Progressive Mobility Protocol Analytical paper


Evidence-based Practice

Don't use plagiarized sources. Get Your Custom Essay on
Progressive Mobility Protocol Analytical paper
Just from $9/Page
Order Essay

Progressive Mobility Protocol

This paper is a project based on PICO. The clinical question that serves as the foundation for this data-based design is; for immobile critical care patients, does the use of a nurse driven progressive mobility protocol reduce ICU LOS compared to every hour of repositioning? In this paper, the adult patients admitted to an ICU represent the population (P) of interest. The nurse driven progressive mobility represents the intervention (I), the comparison (C) is the critical care patients repositioned every two hours, and the reduction in LOS represents the result.

Most hospitals place critically ill patients on bed rest and reposition them every two hours in the intensive care unit. Some literature reviews provide evidence in favor of progressive mobility protocols. In addition, the paper also reviews the safety of mobilization of the critical patients and the negative effects bed rest may have on the patient’s outcome and length of stay (LOS). The analysis of literature aims at providing evidence and validates the establishment of an evidence-based progressive mobility protocol (Plis, 2009).


Online research used Ovid Medline, Mosby Nursing Index and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The terms used for searching include critical care, immobility, results, LOS, and positioning. The search results from each search engine showed similar results (Plis, 2009). The literature review depended on articles based on their appropriateness to the PICO question: for immobile critical care patients, does the use of a nurse driven progressive mobility protocol decrease ICU LOS compared to every hour of repositioning?

Evidence from Reviewed Literature

A study on the hemodynamic changes experienced by critical patients when mobilized involved 31 ICU patients deemed favorable for mobilization based on a screening criterion. This study involved the auditing of medical records looking for information on heart rate, blood pressure, and oxygen saturation. In conclusion, the study reveals that, with the appropriate screening mobilization of critically ill patients, the process produces positive results without major deterioration in their clinical status. Therefore, this study demonstrates that mobilizing critical patients can be established safely. Another study that demonstrates the benefits of mobilization was a prospective research that focused on the effects of kinetic therapy on pulmonary complications (Plis, 2009).

Kinetic therapy (A Continuous Side-to-Side Turning Utilizing Specialty Patient Beds) study had 234 critically ill patients in the ICU with ventilation ratios of less than 250, Glascow Coma Scale Score of less than 11, and patients in need of mechanical ventilation (Plis, 2009). A comparison between kinetic therapies and standard repositioning reveals that pneumonia was lower in patients who received kinetic therapy to those of standard repositioning. In addition, the study reveals significance differences in LOS loss, and the cost of stay was less with kinetic therapy. The study points out that kinetic therapy did not influence impact LOS (Plis, 2009).

Another study on the effects of manual turning of patients diagnosed with pneumonia included 284 critically ill patients under mechanical ventilation and tube feeding. This study was not randomized, and the Clinical Pulmonary Infection Score was to establish the incidence of the disease after 3 days of intubation (Plis, 2009). The investigators observed patients for proof of repositioning every two hours and concluded that pneumonia development was higher in the patients who did not undergo repositioning as frequently (Plis, 2009).

Further evidence was from a study that focused on the effect of ICU acquired paresis on mechanical ventilation weaning. This study involved 95 ICU patients who had no history of neuromuscular disease and who were being weaned using mechanical ventilation after seven or more days of mechanical ventilation (Plis, 2009). The research looked at the strength of muscles after awakening the patients. In conclusion, the research suggested that preventing ICU acquired neuromuscular deterioration mechanical ventilation could offer a quick service. The study is a good demonstration that sedating patients followed by long periods of paralyzing, may lead to significant increase in LOS and mechanical ventilation weaning times (Goldhill et. al., 2007).


It is evident that early mobility in and out of the body can both occur successfully. In addition, reduction in progress of problems can lead to a decrease in LOS, and promoting increased healing may influence LOS. Lack of mobilizing patients may be costly in regards of LOS, complications and rehabilitation periods. The research from the review suggests that repositioning, which should occur every two hours happens for 2.7% of the time.

Nurses hesitate to get critically ill patients out of bed from fear of patient deteriorating. Based on the reviewed evidence, establishing a progressive mobility protocol has significant ability to improve the patient’s outcome including reducing their LOS. In addition, a nurse driven mobility protocol will enhance management of the patient’s mobility while providing them with succinct order to develop the patients (Plis, 2009). The protocol will help in changing the culture from one of sedation to one of progressive mobility to decrease LOS.

Conceptual Model for the Evidence-Based Practice Change

Using of evidence-based practice model provides a framework for practice change. In order to understand and implement findings from an evidence-based practice, there is a need to recognize the difference between research utilization and evidence-based practice. “Research utilization is the dependence on research knowledge, often a single study in clinical practice, whereas evidence-based practice depends on a larger skill set and considers many aspects.” In addition, the use of evidence-based practice allows for the integration of the available evidence in conjunction with practice skills, patient preferences, and available resources (Melnyk and Fineout-Overholt, 2005).

