Article provided on ambulation

Article Review
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Abstract
In health research, the researchers seek to provide solutions to perceived gaps in the medical practice. They establish a lacuna in the medical practice, conduct a study on the topic to find solutions to the problem identified. This article critique will provide an evaluation of the article by Drolet et al. (2013) in which these authors conducted research to investigate the practicability of applying an early mobility procedures to escalate movement within the intensive (ICU) as well as intermediate care (IMCU) surroundings. This critique will review the objective, purpose, variables, hypothesis and literature reviewed. Further, it will examine the methodology of the study, particularly critiquing the study design, sampling method, and study population among other areas. It will also examine the results presented by the researchers looking at its clarity, sample features, and the analysis method. This article critique shall conclude with the examination of the discussion section of the article in which clarity of the discussion, limitation of the study and how the article adds to the nursing knowledge shall be examined.
Keywords: Ambulation, ICU, IMCU, mobility program
Introduction
This paper is an article critique by Drolet et al. (2013) in which these authors conducted research to investigate the practicability of applying an early mobility procedure to escalate movement within the ICU as well as IMCU surroundings.

The authors cited that the need for their research was that extended bed rest for the admitted patients might result in de-conditioning, impair patients’ movements, as well as may result in a lengthy stay in the health facility. Therefore, according to these researchers, early mobility procedures could assist in alleviating these occurrences.
Drolet et al. (2013) are clear in their purpose of the research; they asserted that the aim of the research is to establish the efficiency of nurse-led mobility procedures to boost the proportion of patients’ movements within the initial 3 days of the patients’ admission for stay into the health facility (Drolet et al., 2013 p. 197).
In their study Drolet et al. (2013) relied on the independent variable of the formal ambulation plan, sex of the patients and the patients of ages 18 years and above. The dependent variable was the improvement of ambulation within the admitted patients in the ICU as well as IMCU. The independent, as well as dependent variables, were not clearly described but they were related to the study since they resulted in the measurement of the increase in the number of patients movements within the study population.
In their study, these researchers presented two hypotheses that guided their investigation or sought to establish their veracity. One, they hypothesized that a nurse-led mobility procedures might offer significant advantages to the admitted patients. Secondly, they hypothesized that execution of mobility plans should encourage the possibility of early patients’ movements within the ICU as well as IMCU surroundings. These hypotheses were relevant to the study topic and the aim of the study since the investigators intended to establish the practicability of applying early mobility procedures to escalate movement within the ICU as well as IMCU surroundings. However, the investigators did not provide any clear theoretical framework they relied on to perform the research.
Review of Literature
Drolet et al. (2013) conducted a review of various works of literature that were pertinent to the research topic. They reviewed fairly current studies which were related to the research subject under investigation. Apart from the two studies that were from the 1990s, the majority of these studies was fairly current and was written within the past 9 years from the date of conducting this study (2013). Therefore, they reflected the approaches as at that time within health research and were the prevailing methods during that period. These studies established the background of the study assisting the researchers to formulate a research problem that existed within the health practice that of extended bed rest for the admitted patients resulting in de-conditioning, impair patients’ movements, as well as may lead to a lengthy stay in the health facility. It is this existing problem that inspired their study. The review was succinct and to the point, which provided a quick understanding of the background of the research; however, this did not provide deep comprehension of the topic through other past researchers.
Methods
The researchers applied a quasi-experimental study design in which data was gathered before as well as after the execution of the mobility program within a 16-bed capacity adult ICU as well as a 26-bed capacity adult IMCU in a big community health facility (Drolet et al., 2013 p. 199). This study design was appropriate since the researchers aimed at investigating whether early mobility procedures escalates movement within the ICU as well as IMCU surroundings which must involve a comparison before and after the execution of the mobility plan. The study design which the researchers used fell in the controlled clinical study level of the pyramid of evidence. It is because the study involved a comparison of patients’ movement results before and after the implementation of the mobility program.
