DESIMINASI

REFLEKTIF JURNAL

Oleh :
Kelompok IV

1. Apriana Hijriatun Hasanah 6. Nurrahmawati

2. Baiq Rista Ananta Pratiwi 7. Rahmatullah Azmi
3. Gina Sonia 8. Septiara Auziah
4. Irma Zulhafni Triantari 9. Suyati
5. Nurhasanah F.  
 DIFFERENT/DOUBT

Can progressive mobilization have an effect on oxygen saturation

in critically ill patients undergoing bed rest due to the patient's
illness in the ICU?
 DESCRIPTION

During practice in the ICU room of the NTB Provincial Hospital which is
currently ongoing, we observe every action taken in that room. Mr. "R" who is
82 years old is a patient in the ICU room of the NTB Provincial Hospital with
NPH (Normo Pressure Hydrocephalus) Post Op VP SHUNT has been treated
for more than 1 month, the patient has been doing bed rest and using a
breathing aid, namely a ventilator, this is because the patient's condition is not
stable so that they still depend on the ventilator to support the patient's status.
 DISSECTION

In monitoring Oxygen Saturation levels in patients Mr. “R” in the ICU (Intensive Care Unit) it
was found that the patient underwent bed rest due to the patient's illness. Stabilization of
hemodynamic conditions, installation of various monitoring tools and life support,
postoperative patients and decreased status of consciousness both physiological and
sedation programs are challenges for nurses to mobilize critical patients.

The complexity of the therapy program and monitoring of critically ill patients requires
nurses to be able to continue to focus on stabilizing the condition of respiration,
circulation and other physiological statuses to maintain the patient's life. This causes
mobilization is sometimes missed by nurses. Bed rest for critical patients for too long
will cause various problems, namely increasing morbidity, mortality, prolonging
treatment time, and increasing treatment costs. Therefore it is important to do an
intervention for nurses to minimize this problem, namely by mobilization, especially
progressive mobilization.
 DISCOVER

NPH (Normo Pressure Hydrocephalus) is a type of hydrocephalus that is often

experienced by elderly people (> 60 years). If there is a disturbance in the flow and
absorption of cerebrospinal fluid, this fluid will collect in the cerebrospinal fluid
(ventricle) and cause this sac to swell and compress the surrounding brain, resulting in
impaired brain function. This condition is known as hydrocephalus. The treatment for
NPH is surgical insertion of a tube to drain the cerebrospinal fluid that is blocked in the
cerebrospinal fluid bag into the abdominal cavity. This operation is called a
cerebrospinal fluid shunt operation from the cerebrospinal fluid/ventricle into the
peritoneal cavity in the abdomen, so it is called a Ventriculo Peritoneal Shunt (VP
shunt).
One of the interventions that can be performed on Mr. “R” is Progressive Mobilization
Level 1. Progressive Mobilization is a series of movements performed for critical
patients in the Intensive Care Unit which are planned sequentially based on the status
or condition of the patient which aims to reduce the risk of pressure sores, reduce the
length of ventilator use, reduce the incidence of ventilated acute pneumonia (VAP),
reduce sedation time, increase patient's ability to move, improve organ function,
improve functional status and reduce length of stay and discharge with low risk.
One of the interventions that can be performed on Mr. “R” is Progressive Mobilization
Level 1. Progressive Mobilization is a series of movements performed for critical
patients in the Intensive Care Unit which are planned sequentially based on the status
or condition of the patient which aims to reduce the risk of pressure sores, reduce the
length of ventilator use, reduce the incidence of ventilated acute pneumonia (VAP),
reduce sedation time, increase patient's ability to move, improve organ function,
improve functional status and reduce length of stay and discharge with low risk.
The American Association of Critical Care Nurses (AACN) introduced a
progressive mobilization intervention. Progressive mobilization is a
series of movements performed on critically ill patients in the Intensive
Care Unit which are planned sequentially based on the status or
condition of the patient.