Stettler Model in Evidence-Based Practice

The Stetler model is ideal for the implementation of a nurse driven progressive mobility protocol. This is because the model concentrates on critical thinking and application of findings by the individual practitioner. In addition, the model is relevant to this project because it aims at promoting critical thinking and the application of findings in practice. The Stetler model has five progressive phases of activity including preparation, validation, evaluation, translation and evaluation. The preparation phase involves identifying the aim, validation phase involves establishing whether the research is relevant, and the evaluation phase assesses the research for relevance concerning the aim. The translation phase involves making of a decision what research to retain, and the final evaluation involves establishing the influence the findings may have on the aim of the problem (Melnyk and Fineout-Overholt, 2005).

Project Design

The evidence supporting the significance and safety of mobility in the critically ill patients is enough to boost development of a nurse driven progressive mobility protocol. This protocol will be a useful tool for nursing practice especially for the development of patient’s mobility. In addition, the protocol will empower nurses/practitioners by providing them necessary tools to provide safe therapeutic mobility for their patients (Plis, 2009). The protocol further is based on the progression from a recumbent to an upright out of bed position. However, the transition towards an erect position depends on the patient’s psychological response to the mobility. If successful, the protocol will allow safe progress in patient mobility and decreased LOS.

Development of a Progressive Mobility Protocol

The staff experiences, patient needs and availability of resources guided the establishment of this mobility protocol. The progressive mobility protocol developed in this paper is based on prior studies that support the safety and positive outcomes of patients. In addition, the project development included input from ICU nurses. The development includes elevating the head of patient care beds higher than the feet in 15 degrees. To achieve this, head of the bed is elevated and subsequent lowering the bottom of the bed. This helps to decreases pressure on the abdomen by eliminating the sitting in the bed (Plis, 2009).

Description of the Progressive Mobility Protocol

The design of the progressive mobility protocol aimed at making it a standing order in the ICU. Critically ill patients had the protocol prescribed as part of their Medicare. In addition, its design aimed at promoting the protocol three times a day. The mobility protocol recognizes the significance of sleep in the healing process; therefore, it is implemented three times during the day and evening hours. The nurses are to determine the exact timing of the progressive mobility protocol to promote nursing management of the protocol while supporting individual needs of the critically ill patients (Plis, 2009).

Project outcomes

The awaited outcome is the effect of early mobilization on LOS for critically ill patients. In this case, the LOS (Length of Stay) for patients in the ICU for the preceding year was 13.5 days. Evaluation of LOS happened 12 months before implementation (Plis, 2009). The plan aimed to evaluate LOS for 1 month, 3 months, 6 months and 12 months post implementation. However, such data needs a comparison with another hospital to establish whether the progressive mobility had a direct influence to the LOS in the hospital for patients spending time in the intensive care unit (Plis, 2009).


The critically ill patients face long periods of immobility, which may result in prolonged intubation and increased LOS in the ICU. Development of an early mobility aimed to decrease the LOSS in the ICU, and the project used an evidence-based practice change, recognizing available studies, applying experiences of the ICU nurses, specific needs of the patients, and the availability of resources to generate a progressive mobility protocol. The application of response from nursing and medicine to this evidence-based practice provided support to establish the ICU’s patient’s mobility (Plis, 2009).


Plis, L. (2009). The Effectiveness of A Nurse-Driven Progressive Mobility Protocol on Reducing

Length of Stay in the Adult Intensive Care Unit. Retrieved from

Melnyk, B.M. & Fineout-Overholt, E. (2005). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice.Philadelphia, PA: Lippincott Williams & Wilkins

Goldhill, D., Imhoff, M., McLean, B., & Waldmann, C. (2007). Rotational Bed Therapy to Prevent and Treat Respiratory Complications: A Review and Meta-analysis. American Journal of Critical Care, 16(1), 50-61.

Get Professional Assignment Help Cheaply

Buy Custom Essay

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

  • Plagiarism free papers
  • Timely delivery
  • Any deadline
  • Skilled, Experienced Native English Writers
  • Subject-relevant academic writer
  • Adherence to paper instructions
  • Ability to tackle bulk assignments
  • Reasonable prices
  • 24/7 Customer Support
  • Get superb grades consistently

Online Academic Help With Different Subjects


Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.


Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!


While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.


Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.


In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.


Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.


We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!


We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.


Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment Help Service Works

1. Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2. Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3. Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4. Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

smile and order essay GET A PERFECT SCORE!!! smile and order essay Buy Custom Essay

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
The price is based on these factors:
Academic level
Number of pages
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
error: Content is protected !!
Open chat
Need assignment help? You can contact our live agent via WhatsApp using +1 718 717 2861

Feel free to ask questions, clarifications, or discounts available when placing an order.
  +1 718 717 2861           + 44 161 818 7126           [email protected]
  +1 718 717 2861         [email protected]