Date of Award


Document Type



College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Benjamin J Miller


Diane Fuller Switzer


Background: Prone positioning has traditionally been implemented in the ICU as a last resort measure to treat ventilator-induced lung injury (VILI) and acute respiratory distress syndrome (ARDS). With the COVID-19 pandemic, awake prone positioning (APP) in non-intubated patients emerged as an intervention on general medical wards to prevent respiratory decompensation and transfer to the ICU as these patients frequently developed acute hypoxemic respiratory failure (AHRF) and ARDS. Methods: A critical analysis of a local community APP protocol was performed with updated recommendations from a comprehensive review of literature and feedback from stakeholders. Results: Early initiation and longer duration of APP is associated with improved patient outcomes, with periods of 30 minutes to 2 hours having immediate improvement on oxygenation and periods of >8 hours reducing intubation and mortality rates. Few adverse side effects have been identified. Barriers to implementation include adequate equipment and staffing resources, consideration of relative and absolute contraindications, and awareness of APP as an existent, nurse-initiated protocol. Conclusion: APP is a non-invasive, feasible, nurse-driven intervention that may be applied in both ICU and non-ICU settings to decrease the risk of respiratory decompensation. APP may be considered outside of the context of the COVID-19 pandemic in cases of future respiratory illnesses in which physiological effects of APP may have similar outcomes.