Progressive Mobilization Stages Progressive mobilization has five

stages/levels, namely:

 Level 1 begins with assessing the patient's medical history for

whether there are cardiovascular and respiratory disorders. First,
start by elevating the patient's position >30º then give passive Range
of Motion. Progressive mobilization is followed by continuous lateral
rotation therapy (CLRT). The form of exercise is to give right and left
tilted positions according to the patient's ability.
 Level 2 starts with Range of Motion, starts to plan to activate
Range of Motion, then starts leaving the patient's sleeping
position up to 45º - 65º and continues by training the patient to
sit
 Level 3, trains the patient's muscle strength to tolerate gravity.
Mobilization activities at this level begin with practicing sitting on
the edge of the bed and then placing your feet hanging
(tolerating gravity).
 Level 4, in this mobilization activity, the mobilization activity
begins with sitting completely, such as sitting in a chair, then
continues by sitting on the edge of the bed independently and
finally moving from sitting or bed to a special chair. Patients at
this level are fully aware and in a calm condition

 Level 5, to increase the patient's ability to move and move.

Patients at this level are cooperative, fully aware. Mobilization
activities at this level involve sitting in a special chair and then
standing up and changing places.
Level 1 Progressive Mobilization has been shown to be effective in
improving patient status, one of which is blood pressure, oxygen
saturation, and hemodynamic status of critically ill patients who
have decreased consciousness..
This is in line with the research conducted by Mugi Hartoyo, Shobirun, Budiyati, and
Rizqi Rachmilia (2017) where the results of the research are that there is an effect
of level 1 progressive mobilization on blood pressure in critical patients with
decreased consciousness. Blood pressure between before and after level 1
progressive mobilization was increased. Oxygen saturation before and after level 1
progressive mobilization also increased.

A similar study was conducted by Suyanti, Miranti Florencia Iswari, and Marwan
Riki Ginanjar (2019) with results stating that there is an effect of level 1 progressive
mobilization on systolic blood pressure, diastolic blood pressure and oxygen
saturation.

This is also supported by research conducted by Wahyu Rima Agustin, Gatot

Suparmanto, and Wahyuningsih Safitri who found that progressive mobilization 1
had an effect on increasing hemodynamic status, which was marked by an increase
in Heart Rate (HR), Respiratory Rate (RR), saturation oxygen (SaO2), systolic and
diastolic pressure, and Mean Arterial Pressure (MAP) in critically ill patients in the
ICU.
 DECISION

1. Students can provide nursing care to critical patients in the ICU

2. Provide KIE regarding actions that can be taken by the patient's family in
helping patient care so as to support the needs related to patient recovery
3. For Health Services The results of the journal's reflective dissemination with
regard to progressive mobilization are input for nurses, especially to ICU
(Intensive Care Unit) nurses, so that through these studies nurses can know
and can provide evidence-based nursing care, one of which is progressive
mobilization to critically ill patients. with decreased awareness to minimize
the risk to patients, especially in patients who experience total bedrest.
DAFTAR PUSTAKA

● Mugi Hartoyo, Shobirun, Budiyati, Rizqi Rachmilia. 2017. Pengaruh

Mobilisasi Progresif Level I Terhadap Tekanan Darah Dan Saturasi Oksigen
Pasien Kritis Dengan Penurunan Kesadaran
● Suyanti, Miranti Florencia Iswari, Marwan Riki Ginanjar. 2019. Pengaruh
Mobilisasi Progresif Level 1 Terhadap Tekanan Darah Dan Saturasi Oksigen
Pasien Dengan Penurunan Kesadaran
● Wahyu Rima Agustin, Gatot Suparmanto, Wahyuningsih Safitri. 2020.
Pengaruh Mobilisasi Progresif Terhadap Status Hemodinamik Pada Pasien
Kritis Di Intensive Care Unit
● Zakiyyah, Syifa. 2014. Pengaruh mobilisasi progresif level 1 terhadap
resiko decubitus dan perubahan saturasi oksigen pada pasien kritis
terpasang ventilator di ruang ICU RSUD Dr. Moewardi Surakata
 
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