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Zhang X, Wang X. Comment on 'Effectiveness of non-instrumental early mobilization to reduce the incidence of deep vein thrombosis in hospitalized patients'. Int J Nurs Stud 2025; 161:104954. [PMID: 39541640 DOI: 10.1016/j.ijnurstu.2024.104954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Revised: 10/31/2024] [Accepted: 11/05/2024] [Indexed: 11/16/2024]
Affiliation(s)
- Xuerong Zhang
- Department of Orthopedics, Zhongshan Xiaolan People's Hospital (The Fifth People's Hospital of Zhongshan), Zhongshan, Guangdong, China
| | - Xiaoping Wang
- Department of Orthopedics, Zhongshan Xiaolan People's Hospital (The Fifth People's Hospital of Zhongshan), Zhongshan, Guangdong, China.
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Wang J, Shi C, Xiao Q, Jia Y. ICU nurses' practice and intention to implement early mobilization: A multi-centre cross-sectional survey. Nurs Crit Care 2024; 29:1067-1077. [PMID: 39207037 DOI: 10.1111/nicc.13100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Early mobilization (EM) is acknowledged for its safety and benefits in the recovery of critically ill patients, yet its implementation in intensive care units (ICU) remains inconsistently aligned with established guidelines. This discrepancy highlights a gap between theoretical endorsement and practical application. While barriers to EM have been extensively studied, the intentions and perceived practices of ICU nurses towards EM, especially in certain geographical regions, have not been adequately understood. AIM The objective of this study is to assess the perceptions, actual practices and intentions of ICU nurses regarding the implementation of EM for patients in the ICU setting. STUDY DESIGN A cross-sectional, multi-centre, survey-based study. RESULTS The study collected data through an electronic questionnaire from 227 ICU nurses across eight hospitals in Beijing, China, concerning their experiences, practices and intentions related to EM. The survey response rate was 50% (114 of 227), indicating a moderate level of engagement by the target population. Among the surveyed participants, 68.7% (n = 156) reported having experience with EM for critically ill patients. Of these experienced nurses, 49.3% (n = 77) indicated they carried out EM less frequently than once per week, while only 29.5% (n = 46) reported dedicating more than 20 min to EM activities per patient. Only 24.2% (n = 55) of participants confirmed the presence of specific EM guidelines in their workplace. Notably, guideline adherence could be influenced by the patient's condition severity, which may affect how these protocols are applied. Notably, the approach and frequency of EM practices showed significant variation across different ICUs. A substantial majority (75%, n = 170) of participants expressed a strong intention towards implementing EM, correlating significantly with factors such as having a higher education level (bachelor's degree or higher), receiving departmental support, encountering fewer perceived barriers, and belonging to specific departments like respiratory (SICU) and surgery (RICU). The EM guidelines mentioned by participants were primarily focused on specific protocols and guidance, highlighting the emphasis on structured approaches to EM in their clinical settings. CONCLUSIONS Despite the recognized experience with EM among ICU nurses, there is a notable divergence between their practices and the recommendations outlined in EM guidelines. This study underscores the need for the establishment of clear, actionable guidelines, alongside the provision of targeted educational programmes and robust support systems, to foster the consistent and effective implementation of EM in ICU settings. RELEVANCE TO CLINICAL PRACTICE This study underscores the clinical relevance of EM in ICU settings, advocating for the development of precise EM guidelines to improve patient outcomes.
