Effects of Progressive Mobilization on Awareness Levels in Intensive

Care Unit

Gusti Pandi Liputo

, Nursalam

and Puji Rahayu

Indonesia Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

RSUD Haji, Surabaya, Indonesia

Keywords: Progressive Mobilization, Awareness Level, GCS, ICU.

Abstract: Decreased awareness is one indicator of gravity and prognosis in critical patients. One of the therapies used

in treating patients with the decreasing of consciousness is by the arrangement of position in the form of

mobilization progressive. This study used pre Experiment with one group pre-post-test design. Sample were

20 patients selected by using purposive sampling technique. Data were collected through observation,

measurement of awareness level with Glasgow Coma Scale (GCS) instrument before and after which was

analysed by Paired T-Test. The results showed an increase in GCS value between before and after progressive

mobilization treatment with p=0.000 which was smaller than α=0.05. Progressive mobilization is able to serve

as additional interventions that can be applied to improve patient awareness status and improve ventilation,

circulation, and perfusion.

1 BACKGROUND

Disturbance of consciousness can occur in

neurological disease and non-neurological conditions

(Wuysang et al. 2015). The problem that often arises

in critical patients treated in the intensive care unit

(ICU) is the decrease of consciousness. The

prevalence of delirious patients (delirium) reaches

80% (Bashar et al. 2017). The study found that

critically ill patients were at high risk for delirium,

with 50% of ICU patients and 80% of mechanical

ventilation patients experiencing delirium. Patients

with delirium have a higher risk of complications of

nosocomial pneumonia, longer duration of

mechanical ventilation, longer treatment period and a

higher risk of death compared to patients without

delirium (Munro et al. 2017). The indicator of gravity

and prognosis in critical patients are the patient's

awareness status. Prevention and management of

decreased levels of patient awareness in intensive

care is essential for identifying risk factors,

evaluating the patient's environment, maintaining

basic nursing care activities and being able to

implement nonpharmacological interventions (Tel

2017). Nonpharmacological interventions that can be

applied to critical patients are progressive

mobilization therapy (Tel 2017).

Mobilization refers to adequate physical activity

to obtain acute physiological effects that increase

ventilation, peripheral and peripheral perfusion,

circulation, muscle metabolism, and alertness and to

prevent deep vein thrombosis. The benefit of

progressive mobilization in critical patients is to

improve physiological function and fulfill adequate

oxygen demand (Roos 2015). Other studies have also

found mobilization therapy to improve oxygenation

in critical patients, preventing respiratory

complications and delirium (Umei et al. 2016).

Progressive mobilization can have a positive impact

on the awareness of the patient with a ventilator in

ICU. We tested this hypothesis in a fundamental

study of the effects of progressive mobilization on

awareness levels in patients with decreased

awareness in ICU RSUD Prof. Dr. H. Aloei Saboe

Gorontalo.

2 METHODS

2.1 Study Design, Population and

Sampling

This study used pre experiment research type with

one group pre-post-test design. Sample were 20

patients in Intensive Care Unit (ICU) who met

188

Liputo, G., Nursalam, . and Rahayu, P.

Effects of Progressive Mobilization on Awareness Levels in Intensive Care Unit.

DOI: 10.5220/0008322501880191

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 188-191

ISBN: 978-989-758-336-0

inclusion criteria: 1) GCS <11), 2) O2 Saturation≥

90%, 3) Heart rate > 60 <120, 4) age 29-45 years old

taken by purposive sampling. Measurement of

awareness level with Glasgow Coma Scale (GCS)

instrument (Institute of Neurological Sciences NHS

Greater Glasgow and Clyde 2015). The Ethics

Commission of the Faculty of Nursing Universitas

Airlangga approved the study and all recruits

provided voluntary written consent to participate after

being fully informed about the procedure, risk, and

protocol.

2.2 Procedure and Analysis

Progressive mobilization in this study was head of

bed 300 with trunk position, a range of motion 2 times

a day (morning and afternoon) and Continuum

Lateral Rotation Therapy every 2 hours. Perform

initial mobility screen 8 hours of ICU admission.

Progressive mobilization is given for 5 days. The data

were analysed by using Independent T-Test with

significance level α=0.05.

Table 1: Demographic characteristics and clinical data of

the 20 patients.

Variable

Patients (n=20)

Age

Sex

Male

Female

Diagnosis

Stroke

Respiratory Distress Syndrome

Sepsis

29-45

12 (60%)

8 (40%)

7 (35%)

12 (60%)

1 (5%)

Table 2: The effect of progressive mobilization in ICU

Patients.

