الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 77 |  |  |
| | | from | 77 | | |
Abstract
The majority of mechanically ventilated patients are often exposed to prolonged immobilization, which can lead to rapid deterioration in muscles strength to all body systems. Immobility can influence significantly the patients’ outcomes and their recovery due to its effect on the respiratory and cardiovascular muscles. Therefore, improvement of the respiratory and cardiovascular functions in those patients are very important factor that can be achieved by implementation of the early exercises
Early exercises for MVPs have been suggested as an important intervention to avoid the risk of developing consequences of immobility. Passive exercise are usually used for unconscious or patients unable to cooperate with instructions. It can be started until the MVPs will be ready to participate in the exercise that is more active. The CCNs should consider the concerns regarding the type and duration of the exercises, as well as the existing hemodynamic and respiratory safety. Safe early passive exercises will provide benefits to the MVPs. It can protect the muscles of the critically ill patients that would improve the physiological responses, facilitate weaning, and improve the quality of life
Critically Care Nurses are responsible for monitoring and assessing the hemodynamic; oxygenation and ventilation parameters, pain response and the other parameters in order to accomplish safely and cost effective care. This care is useful to promote early recovery and reduce length of stay in the ICU
The aim of the current study was to evaluate the effect of passive exercise intervention on the physiological responses among mechanically ventilated patients.
Materials and Method:
The present study was conducted in the ICUs of Alexandria Main University Hospital; namely unit I, unit II, and unit III. A convenience sample of sixty adults MVPs, who are hemodynamically stable, with ventilation, and oxygenation safe values.
To accomplish the aim of the current study; two tools were used for data collection: Tool one was developed by the researcher after reviewing the relevant literature except part III, it was adopted.
Tool one: ”Mechanically ventilated patients screening form” which includes three parts to assess MVPs readiness and safety criteria before implementing the passive exercises. The first part: ”Patients’ baseline hemodynamic parameters record”, the second part: ”Patients’ ventilation and oxygenation parameters” and the third part: ”Patients’ non-verbal pain scale ”was adopted from Odhner et al 2004. In addition to the patients’ demographic and clinical data
Tool two:” Physiological responses of mechanically ventilated patient’s record” which includes assessment of the following parameters hemodynamic; ventilation and oxygenation; level and intensity of pain; and other parameters as ICU length of stay, duration of MV, occurrence of pressure ulcers, occurrence of VAP, and mortality rate.
The main results and conclusion of the current study included:
Passive exercises interventions for MVPs have different effects on the physiological responses (hemodynamic; ventilation and oxygenation parameters; and the pain response).
Some physiological responses such as heart rate and respiratory rate, pain response values increased immediately after implementing the passive exercises but these values returned to baseline values after 60 minutes of intervention with complete rest.
On the other hand, oxygen saturation decreased immediately after implementing the passive exercise but these values returned to baseline after 60 minutes of intervention with complete rest.
Pain response was significantly decreased among the intervention group in comparison with the control group.
Occurrence of pressure ulcer and VAP were significantly decreased in the intervention group patients in comparison with the control group patients.
Moreover, the current study findings illustrated that the duration of MV and ICU length of stay significantly decreased in the intervention group patients in comparison with the control group patients.
Based on the current study findings the following recommendations are suggested:
- Critical care nurses should monitor the hemodynamic; ventilation and oxygenation parameters; and the pain score for the MVPs before and the exercise intervention to ensure patients’ safety
- Critical care nurses should measure the patients’ tolerance to exercise before starting the passive exercises
- Critical care nurses should monitor the hemodynamic; ventilation and oxygenation parameters; and the pain score for the MVPs after the exercise intervention to indicate the patients’ responses.
- Critical care nurses should update their knowledge and practice about the passive exercises and increase their awareness about its benefits, and the risk associated with the immobility..
- Critical care nurses should attend to in-service training programs to improve their practice about the passive exercises and increase their awareness about its benefits, and the risk associated with the immobility for the MVPs.
- The undergraduate nursing curriculum should include knowledge about importance of starting early exercise.
- The undergraduate nursing curriculum should be revised to cover knowledge related to the principles; limitation; and recent guidelines about the range of motion exercise
- Written guidelines about the early exercises intervention: initiation, technique, duration, patients’ monitoring, and safety criteria before and after the exercises should be provide to the ICU nurses
- Strategies to overcome the nursing shortage, and the increased nursing workload should be developing to enable nurses to start early exercise.
- All recourses needed for the exercises intervention should be made available
- Conduct a study to identify the barriers to implement the early exercises for MVPs to find alternative strategies.
- Replicate the current study on larger sample size and in different ICUs.