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Affiliation(s)
- Jiani Wang
- Fuwai Hospital, CAMS & PUMC, Beijing, China
| | - Chenxi Shi
- Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China
| | - Yanrui Jia
- Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, China
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Sui W, Gong X, Zhuang Y. Impact of knowledge, attitudes and self-reported practices of nurses on early mobilization of mechanically ventilated patients in the ICU. Nurs Crit Care 2024; 29:573-583. [PMID: 38410092 DOI: 10.1111/nicc.13041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Many ICUs worldwide are striving to integrate early mobilization as part of critical care rehabilitation. However, ICU nurses, who are essential contributors to the early mobilization of critically ill patients, still lack comprehensive surveys assessing their knowledge, beliefs, and practices regarding the early mobilization of mechanically ventilated patients. AIM To analyse the knowledge, attitudes, and practices of intensive care unit (ICU) nurses regarding the early mobilization of mechanically ventilated patients and to explore the effects of these practices. STUDY DESIGN A multicentre cross-sectional study. ICU nurses in five tertiary hospitals in Zhejiang Province, China, were selected by convenience sampling and invited to complete an online questionnaire between 1 June 2021 and 15 June 2021. Sociodemographic data and the knowledge, attitudes, and practices of ICU nurses regarding early mobilization. RESULTS A total of 296 valid questionnaires were collected, for a response rate of approximately 77.5%. The average scores for knowledge, attitudes, and practices of ICU nurses regarding the early mobilization of mechanically ventilated patients were 42.7 ± 7.4, 34.3 ± 6.5, and 47.1 ± 6.5, respectively, which were good scores. Quantile regressions showed that at the 25% and 50% quartiles, increases in knowledge and attitude scores resulted in increases in practice scores (p < .001); however, at the 75% quartile, increases in knowledge scores did not result in practice score increases (t = 0.000, p = .999); moreover, there was still a 0.5-point increase in practice scores per 1-point increase in attitude scores (t = 0.500, p < .001). CONCLUSIONS The knowledge, attitudes, and self-reported practices of ICU nurses were good, although there is room for improvement. Considering that the influence of attitudes on practice improvement is more important than knowledge, ICU managers should promote knowledge transformation, strengthen attitudes, and adopt comprehensive measures to promote the early mobilization of mechanically ventilated patients in the ICU. RELEVANCE TO CLINICAL PRACTICE To optimize the early mobilization of mechanically ventilated patients in the ICU, introducing multipronged support strategies based on the knowledge and attitudes of ICU nurses is recommended to promote the implementation of such practices.
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Affiliation(s)
- Weijing Sui
- Nursing Department, Sir Run Run Shaw Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Xiaoyan Gong
- Nursing Department, Sir Run Run Shaw Hospital School of Medicine Zhejiang University, Hangzhou, China
| | - Yiyu Zhuang
- Nursing Department, Sir Run Run Shaw Hospital School of Medicine Zhejiang University, Hangzhou, China
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Knutsen K, Solbakken R, Gallagher S, Müller RT, Normann B. Patients' experiences with early rehabilitation in intensive care units: A qualitative study about aspects that influence their participation. J Adv Nurs 2024; 80:1984-1996. [PMID: 37962126 DOI: 10.1111/jan.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023]
Abstract
AIM To explore patients' experiences with early rehabilitation in the intensive care unit and what they perceive to influence their participation. DESIGN A qualitative design anchored in phenomenological and hermeneutical traditions utilizing in-depth interviews. METHODS Thirteen patients were interviewed from 5 to 29 weeks following discharge from three units, in January-December 2022. Analysed using systematic text condensation and the pattern theory of self. Reporting adhered to consolidated criteria for reporting qualitative research. RESULTS Interviews described four main categories: (1) A foreign body, how the participants experienced their dysfunctional and different looking bodies. (2) From crisis to reorientation, the transformation the participants experienced from a state of crisis to acceptance and the ability to look forwards, indicating how bodily dysfunctions are interlinked to breakdowns of the patients' selves and the reorganization process. (3) Diverse expectations regarding activity: ambiguous expectations communicated by the nurses. (4) Nurse-patient: a powerful interaction, highlighting the essential significance of positive expectations and tailored bodily and verbal interaction for rebuilding the patient's outwards orientation. CONCLUSION Outwards orientation and reorganization of the self through a reduction in bodily dysfunctions, strengthening the patients' acceptance of the situation, providing tailored expectations and hands-on and verbal interaction appear to be fundamental aspects of patient participation in early rehabilitation. IMPLICATIONS Insights into patients' perceptions show how dysfunctional bodies cloud individuals' perceptual fields, causing inwards orientation and negative thoughts concerning themselves, their capabilities, environment and future. This knowledge can improve nurses' ability to tailor care to promote optimal recovery for patients. PATIENT OR PUBLIC CONTRIBUTION User representative contributed to the design of the study.
