Early mobilisation of intensive care unit patient: the challenges of morbid obesity and multiorgan failure.

A 44-year-old morbidly obese (body mass index 69 kg/m(2)) woman presented to our medical intensive care unit (ICU) with septic shock and multiorgan failure requiring mechanical ventilation, a vasopressor infusion, and haemodialysis. Before this admission, the patient reported being able to ambulate approximately 3 m with a walker. Intensive physical therapy was started on ICU day 2, and the patient was successfully mobilised throughout her ICU stay despite the extreme challenges posed by her morbid obesity and critical illness. After only a 9 day stay, the patient was discharged directly home from the medical ICU, walking a total distance of 37 m in a single physical therapy session.

Tool kit for the staff mentor: strategies for improving retention.

Retention of new graduates in nursing continues to be a significant workplace issue, particularly in light of the heightening nursing shortage. Experienced nurses are in a pivotal position to positively impact retention, and, because of this, they can be called "keystoners". Mentoring, an important role of the keystoner, requires specific skills and knowledge and can be learned. A tool kit designed to develop the mentoring skills of keystoners is described. The result of successful mentoring among keystoners can be multifaceted; workplace satisfaction and higher retention of new graduates are targeted outcomes.