatric units" concludes Kristina Haglund.
"On the one hand locked doors can undermine the purpose of the care being provided. But on the other hand, they can help staff to provide patients with a structured and safe environment that reduces the risk of them leaving the ward and harming themselves or others."
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Article adapted by Medical News Today from original press release.
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Psychiatric wards with locked doors - advantages and disadvantages according to nurses and mental health assistants. Haglund, von Knorring and von Essen, Uppsala University, Uppsala, Sweden. Journal of Clinical Nursing. Volume 15, pages 387-394.
Founded in 1992, Journal of Clinical Nursing is a highly regarded peer reviewed Journal that has a truly international readership. The Journal embraces experienced clinical nurses, student nurses and health professionals, who support, inform and investigate nursing practice. It enlightens, educates, explores, debates and challenges the foundations of clinical health care knowledge and practice worldwide. Edited by Professor Roger Watson, it is published 10 times a year by Blackwell Publishing Ltd, part of the international Blackwell Publishing group. http://www.blackwellpublishing.com/jcn
Contact: Annette Whibley
Blackwell Publishing Ltd.
Physical Therapy In ICU Reduces Hospital Stays, Study Shows
The American Physical Therapy Association (APTA) cites the results of the first study to show the effectiveness of early physical therapy for patients in a medical intensive care unit (ICU). The study, conducted by Peter Morris, MD, associate professor in the Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases at Wake Forest University Baptist Medical Center, was presented at the October 23 meeting of the American College of Chest Physicians in Chicago.
"This non-randomized study, the first of its kind on this particular topic, proves that the skills of a physical therapist are essential to the expedient recovery of ICU patients," said Mary Pat C Jobes, PT, MA, president of APTA's Acute Care Section and manager of physical therapy at Haywood Park Community Hospital in Brownsville, Tennessee.
Depending on the medical history and status of a patient, physical therapy can begin as soon as an ICU patient regains consciousness, notes Ethel Frese, PT, DPT, CCS, president of APTA's Cardiovascular and Pulmonary Section and an associate professor at St Louis University's Department of Physical Therapy. "Physical therapists work with ICU patients, both those breathing with or without a ventilator, with breathing exercises that use respiratory muscles, as well as range of motion exercises to do either sitting up in bed or in a chair," she said. "What physical therapists have always known and what Morris has proven in his study is that for patients who receive initial physical therapy, the number of days in the ICU and total number of hospital days were dramatically reduced," she added.
The length of stay for a group of respiratory-failure patients who received early mobilization and physical therapy within 48 hours of the insertion of a breathing tube was reduced by an average of 3 days compared with the stay for patients who did not receive the therapy. This reduced length of stay included a reduction of time in the ICU of more than a day.
Initial therapy - called passive range of motion - was provided by nursing assistants, with their training designed and implemented by physical therapists. The nursing assistants flexed the joints of the patients' upper and lower limbs 3 times a day, 7 days a week. As patients progressed, they received more advanced physical therapy from a physical therapist. The therapy proved safe, and there was also no addition to hospital costs because the salaries of the employees who provided range of motion and physical therapy were offset by reduced lengths of stay in the hospital, according to Morris and his research colleagues, Karen Taylor, PT, MPT and Bethany Harry, PT, MPT.
"Dr. Morris's study is particularly compelling because it so clearly demonstrates that it takes a multi-disciplinary team to care for ICU patients," observed Jobes. "The patients in the study were treated by a medical team that included an attending physician, critical care nurse, physical therapist and nursing assistant. Just as the patient could not recover without the skills of a critical care nurse, this study proved that the skills of a physical therapist were equally integral to recovery."
Immobility and the resulting loss of physical conditioning are common problems for patients with respiratory failure, which means they cannot breathe without the assistance of a ventilator, said Morris. However, little data exist on whether early mobility therapy for ICU patients is associated with improved outcomes or cost benefits.
"Although there are data for efficacy of exercise for emphysema patients and for congestive heart failure patients in the outpatient setting, this was the first time for ICU administration of exercise as a therapeutic agent," said Morris. "The project confirms that it is safe to administer early mobility to ICU patients, and that it was associated with benefit."
Phase I of a planned two-phase study was designed to address this lack of data by conducting a structured project, or protocol, over 24 consecutive months from 2004 to 2006 in which respiratory-failure patients admitted to the Medical Center's ICUs were assigned to one of two groups: 165 to a protocol group, which received early therapy from a mobility team (a critical care nurse, a nursing assistant and a physical therapist), and 165 to a control group, which received usual care. Some of those patients who received usual care also received physical therapy, although not as early or as frequently as those in the protocol group. Once patients were transferred to a regular nursing unit, both groups received usual care.
In addition to shorter hospital stays, the protocol patients also progressed more quickly to active physical therapy, were out of bed earlier, and experienced no adverse events during an ICU therapy session.
Physical therapists are health care professionals who diagnose and manage individuals of all ages, from newborns to elders, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. Physical therapists examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.
The American Physical Therapy Association is a national organization representing more than 73,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access "Find a PT" to find a physical therapist in their area, as well as physical therapy news and information at http://www.apta.org/consumer.
American Physical Therapy Association
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