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Affiliation(s)
- Karina Knutsen
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
| | - Rita Solbakken
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
| | - Shaun Gallagher
- Department of Philosophy, University of Memphis, Memphis, Tennessee, USA
- Faculties of Law, School of Liberal Arts, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Britt Normann
- Faculty of Nursing and Health Science, Nord University, Bodø, Norway
- Department of Physiotherapy, Nordland Hospital, Bodø, Norway
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Wells CL, Resnick B, McPherson R, Frampton K. Implementation of the UMove Mobility Program to Promote Safe Patient Mobility and Reduce Falls in the Hospital Setting. Res Gerontol Nurs 2024; 17:19-29. [PMID: 37878599 DOI: 10.3928/19404921-20231013-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
The purpose of the current quality improvement (QI) project was to implement the UMove Early Mobility Program to engage patients in safe out of bed (OOB) activities and reduce falls, specifically focusing on toileting-related falls, during the hospital stay. Eight nursing units implemented the UMove program, including the UMove Mobility Screen (UMove MS), to select strategies to reduce toileting-related falls while increasing mobility. De-identified, unit-based data were collected from hospital reports. Nursing had a 95% documentation compliance rate for the UMove MS, and OOB activities and ambulation were documented at 50% and 57%, respectively. There was no statistical difference found in reducing toileting-related falls or sustaining increased OOB activities across the 15-month QI project. Toileting-related falls approached significance with a rate reduction from 1.77 pre-implementation to 0.23 at 6 months and no toileting-related falls at 12 months. Despite no significant findings, there is evidence that clinical changes occurred with nurses assessing and promoting mobility, while implementing strategies to reduce toileting-related falls. [Research in Gerontological Nursing, 17(1), 19-29.].
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Tirona K. Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation. Crit Care Nurse 2023; 43:75-79. [PMID: 36720273 DOI: 10.4037/ccn2023754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kelsey Tirona
- Kelsey Tirona is a clinician III registered nurse in the heart and vascular intensive care unit at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania
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Mukpradab S, Mitchell M, Marshall AP. An Interprofessional Team Approach to Early Mobilisation of Critically Ill Adults: An Integrative Review. Int J Nurs Stud 2022; 129:104210. [DOI: 10.1016/j.ijnurstu.2022.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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Cuthbertson BH, Goddard SL, Lorencatto F, Koo E, Rose L, Fan E, Kho ME, Needham DM, Rubenfeld GD, Francis JJ. Barriers and Facilitators to Early Rehabilitation in the ICU: A Theory Driven Delphi Study. Crit Care Med 2021; 48:e1171-e1178. [PMID: 33003076 DOI: 10.1097/ccm.0000000000004580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES There is conflicting evidence for the effectiveness of early rehabilitation in the intensive care and marked variation in rates of implementation in practice. We aimed to identify barriers and facilitators to early rehabilitation in mechanically ventilated patients and their relevance to practice, as perceived by key ICU clinicians across North America. DESIGN A Delphi study using the Theoretical Domains Framework, consisting of an initial qualitative round and subsequent quantitative rounds, was conducted to gather clinician agreement and perceived importance of barriers and facilitators to early rehabilitation. The survey included questions on the range of individual, sociocultural, and broader organizational influence on behaviors. SETTING Clinical practice in North America. SUBJECTS Four clinician groups (intensive care physicians, nurses, therapists, and respiratory therapists). INTERVENTIONS A three-round Delphi study. MEASUREMENTS AND MAIN RESULTS Fifty of 74 (67%) of invited clinicians completed the study. Agreement and consensus with Delphi survey items were high in both rounds within and between professional groups. Agreement was highest for items related to the domain "Beliefs about Consequences" (e.g., mortality reduction) and lowest for items related to the domain "Behavioral Regulation" (e.g., team discussion of barriers). Beliefs expressed about improved mortality and improvements in a variety of other long-term outcomes were not consistent with the current evidence base. Individual agreement scores changed very little from Round 2 to Round 3 of the Delphi, suggesting stability of beliefs and existing consensus. CONCLUSIONS This study identified a wide range of beliefs about early rehabilitation that may influence provider behavior and the success and appropriateness of further implementation. The apparent inconsistency between the optimism of stakeholders regarding mortality reductions and a low level of implementation reported elsewhere represent the most major challenge to future implementation success. Other foci for future implementation work include planning, barriers, feedback, and education of staff.