Variable

Pre-test

(mean (SD))

Post-test

(mean

(SD))

Awareness

levels/

GCS

9.50

(0.889)

10,95

(0.826)

0.000

* GCS is only seen on the eye and motoric because the patient is on a ventilat

3 RESULTS

During the study from 5 January 2018 to 03 March,

2018 found 56 patients who installed ventilator. 20

(n=20) patients were respondents who met the

criteria.

This study found that after 5 days of progressive

mobilization in 20 respondents experienced a change

in awareness status characterized by an increase in

GCS score. Paired T-Test test results found P-value =

0.000 <0.005 and the value of CI do not pass the

number 0 then statistically there is the effect of

progressive mobilization of the level of awareness of

patients in ICU.

4 DISCUSSION

Head of bed or head elevation in head injury patients

is expected so that venous drainage to the brain

remains smooth. Head of bed can be done if there is

no contraindication for the patient to do (Mahfoud et

al. 2010). The position of the head of bed does not

interfere with the perfusion of oxygen to the cerebral

(Olviani, 2015).

Provision of a higher head position may provide

good lung performance in the ventilation distribution

process as well as perfusion will improve during

mobilization. Blood circulation is also affected by

body position and gravitational changes of the body.

So that perfusion, diffusion, the distribution of blood

and oxygen flow can flow throughout the body. Head

of the bed has an effect on oxygen saturation. Head of

bed position causes the body to perform various ways

to adapt psychologically to maintain cardiovascular

homeostasis. Critical patients usually have a weak

pulse, unstable breathing or low cardiovascular

reception so it is better to be given intervention rather

than being left in a static position (Vollman 2010).

The Range of motion (ROM) is an exercise

performed to maintain or improve the ability to move

the joints normally and completely to increase muscle

mass and muscle tone (Potter & Perry, 2010). ROM

exercises determine the value of bone and muscle

joint ability in performing a movement, improving

muscle tone, improving muscle tolerance for

exercise, preventing joint stiffness, and improving

blood circulation (Beebe & Lang 2009)

ROM can affect the development of awareness in

patients in the ICU room. Implementation of ROM in

critical patients runs well and is digested by patients

with mechanical ventilation. ROM may affect blood

pressure, heart, respiratory rate, central venous

pressure and oxygen saturation within the normal

range (Younis & Sayed Ahmed 2015).

CLRT was found to reduce the incidence of

ventilator-associated pneumonia in patients with

mechanical ventilation (Bein et al. 2012). CLRT is

continuously shown to reduce the risk of nosocomial

pneumonia, pulmonary complications, reduce the

number of days of ventilation, length of stay and

reduce overall treatment costs (Swadener-Culpepper

Effects of Progressive Mobilization on Awareness Levels in Intensive Care Unit

189

et al. 2008). CLRT improves the drainage of secretion

in the lungs, optimizes pulmonary expansion, reduces

respiratory complications (VAP, atelectasis, ARDS)

and reduces the associated risk of venous and PE

thrombosis from immobilization (Kubo 2008). CLRT

achieve best results when done at least 18 hours two

times a day (Timmerman 2007).

The decrease in physical function that occurs in

critical patients in ICU can be countered with

physical therapy to increase muscle strength and to

apoptosis (Suwardianto 2006).

Level of awareness each patient has with a variety

of average clinical problems is influenced by the

inadequate supply of oxygen to the brain tissue

(hypoxia) so that the need for improved ventilation

and circulation in the body. Progressive mobilization

consisting of the head of bed 300 with trunk position,

ROM, and CLRT.

Head of bed can reduce intracranial pressure,

launching venous drainage to the brain and increasing

oxygen saturation in the body. Passive ROM by

nurses in addition to preventing complications due to

immobilization, can also reduce the accumulation of

sputum and increase the elasticity of blood vessel

walls so that the circulation of virgin, oxygen, and

nutrients smoothly. CLRT every 2 hours can

maximize ventilation and prevent and treat

respiratory complications. Hypoxia will be handled

when oxygenation in the body is supported by good

circulation and ventilation so perfusion to the brain

can improve the patient's awareness status.

Progressive mobilization may increase the transport

of oxygen in the patient's body.

Mobilization of patients in ICU as early

rehabilitation to maintain muscle strength and to

prevent poor changes in cardiovascular response, in

addition, mobilization is expected to shorten the

length of care in ICU (Morris & Herridge 2007).

Progressive mobilization is a recommended

intervention to improve the awareness status of

patients with critical conditions, especially patients

with hypoxia.

5 CONCLUSIONS

Progressive mobilization in ICU patients can support

ventilation and circulation improvements to provide

adequate perfusion effects to the brain tissue that can

boost the patient's awareness status.

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