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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).
Background:
Proning intubated intensive care unit patients for the management of acute respiratory distress syndrome is an accepted standard of practice. We examined the nursing climate in 4 units and its impact on implementing a novel self-proning protocol to treat COVID-19 patients outside the intensive care unit.
Local Problem:
Nursing units previously designated for medical/surgical populations had to adjust quickly to provide evidence-based care for COVID-19 patients attempting self-proning.
Methods:
Nurses from 4 nursing units were surveyed about the implementation process on the self-proning protocol. Their perception of unit implementation was assessed via the Implementation Climate Scale.
Interventions:
A new self-proning nursing protocol was implemented outside the intensive care unit.
Results:
Consistent education on the protocol, belief in the effectiveness of the intervention, and a strong unit-based climate of evidence-based practice contributed to greater implementation of the protocol.
Conclusions:
Implementation of a new nursing protocol is possible with strong unit-based support, even during a pandemic.
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