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Affiliation(s)
- Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Anesthesia, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Behaviour Change, University College London, London, United Kingdom.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.,Provincial Centre for Weaning Excellence, Toronto East General Hospital, Toronto, ON, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.,Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.,School of Health Sciences, City University of London, London, United Kingdom
| | - Shannon L Goddard
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London, United Kingdom
| | - Ellen Koo
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Louise Rose
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.,Provincial Centre for Weaning Excellence, Toronto East General Hospital, Toronto, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD
| | - Gordon D Rubenfeld
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jill J Francis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,School of Health Sciences, City University of London, London, United Kingdom
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Yong SY, Siop S, Kho WM. A cross-sectional study of early mobility practice in intensive care units in Sarawak Hospitals, Malaysia. Nurs Open 2021; 8:200-209. [PMID: 33318828 PMCID: PMC7729545 DOI: 10.1002/nop2.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/02/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
Aims To determine the prevalence, characteristics of EM activities, the relationship between level of activity and mode of ventilation and adherence rate of EM protocol. Background Mobilizing ICU patients remains a challenge, despite its safety, feasibility and positive short-term outcomes. Design A cross-sectional point prevalence study. Methods All patients who were eligible and admitted to the adult ICUs during March 2018 were recruited. Data were analysed by using the Statistical Package for Social Sciences version 24 for Windows. Results The prevalence of EM practice was 65.6%. The most frequently reported avoidable and unavoidable factors inhibit mobility were deep sedation and vasopressor infusion, respectively. Level II of activity was the most common level of activity performed in ICU patients. The invasive ventilated patient had 12.53 the odds to stay in bed as compared to non-invasive ventilated patient. An average adherence rate of EM protocol was 52.5%.
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Affiliation(s)
- Siew Yieng Yong
- Advanced Diploma in Intensive Care NursingMinistry of Health Malaysia Training InstitutionKuchingMalaysia
| | - Sidiah Siop
- Nursing DepartmentFaculty of Medicine and Health SciencesUniversiti Malaysia Sarawak (UNIMAS)KuchingMalaysia
| | - Wee Meng Kho
- Internal Medicine and DermatologyTimberland Medical CentreKuchingMalaysia
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The use of national collaborative to promote advanced practice registered nurse-led high-value care initiatives. Nurs Outlook 2020; 68:626-636. [PMID: 32739096 DOI: 10.1016/j.outlook.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 04/17/2020] [Accepted: 04/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND High-value healthcare focuses on improving healthcare to produce cost effective care, however limited information on the role of advanced practice registered nurses (APRNs) exists. PURPOSE This descriptive report describes APRN-led initiatives implemented as part of a national collaborative promoting the Choosing Wisely® campaign and high-value care measures. METHOD An APRN national collaborative focuses on developing and implementing high-value care initiatives. Monthly calls, podcasts, and a file sharing platform are used to facilitate the work of the national collaborative. FINDINGS A total of 16 APRN teams from 14 states are participating and have implemented a number of initiatives to reduce unnecessary testing and treatments, promote appropriate antibiotic use, and promote optimal clinical practices such as mobility for hospitalized elderly patients, among others. DISCUSSION A national collaborative has proven to be a successful way to engage APRN teams to focus on targeting high-value care and promoting evidence-based practices in clinical care.
