Running head: ICU Mobility Quality Improvement 1

ICU Mobility Quality Improvement

Samantha Moussari

Bon Secours Memorial College of Nursing

Professor Barbara Ellcessor

NUR 4144 Professional Role Development: Servant Leadership

March 27th, 2018

Honor Code “I pledge..”

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ICU Mobility Quality Improvement

QI Project

In the intensive care unit setting, mobility is a struggle for the patient and caregiver.

Intensive care unit patients are often on ventilators or other critical equipment that puts them at

risk for bed rest leading to decreased mobility. According to the journal of Critical Care

Medicine, evidence demonstrates that after 48 hours of being on a ventilator, 39% of patients are

unable to walk & 34% need assistance with walking (Bailey & Miller, 2009). The short time

frame of 48 hours illuminates the severity of the results and indicates that there needs to be a

change in practice for the critically ill population. According to the journal of Cardiopulmonary

Physical Therapy, the lack of mobility leads to “severe weakness, deficits in self-care and

ambulation, poor quality of life, hospital readmission, and death have all been reported in

patients up to 5 years after discharge from the ICU ” (Alder & Malone, 2012, p. 5). Although it

is recognizable that there is a safety concern for mobilizing critical care patients, the devastating

outcomes occurring require the immediate attention of nurses and other staff members working

with this patient population.

Four Domains of Leadership & Exemplary Leadership

For a quality improvement project to be successful, such as increasing mobility

awareness in critical care, servant leaders need to understand and be cognizant of the four

domains of leading like Jesus. The four domains include: heart, head, hands, and habits. Servant

leaders, such as nursing managers, must be aware of their internal domains and external

domains. According to Blanchard and Hodges, internal domains are the “motivations of your
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heart and the leadership perspectives of your head” (2008, p. 31). Blanchard and Hodges explain

that the external domains are your “public leadership behavior, or hands, and your habits as

experienced by others,” which will determine your following (2008, p. 31). The five practices of

exemplary leadership include: model the way, inspire a shared vision, challenge the process,

enable others to act, and encourage the heart. It is essential for nursing managers to recognize

how they can implement this into their servant leadership style.

Heart & Enable Others to Act

As a nursing manager I would be a servant leader, rather than a self-serving leader. I

recognize that the success of this type of quality improvement stems from the motivation behind

it. The intent to succeed with this quality improvement project would be for the patients and not

for my personal self-satisfaction. A motto to be instilled in all unit members would be “life is

about what you give rather than what you get” (Blanchard & Hodges, 2008, p. 40). This motto

would be overly emphasized on the intensive care unit with the hope that nurses are constantly

reminded, especially during hard times, why they are serving the patient population that they are.

Additionally as a nurse manager I would assess the motivation of the team that will be working

towards early mobility. Establishing a common motivation will foster collaboration throughout

the unit. Ensuring that there is trust amongst coworkers, enable others to act because they are

assured that they are supported. I recognize that in order to enhance patient outcomes, there

needs to be a joint effort working towards the same goal.

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Head, Model the Way, & Inspire a Shared Vision

The head domain for leading like Jesus examines beliefs and theories, which lead the

motivation for the objective (Blanchard & Hodges, 2008). In this instance, early mobility is the

objective and the motivation is guided by ones beliefs and supporting evidence. I as a servant

leader will inspire a shared vision. I would do this by creating a vision and plan for how patient

outcomes can be better achieved with early mobility. This act as nurse manager would be

recognized as a visionary role. Secondly, I would get engaged with the implementation role and I

would do that through a multitude of ways. Additionally, it would be important to integrate

hospital values so that employees recognize the importance of enhancing patient outcomes; such

as increasing mobility. As a nurse manager I can model the way by integrating these values and

beliefs into the quality improvement project. Every quality improvement project starts with a

dream and a team.

Hands & Challenge the Process

Hands are the actions of the servant leader (Blanchard & Hodges, 2008). As a nurse

manager I would implement in the following ways. For starters, I would perform morning rounds

on the nurses and their patients about their plan for mobility. This would assess the nurse’s

willingness and their plan for the patient. Secondly, during patient rounds I would question the

mobility progress and initiative to further the next steps. This brings mobility awareness to all

interdisciplinary team members on a daily basis. Thirdly, I would go to education councils on the

hospital board and I would educate nurses about the current evidence that is out there. Having a

purpose and a plan will allow the goal to be better controlled and more likely attained.

Challenging the process is how change is brought about. All good change that comes about in
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hospitals is once challenged and therefore the staff and servant leader need to be persistent for

the better good of the patients.

Habit & Encourage the Heart

Habits are how a nurse manager renews the daily goal (Blanchard & Hodges, 2008). As a

nurse manager I would do this by repeating the mobility mission daily in rounds and when

meeting with nurses. The repetition will hopefully make the practice of mobilizing patients a

more standard part of practice. When new practices are brought about in a hospital, many people

are frightened and do not like change, but eventually the change occurs due to persistence. As a

servant leader I will encourage the heart by acknowledgement of staff work ethic towards the

goal. As a nurse manager I could encourage the heart effectively by being clear about the

expectations for early patient mobility. With daily positive reinforcement and constructive

criticism, a transformation can be made.

Professional Practice Implications

Increasing patient mobility in the critical care units will enhance patient outcomes and

increase staff trust and collaboration. According to the journal of Cardiopulmonary Physical

therapy, functional mobility is enhanced through occupational therapy and physical therapy

(Alder & Malone, 2012). Nursing practice in critical care can be changed because instead of

allowing patients to be continually on bed rest, staff can take the initiative to assist the patients

towards a more progressive care. Trust and collaboration will be fostered because “successful

implementation of early mobilization requires a change in ICU culture” (Bailey & Miller, 2009,

p. 433). A change in culture takes an entire unit. In addition to the nurses implanting the change,
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it is important as a nurse manager to collaborate with interdisciplinary teams. With an initiative

that matches all members’ motives, transformation in the critical care population can be made in

professional practice.

Outcomes Evaluation

Although it is recognized in research that some patients cannot benefit from early

mobility, there are patients that benefit. On the intensive care unit at St. Mary’s hospital the

quality improvement project is in action and is being taken serious by the servant leader and

many of the staff members. The progress on the unit is small but recognizable. For example, one

patient that was vented with a tracheostomy was put into a recliner but could only withstand the

chair for 30 minutes. The following day the patient stayed in the chair longer and the day after

that the patient had no issues staying in the chair. For the patients that can withstand the change,

it is our job to provide our patients with the chance to progress. Furthermore, by servant leaders

following the four domains of leadership and utilizing exemplary leadership there is an increased

chance for the quality improvement project to be achieved.

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References

Adler, J., & Malone, D. (2012). Early Mobilization in the Intensive Care Unit: A Systematic

Review. Cardiopulmonary Physical Therapy, 23(1), 5-13.

Bailey, P. P., Miller, R. R., & Clemmer, T. (2009). Culture of early mobility in mechanically

ventilated patients. Critical Care Medicine, 37(10 Suppl, ICU-Acquired Weakness:

Proceedings of a Round Table Conference in Brussels, Belgium, March 2009), S429-

S435.

Blanchard, K., & Hodges, P. (2008). Lead like Jesus: Lessons for everyone from the greatest

leadership role model of all time. Nashville, TN: Thomas Nelson.