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Updated: Nov 28, 2025

An Educational Video Demonstration of How to Prone a Critically Ill Intubated Patient
Published on: November 30, 2022
Implementing Prone Positioning for COVID-19 Patients Outside the Intensive Care Unit
Mary Ann Francisco1, Nicole L Pierce, Elizabeth Ely
1Department of Nursing Research and Evidence Based Practice, University of Chicago Medical Center, Chicago, Illinois (Ms Francisco and Drs Pierce and Ely); and The University of Chicago Biological Sciences Division, Chicago, Illinois (Drs Pierce, Cerasale, Anderson, Pavkovich, Puello, Tummala, Tyker, and D'Souza).
Implementing a new self-proning protocol for COVID-19 patients outside the intensive care unit was successful. Strong nursing unit support and evidence-based practice climate were key factors for effective protocol implementation.
Area of Science:
- Nursing
- Critical Care
- Infectious Disease Management
Background:
- Proning is standard for ARDS in ICUs.
- COVID-19 necessitated adapting care for non-ICU settings.
- Self-proning protocols were explored for COVID-19 patients outside the ICU.
Purpose of the Study:
- To examine the nursing climate's impact on implementing a novel self-proning protocol.
- To assess the feasibility of evidence-based care in non-ICU settings during a pandemic.
Main Methods:
- Surveyed nurses on protocol implementation in 4 units.
- Utilized the Implementation Climate Scale to assess perceptions.
- Implemented a new self-proning nursing protocol for COVID-19 patients.
Main Results:
- Consistent education on the protocol was crucial.
- Belief in the intervention's effectiveness positively impacted implementation.
- A strong unit climate supporting evidence-based practice enhanced protocol adoption.
Conclusions:
- Successful implementation of new nursing protocols is achievable.
- Strong unit-level support is vital for protocol adoption, even during crises like a pandemic.
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