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11
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Crafting age friendly cancer care: A model for improvement utilizing the 4Ms framework across the continuum of an NCI-designated Cancer Center. J Geriatr Oncol 2020; 12:152-156. [PMID: 32546367 DOI: 10.1016/j.jgo.2020.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/03/2020] [Indexed: 11/22/2022]
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Wang J, Xiao Q, Zhang C, Jia Y, Shi C. Intensive care unit nurses' knowledge, attitudes, and perceived barriers regarding early mobilization of patients. Nurs Crit Care 2020; 25:339-345. [PMID: 32285599 DOI: 10.1111/nicc.12507] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/16/2020] [Accepted: 03/16/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Jiani Wang
- School of Nursing Capital Medical University Beijing China
| | - Qian Xiao
- School of Nursing Capital Medical University Beijing China
| | - Chunyan Zhang
- Beijing Chaoyang Hospital affiliated to Capital Medical University Beijing China
| | - Yanrui Jia
- Beijing Chaoyang Hospital affiliated to Capital Medical University Beijing China
| | - Chenxi Shi
- Beijing Chaoyang Hospital affiliated to Capital Medical University Beijing China
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Chung C, McKenna L, Cooper SJ. Patients' experiences of acute deterioration: A scoping review. Int J Nurs Stud 2020; 101:103404. [PMID: 31670222 DOI: 10.1016/j.ijnurstu.2019.103404] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Patient experience is recognised as a means of assessing healthcare delivery with organisations in many countries now gathering patient experience or satisfaction data. It is well documented that the benefits of improving a patients' experience include increased satisfaction, reduced length of stay, improved patient outcomes and reduction of costs. The experience of acute clinical deterioration is unique, extensive and complex as well as being a difficult experience for all involved. However, little is known about this experience from the patient's perspective. AIM To explore what is known about the experiences of acute deterioration from the perspective of the patient. DESIGN A scoping review of international, peer-reviewed research studies and grey literature published between the years of 2000 and 2018. This review was guided by the three-step search strategy recommended by the Joanna Briggs Institute (JBI). DATA SOURCES A range of databases were searched, including CINAHL, Medline, Health Source, Joanna Briggs Institute, PsycINFO, Embase via Ovid, Cochrane library, Ovid Emcare, Scopus as well as grey literature, reference lists and the search engine Google Scholar. REVIEW METHODS Joanna Briggs Institute (JBI) scoping review framework was utilised to identify patients' experiences of acute deterioration. Ten databases were searched, and 249 articles were retrieved. After screening the titles and abstracts, 102 articles were assessed in full text for eligibility, and finally 23 articles were further analysed and synthesised using inductive thematic analysis. RESULTS 19 qualitative studies, three quantitative and one mixed methods study met the inclusion criteria. Seven key themes emerged related to patients' experience of acute deterioration: (1) transformation of perception: memories of factual events; (2) psychological transformation: emotional distress and well-being; (3) physiological transformation: physical distress; (4) facing death; (5) the severity of acute deterioration: from the perspective of the patient; (6) relationship with healthcare professionals and the clinical environment; and (7) the value of relationships: the support of family and friends. CONCLUSIONS Participants had considerable recall of their experiences and hospital admissions. The themes highlight the important issues patients face during their own acute physiological deterioration. This review has highlighted that further research is needed to specifically explore the patients' experience of acute deterioration and the emergency management they receive, for example from a hospital's rapid response team (RRT) or medical emergency team (MET).
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Affiliation(s)
- Catherine Chung
- Nursing and Healthcare Professions, Federation University Australia, Northways Rd., Churchill, Victoria 3842, Australia.
| | - Lisa McKenna
- Nursing and Healthcare Professions, Federation University Australia, Northways Rd., Churchill, Victoria 3842, Australia; School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Simon J Cooper
- Nursing and Healthcare Professions, Federation University Australia, Northways Rd., Churchill, Victoria 3842, Australia
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Nurses' perceived barriers and educational needs for early mobilisation of critical ill patients. Aust Crit Care 2019; 32:451-457. [DOI: 10.1016/j.aucc.2018.11.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/12/2018] [Accepted: 11/18/2018] [Indexed: 11/19/2022] Open
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15
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Ding N, Zhang Z, Zhang C, Yao L, Yang L, Jiang B, Wu Y, Jiang L, Tian J. What is the optimum time for initiation of early mobilization in mechanically ventilated patients? A network meta-analysis. PLoS One 2019; 14:e0223151. [PMID: 31589642 PMCID: PMC6779259 DOI: 10.1371/journal.pone.0223151] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/13/2019] [Indexed: 01/05/2023] Open
Abstract
Early mobilization has been proven to be an effective and safe intervention for preventing complications in mechanically ventilated patients; however, there is currently no unified definition of the optimal mobilization initiation time, hindering widespread clinical implementation. As clinicians are increasingly aware of the benefits of early mobilization, the definition of early mobilization is important. The purpose of this study was to evaluate the effects of different early mobilization initiation times on mechanically ventilated patients and rank these times for practical consideration. The Chinese Biomedical Literature Database, the Chinese Knowledge Infrastructure, Wanfang Data, PubMed, Cochrane Library, Web of Science, and Embase databases, along with grey literature and reference lists, were searched for randomized control trials (RCTs) that evaluated the effects of early mobilization for improving patient outcomes; databases were searched from inception to October 2018. Two authors extracted data independently, using a predesigned Excel form, and assessed the quality of included RCTs according to the Cochrane Handbook (v5.1.0). Data were analyzed using Stata (v13.0) and Review Manager (v5.3.0). A total of 15 RCTs involving 1726 patients and seven mobilization initiation times (which were all compared to usual care) were included in our analysis. Network meta-analysis showed that mechanical ventilation for 48-72 h may be optimal to improve intensive care unit acquired weakness (ICU-AW) and reduce the duration of mechanical ventilation; however, there were no significant differences in length of ICU stay according to mobilization initiation time. The results of this study indicate that initiation of mobilization within 48-72 h of mechanical ventilation may be optimal for improving clinical outcomes for mechanically ventilated patients.
