The Challenge of Early Mobilization on the Intensive Care Unit: The Ergonomic Opportunities and Barriers

In recent years ICU-care and ICU-management of the critically ill patient is paying more attention to long term effects of the stay on the ICU and of the negative consequences of immobilization, long periods of bed rest, mechanical ventilation and medication aimed at pain reduction and sedation. Immobilization in bed affects practically all body conditions within a very short time frame: ranging from less than an hour to a few days. Some of these effects are reversible, some are not and may result in negative long term effects of the stay on the ICU. Recently new devices and equipment have been developed that enable mobilization of ICU patients at an extremely early stage, even without the patient being aware of being mobilized and being ventilated. This so-called Early Mobilisation (EM) has shown to be safe, feasible and improves outcomes both in the short term and especially also in the long run. There is a gradually building body of knowledge demonstrating the positive effects. In spite of these positive developments mobilizing critically ill and very passive patients in the complicated and often crowded ICU environment is also a first degree ergonomic challenge. Currently occupational musculoskeletal disorders are already prevalent in an ICU environment among nurses and physical therapists across the world. Lifting, assisting and supporting these complicated patients often attached to monitoring and (live) supportive equipment 24 hours a day can be very strenuous. EM requires considerable additional effort from these workers. These ergonomic implications will need to be resolved if an EM policy is to be successfully implemented. Therefore a study was undertaken describing the current situation and the potential of EM for the ICU’s in Dutch hospitals. The results indicate a whole array of different descriptions of EM and a lack of consensus, the lack of sufficient and adequate equipment especially when it comes to ergonomic considerations for the nurses, a lack of knowledge of what is required for EM and a lack of up-to-date protocols indicating safe procedures for both patient and nurse. Nevertheless most nurses are convinced of the need for and relevance of EM and see opportunities there. However: they are mostly focused on the patient side of EM and have not sufficiently analyzed the potential consequences for their own health.