1. Pattillo, Marilyn PhD, RN, GNP-BC, CNS-BC, FAAN

Article Content

In one of their health columns this year, The Wall Street Journal published "Changing Intensive Care to Improve Life Afterward" (February 15, 2011). This article featured ways hospitals are changing to care for their sickest patients using the "ABCDEs of Prevention and Safety" ( Written for public reading, this article should hearten nurses everywhere for many reasons.


1. It promotes the role of nurse assessment and skill in the foundational care of patients in intensive care (for example, breathing is good and moving is good) to promote long-term cognitive and functional outcomes.


2. Traditional nursing practice (astute observation, early intervention, advocacy, vigilant monitoring, interdisciplinary team work, and educating family and caregiver) sometimes trumps sophisticated technology.


3. It reveals to the public that nursing care is very important in the attentive care of the sickest patients but it requires competence, compassion, and keeping up with the literature.



Developed by the ICU (intensive care unit) Delirium and Cognitive Impairment Study Group from Vanderbilt University (, ABCDE is an evidence-based standard bundle of ICU measures that include spontaneous Awakening and Breathing Coordination, attention to the Choice of sedative, Delirium monitoring, and Early mobility and exercise.


Three authors addressed 3 of the 5 interventions within the ABCDE bundle, and their assessment of the validity of these interventions resulted in 3 papers that follow: Awakening, Choice of sedative, and Early mobility. Their collective conclusion is that implementing the intervention bundle ABCDEs in the ICU can substantially improve short- and long-term patient care outcomes. Daily sedation interruption can decrease the duration of necessary mechanical ventilation and provide safe measures for implementing early mobility. The awareness of the choice of sedation medication can influence the risk of complications and long-term effects of the patient by influencing the risk of hospital delirium and other cognitive concerns. Closely related to the choice of sedation, daily sedation interruption, and intensive care delirium is early mobility. Early mobility is safe and feasible and has a lasting effect for the patient after discharge. Coupling the individual interventions into a bundle of practice has a synergistic effect, and it stresses the significance of more research and practice in the ICU to bring about change.


Marilyn Pattillo, PhD, RN, GNP-BC, CNS-BC, FAAN


Department of Clinical Nursing


The University of Texas at Austin


School of Nursing