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Affiliation(s)
- Nannan Ding
- School of Nursing, Lanzhou University, Lanzhou, China
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhigang Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Caiyun Zhang
- School of Nursing, Lanzhou University, Lanzhou, China
- Department of Nursing, The First Hospital of Lanzhou University, Lanzhou, China
| | - Li Yao
- School of Nursing, Lanzhou University, Lanzhou, China
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Liping Yang
- School of Nursing, Lanzhou University, Lanzhou, China
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Biantong Jiang
- School of Nursing, Lanzhou University, Lanzhou, China
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yuchen Wu
- School of Nursing, Lanzhou University, Lanzhou, China
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Lingjie Jiang
- School of Nursing, Lanzhou University, Lanzhou, China
- Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
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17
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Hsu SH, Campbell C, Weeks AK, Herklotz M, Kostelecky N, Pastores SM, Halpern NA, Voigt LP. A pilot survey of ventilated cancer patients' perspectives and recollections of early mobility in the intensive care unit. Support Care Cancer 2019; 28:747-753. [PMID: 31144173 PMCID: PMC7223790 DOI: 10.1007/s00520-019-04867-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/09/2019] [Indexed: 11/29/2022]
Abstract
Purpose To determine the level of recall, satisfaction, and perceived benefits of early mobility (EM) among ventilated cancer patients after extubation in the intensive care unit (ICU). Methods A survey of patients’ perceptions and recollections of EM was administered within 72 h of extubation. Data on recall of EM participation, activities achieved, adequacy of staffing and rest periods, strength to participate, activity level of difficulty, satisfaction with staff instructions, breathing management, and overall rating of the experience were analyzed. The Confusion Assessment Method for ICU (CAM-ICU) was used for delirium screening. Results Fifty-four patients comprised the study group. Nearly 90% reported satisfaction with instructions, staffing, rest periods, and breathing management during EM. Participants indicated that EM maintained their strength (67%) and gave them control over their recovery (61%); a minority felt optimistic (37%) and safe (22%). Patients who achieved more sessions and “out-of-bed” exercises had better recall of actual activities compared with those who exercised in bed. Overall, patients with CAM-ICU-positive results (33%) performed less physical and occupational therapy exercises. Conclusions Ventilated cancer patients reported an overall positive EM experience, but factual memory impairment of EM activities was common. These findings highlight the needs and the importance of shaping strategies to deliver a more patient focused EM experience. Electronic supplementary material The online version of this article (10.1007/s00520-019-04867-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven H Hsu
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA.,Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Claudine Campbell
- Department of Neurology and Rehabilitation Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amanda K Weeks
- Department of Neurology and Rehabilitation Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maryann Herklotz
- Department of Neurology and Rehabilitation Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natalie Kostelecky
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA
| | - Stephen M Pastores
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA
| | - Neil A Halpern
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA
| | - Louis P Voigt
- Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Suite C-1179, New York, NY, 10065, USA.
