NURS 8750 Week 7 Podium Presentation Script Example

Sitting Up on a Ventilator Without a Therapist in the Room: A Nurse-Led Routine in a Community ICU (Twelve-Minute Podium Script)

Student Name

College of Nursing, Walden University

NURS 8750: Doctoral Seminar V

Instructor Name

Month Day, Year

Slide 1: Opening (0:00 to 0:30)

Title slide: project name, presenting student, Walden University College of Nursing

Speaker notes: Good morning. I want to talk about something simple that turned out to be hard: getting patients on ventilators upright with their feet over the side, in an ICU where there is usually no physical therapist in the building.

Slide 2: The Problem (0:30 to 1:45)

Fewer than 1 in 5 ventilator days with sitting up

31 of 40 patients never sat up while ventilated

One physical therapist for 160 beds, weekdays only

Speaker notes: Our unit has fourteen beds. When we looked back at four months of records, ventilated patients sat up with their legs over the side on fewer than one day in five. Thirty-one of forty never did it at all while on the ventilator. That was not because nurses did not believe in it. It was because nobody owned the decision each morning, and the one physical therapist we share with the whole hospital usually reached us late, if at all.

Slide 3: What the Evidence Lets Us Promise (1:45 to 2:45)

Safe within agreed criteria

Benefit clearest where baseline activity is low

No promise of shorter stays

Speaker notes: Two things from the literature shaped what we promised. First, there are published consensus criteria for when it is safe to mobilize a ventilated adult, and we used them word for word (Hodgson et al., 2014). Second, the largest trial found that pushing activity harder in units that already do a lot does not improve survival or time at home (TEAM Study Investigators, 2022). So we did not promise shorter stays. We promised to make sitting up a normal part of the day.

Slide 4: The Routine (2:45 to 4:30)

0400 night screen, written on the whiteboard

0900 round: results read aloud; overrides spoken

After 0900: nurse and respiratory therapist

1800: highest level charted

Speaker notes: Here is the whole routine in four times of day. At four in the morning the night nurse goes down the safety list and puts the answer on the whiteboard, with a reason whenever it is a no. At nine, during rounds, the charge nurse calls out each result, and a physician who overrules a pass has to say why, out loud. After the round the day nurse pages respiratory therapy and the two of them sit the patient up. At six in the evening the nurse charts the highest level of the day. [Pause.] Notice that nothing here needs a physical therapist.

Slide 5: How We Measured (4:30 to 5:30)

Share of qualifying ventilator days at level 3

Four-week baseline, then weekly

Run chart rules decided in advance

Speaker notes: We counted days, not patients. A day counted once the patient had a full day on the ventilator behind them at midnight, and it was a success if they scored 3 or more on the ICU Mobility Scale, which means sitting up with legs over the side. We recorded four weeks of baseline with no other change, then plotted every week on a run chart and decided before we had any data which rules we would use to call a change real (Perla et al., 2011).

Slide 6: What Happened (5:30 to 7:00)

Run chart: 22% baseline median; every protocol week above it

Weekdays: 23% to 48%

Weekends: 19% to 21%

Speaker notes: This is the chart. The dashed line is our baseline median, twenty-two percent. Every week after we started sits above it, and by March we were sitting patients up on close to half of all ventilator days. [Point to the right side.] But that average hides something. On weekdays we went from twenty-three to forty-eight percent. On weekends, nineteen to twenty-one. Essentially no change.

Slide 7: Safety (7:00 to 8:00)

81 sessions; 6 stopped by the rules

All recovered within 15 minutes

No falls, no tubes or lines out

Speaker notes: Eighty-one sessions. Six were stopped because a number crossed a threshold: three for oxygen, two for blood pressure and one for agitation. All six recovered within fifteen minutes. Nobody fell, and no tube or line came out. Our stop rate is higher than published reviews report (Nydahl et al., 2017), and I think that is because we stopped and wrote a form for every threshold crossing, however brief.

Slide 8: What We Are Not Sure About (8:00 to 9:00)

Lighter sedation orders began the same week

A separate weekend design is still to come

Seven emergency calls: too few to judge

Speaker notes: Now the part every audience deserves to hear. The hospital brought in lighter sedation orders the day before we started. Some of this rise may be sedation. We cannot separate them. And respiratory therapists answered emergency ventilator calls a couple of minutes slower this year, but on seven calls that tells us to keep watching, not that there is a cost.

Slide 9: What Comes Next (9:00 to 10:00)

Routine written into templates and roles

Weekend test: earlier respiratory therapy start

Pair first sessions with the physical therapist

Speaker notes: The routine now lives inside the four o'clock assessment form and in what the night charge nurse is hired to do, so it does not depend on me. We are testing a weekend version where respiratory therapy starts thirty minutes earlier. And because five of our six stops happened in a patient's first session, first sessions on weekdays now go with the physical therapist when one is free. Thank you.

Slide 10: Likely Questions (10:00 to 12:00)

Held on screen during questions

Speaker notes: Prepared answers. If asked whether the result is statistically significant: we used run chart rules suited to a single unit and a time series; eight weeks in a row above a frozen median would be very unlikely by chance, and I would rather show you the chart than a p value from a design that was not built for one. If asked who does the screen when the night nurse is admitting a patient: the charge nurse, who has no assignment; that is written into the role. If asked whether physicians resisted: some overrides happened early; saying them aloud at the round made them rarer and gave the nurse a reason to recheck later. If asked whether this would work in a bigger unit: I do not know; our unit has a charge nurse without patients and a late-morning lull, and a unit without those would need to find its own window. If asked about cost: no new staff and no new equipment beyond whiteboard markers and gait belts in every room.

References

Hodgson, C. L., Stiller, K., Needham, D. M., Tipping, C. J., Harrold, M., Baldwin, C. E., Bradley, S., Berney, S., Caruana, L. R., Elliott, D., Green, M., Haines, K., Higgins, A. M., Kaukonen, K.-M., Leditschke, I. A., Nickels, M. R., Paratz, J., Patman, S., Skinner, E. H., . . . Webb, S. A. (2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 18(6), Article 658. https://doi.org/10.1186/s13054-014-0658-y

Nydahl, P., Sricharoenchai, T., Chandra, S., Kundt, F. S., Huang, M., Fischill, M., & Needham, D. M. (2017). Safety of patient mobilization and rehabilitation in the intensive care unit: Systematic review with meta-analysis. Annals of the American Thoracic Society, 14(5), 766-777. https://doi.org/10.1513/AnnalsATS.201611-843SR

Perla, R. J., Provost, L. P., & Murray, S. K. (2011). The run chart: A simple analytical tool for learning from variation in healthcare processes. BMJ Quality & Safety, 20(1), 46-51. https://doi.org/10.1136/bmjqs.2009.037895

TEAM Study Investigators and the ANZICS Clinical Trials Group. (2022). Early active mobilization during mechanical ventilation in the ICU. New England Journal of Medicine, 387(19), 1747-1758. https://doi.org/10.1056/NEJMoa2209083