The researchers have observed ethical standards in dealing with the study subjects. They have not mentioned their nurses or patients’ names or information that could make them identified. They have also not referred to the name of the health facility where the study took place which is a further measure at protecting the human study population concerning their privacy. The researcher sought for approval for their study from the hospital’s administration. The consent for their research was consented to by the health facility’s Medical Executive Committee in 2010.
For data gathering, a team created as well as executed a mobility program having an entrenched algorithm that directed the nursing evaluation of patients’ movement possibility. From that assessment, the program procedure allowed the participating nurses to see physical therapists if proper. Every day ambulation situation reports were evaluated every morning to establish every patient’s movement level. The data were collected by the participating nurses who recorded each patient movement responses before and after the implementation of the mobility program. This approach to data collection was suitable for the study since it was these participating nurses who were involved in assisting the patients in movements and were in the better position to record their progress.
The authors relied on the patients admitted to the ICU and IMCU in a single hospital. Two groups were chosen for this research. First, the IMCU group which consisted of a 26-bed capacity having a mean every day count of 21 patients as well as a nurse-to-patient fraction of 1:4. The population incorporated patients suffering from intricate health conditions. The second group consisted of adult ICU with a 16-bed capacity created to offer rigorous health care services to patients suffering from severe and recurring health conditions. Its daily mean count was 11 patients with a nurse-to-patient fraction of 1:2. The sampling method was systematic since the researchers used the patients as well as nurses within the two units (ICU and IMCU). The information was gathered for 193 and 349 for ICU and IMCU patients respectively within the 3-months pre-implementation duration. The data for the post-implementation duration was gathered for 426 and 358 ICU and IMCU patients respectively throughout the 6-months execution duration (Drolet et al., 2013 p. 199). The sampling method and the population size were appropriate and enough since it helped the investigators to gather enough information for analysis. There were no attrition and validity issues discussed in the study report.
Results
The investigators were very succinct in their presentation of the study results. They utilized retrospective as well as prospective diagram assessments to appraise the efficiency of the mobility procedures for the patients under the study. The diagram was brief and clear showing the outcome in ICU and IMCU both before and after the execution of the mobility program. The demographics of the patients included male and female patients admitted to the ICU and IMCU of a similar hospital. They suffered various intricate health conditions and underwent the ambulation program. The results were compared before and after the execution of the mobility program to the same patient population. The results obtained were analyzed as follows; the data was represented as standard deviation. Contrasts between pre and post-implementation figures were conducted through an unpaired, 2-tailed t-test and analyses done through Ms. Excel 2007 software. These analyses approaches were suitable since they allowed the researchers to perform a profound evaluation of the gathered information.
Discussion
From the results presented by the researchers, they conducted a clear and an informative discussion. The discussion was on the comparison between the pre and post-implementation mobility program whether the execution of the mobility program could have led to the improved ambulation within the ICU and IMCU. They concluded that the mobility program increased patients’ movements. This conclusion was founded on their study results that indicated that after the program’s execution, 20% of ICU and 71% of the IMCU patients ambulated from 6% and 15% respectively (Drolet et al., 2013 p. 201). This research had a single limitation in that it was done within one health facility. They suggest that this form of study should be replicated in other health facilities around the state since these facilities also have same research participants as was used in this study. This suggestion, according to these researchers, would increase the research’s strength. They generalized the outcome through stating that other hospitals have similar participants and facilities, therefore, they could implement the program to increase the ambulation for ICU and IMCU patients. It contributed to the nursing knowledge by providing evidence-based outcomes that early ambulation program can help in increasing ambulation for the ICU and IMCU patients thereby decreasing patients’ movement impairments and lessens their stay in the hospital. It is appropriate and could assist in answering the PICO question since it presents a problem (impaired patients’ movements and hospitals overstay), intervention (early ambulation program), comparison (it compares the results before and after the implementation of the mobility program) and outcome (it presents that results of the intervention, increased patients’ movements).
References
Drolet, A., DeJuilio, P., Harkless, S., Henricks, S., Kamin, E., Leddy, E. A., Lloyd, J. M., Waters, C. & Williams, S. (2013). Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings. Physical Therapy, 93(2), 197-207.