(1341) In Situ Early Mobility Simulations Improve Nurse-Led Rehabilitation of Critically Ill Children

Introduction: Early pediatric intensive care unit (PICU) mobilization is safe and associated with improved outcomes. Nursing-specific mobility training is desired and improves mobilization compliance. Thus, we aimed to implement an in situ nurse-targeted, early mobility simulation to determine if it increases PICU mobilizations.

Methods: We conducted a single-center, pre-post, interventional study of an in situ nurse-targeted, early mobility simulation. We developed and implemented a 15-minute simulation for nurses to participate in during their shifts, and prospectively evaluated mobilization events in 69 patients admitted with the pre-intervention phase (n=50) and the post-intervention phase (n=19). Patient-level clinical and mobility data were collected, in addition to evaluating the simulation’s impact on nursing self-efficacy and knowledge using pre-post interventional surveys.

Results: Eighty PICU nurses participated in the simulation representing 80% (80/100) of all PICU staff nurses. Prior to participating in the in situ simulations, the nurses completed a mean of 5.2 (SD 2.7) mobilization events in a 12-hour shift. After participation, the nurses completed a mean of 5.7 (SD 2.0) mobilizations events (p=0.42). Pre-implementation, the nurses mobilized 50% (25/50) of their patients out-of-bed at least once in a 12-hour shift, with an increase to 68% (13/19) post-implementation (p < 0.001). There were no increases in the rate of safety events. Nurses’ knowledge of their patients’ mobility protocol level improved from 56% (28/50) to 89% (17/19; p< 0.001). Nurses’ self-efficacy mobilizing a critically ill child improved from 29% (26/90) to 50% (27/55) feeling very confident after completing the simulation (p < 0.001), while their knowledge of how to perform a mobilization activity improved from 80% (72/90) to 100% (55/55) after participating in the simulation (p < 0.001).

Conclusions: Implementation of in situ early mobility simulations for nurses increases the amount of out-of-bed mobility critically ill children receive without an increase in safety events. Nurses who participate in in situ early mobility simulation have improved knowledge of the early mobility protocol and how to perform mobility.