Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry

Area of Science:

• Quality Improvement in Healthcare
• Critical Care Medicine
• Patient Mobility Therapy

Background:

• Immobility in critically ill patients leads to adverse outcomes.
• Early progressive mobility mitigates these sequelae but faces implementation challenges.
• Appreciative inquiry is a change philosophy focused on organizational strengths.

Purpose of the Study:

• To assess if appreciative inquiry can revitalize an early progressive mobility initiative in a medical intensive care unit.
• To improve and sustain staff commitment to bedside mobility therapy.
• To contribute to the literature on appreciative inquiry in healthcare and critical care settings.

Main Methods:

• Staff participated in appreciative inquiry workshops utilizing the 4-D cycle.
• Evaluated staff attitudes and knowledge regarding early progressive mobility pre- and post-workshops.
• Tracked early progressive mobility activity performance at baseline, 3 months, and 10 months post-intervention.

Main Results:

• 96-98% of participants found workshops improved understanding, responsibility, and commitment.
• Mobility treatment orders increased from 62% to 88% at 3 months.
• Documentation (52% to 89%) and observation (39% to 87%) also significantly improved and were sustained at 10 months.

Conclusions:

• Workshop participation enhanced staff attitudes and performance of mobility treatments.
• Appreciative inquiry shows promise as an adjunct to traditional quality improvement methods.
• This approach can effectively improve and sustain early progressive mobility in critical care.