Informed patient: Changing the Sedation Status Quo in the ICU

This article spoke about the changes being done to decrease the length of time patients are sedated and immobilized on a ventilator. The article had mentioned that the longer a patient is immobilized and sedated the more likely they will experience delirium which can cause them to suffer from long-term effects of decreased cognitive function. Being immobilized, and heavily drugged with sedatives and paralytics could leave a person depressed, stressed, and suffer with extreme physical limitations. They had given an example of a patient that had received paralytics (however it was not mentioned how long he was on this drug) that had survived and was in a wheelchair because it had taken him 2 years to learn how to walk again. How devastating that could be for people. Knowing that you were capable of walking by yourself, then you wake up days, weeks, or even months later not knowing how to walk because of drugs given to you as well being immobilized the whole time you were hospitalized.  The article spoke about adopting strategies to wean patients off of their sedatives and paralytics and never putting them back on it once they are weaned off. I agree with this idea but wonder how they would deal with unstable patients with extreme conditions. How would they know when to start weaning them off (does their condition warrant otherwise?) Getting them up out of bed is a great idea even if it is just four steps to the chair. As long as they are not just lying in bed the other time they are there and being turned every 2 hours. I also think they should be provided ROM exercise a long with compression stockings on a consistent schedule . Just to get the blood following especially with them being immobilized they are at risk for DVTs so I’m sure lovenox will be administered as well.  What worries me is the veteran nurse who are hesitant to adapt the new changes because they are used to the old ways. How will hospitals deal with these nurses ? I think they need to continue teaching the new grad and other nurses who are on board to adapting the new changes and continue to persuade/convince/teach the older nurses that the change is for a better patient outcome in the long run. They are the ones that will have to live with the life-long effects of depression, constant stress and worry, and decreased cognitive functioning.