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Lin F, Phelan S, Chaboyer W, Mitchell M. Early mobilisation of ventilated patients in the intensive care unit: A survey of critical care clinicians in an Australian tertiary hospital. Aust Crit Care 2019; 33:130-136. [PMID: 30935789 DOI: 10.1016/j.aucc.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Mobilising mechanically ventilated patients is safe and beneficial and improves outcomes. However, early mobilisation is not widely practiced and barriers to its implementation still exist. OBJECTIVE The objective of this study was to assess clinician perceptions, knowledge, attitudes, and behaviours towards mobilising critically ill ventilated patients in the intensive care unit, as well as perceived barriers and facilitators towards mobilisation. METHODS A prospective questionnaire based on three existing questionnaires was administered to nurses, physicians, and physiotherapists from a single mixed medical/surgical intensive care unit in an Australian tertiary hospital. The 32-item questionnaire focused on knowledge, attitudes, behaviour, and perceived facilitators and barriers. Various response options were used, and data were analysed using descriptive statistics. RESULTS The overall response rate was 56.6% (82 of 145). Overall, clinicians' knowledge score was 4.1 (standard deviation = 1.4) out of a possible score of 6. Early mobilisation was not perceived as a top priority by 40.2% of participants. One important facilitator was that majority of the participants perceived early mobilisation was important. The most common perceived barriers to early mobilisation were medical instability, delirium, sedation, and limited staffing. Clinicians' opinions varied on the timing and appropriateness for instituting early mobilisation. CONCLUSIONS Clinicians had various levels of knowledge on early mobilisation as a therapy for critically ill patients. Most clinicians believed that early mobility was important and were willing to reduce sedation; however, several key barriers were identified which need to be addressed by using targeted interventions. This will reduce or close the gap between knowledge and practice.
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Affiliation(s)
- Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Sonja Phelan
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia; Princess Alexandra Hospital, Australia
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Kang J, Jeong YJ. Embracing the new vulnerable self: A grounded theory approach on critical care survivors’ post-intensive care syndrome. Intensive Crit Care Nurs 2018; 49:44-50. [DOI: 10.1016/j.iccn.2018.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/25/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022]
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[Prolonged weaning during early neurological and neurosurgical rehabilitation : S2k guideline published by the Weaning Committee of the German Neurorehabilitation Society (DGNR)]. DER NERVENARZT 2018; 88:652-674. [PMID: 28484823 DOI: 10.1007/s00115-017-0332-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Prolonged weaning of patients with neurological or neurosurgery disorders is associated with specific characteristics, which are taken into account by the German Society for Neurorehabilitation (DGNR) in its own guideline. The current S2k guideline of the German Society for Pneumology and Respiratory Medicine is referred to explicitly with regard to definitions (e.g., weaning and weaning failure), weaning categories, pathophysiology of weaning failure, and general weaning strategies. In early neurological and neurosurgery rehabilitation, patients with central of respiratory regulation disturbances (e.g., cerebral stem lesions), swallowing disturbances (neurogenic dysphagia), neuromuscular problems (e.g., critical illness polyneuropathy, Guillain-Barre syndrome, paraplegia, Myasthenia gravis) and/or cognitive disturbances (e.g., disturbed consciousness and vigilance disorders, severe communication disorders), whose care during the weaning of ventilation requires, in addition to intensive medical competence, neurological or neurosurgical and neurorehabilitation expertise. In Germany, this competence is present in centers of early neurological and neurosurgery rehabilitation, as a hospital treatment. The guideline is based on a systematic search of guideline databases and MEDLINE. Consensus was established by means of a nominal group process and Delphi procedure moderated by the Association of the Scientific Medical Societies in Germany (AWMF). In the present guideline of the DGNR, the special structural and substantive characteristics of early neurological and neurosurgery rehabilitation and existing studies on weaning in early rehabilitation facilities are examined.Addressees of the guideline are neurologists, neurosurgeons, anesthesiologists, palliative physicians, speech therapists, intensive care staff, ergotherapists, physiotherapists, and neuropsychologists. In addition, this guideline is intended to provide information to specialists for physical medicine and rehabilitation (PMR), pneumologists, internists, respiratory therapists, the German Medical Service of Health Insurance Funds (MDK) and the German Association of Health Insurance Funds (MDS). The main goal of this guideline is to convey the current knowledge on the subject of "Prolonged weaning in early neurological and neurosurgery rehabilitation".
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Abstract
Early mobilization of patients in the intensive care unit (ICU) is safe, feasible, and beneficial. However, implementation of early mobility as part of routine clinical care can be challenging. The objective of this review is to identify barriers to early mobilization and discuss strategies to overcome such barriers. Based on a literature search, we synthesize data from 40 studies reporting 28 unique barriers to early mobility, of which 14 (50%) were patient-related, 5 (18%) structural, 5 (18%) ICU cultural, and 4 (14%) process-related barriers. These barriers varied across ICUs and within disciplines, depending on the ICU patient population, setting, attitude, and ICU culture. To overcome the identified barriers, over 70 strategies were reported and are synthesized in this review, including: implementation of safety guidelines; use of mobility protocols; interprofessional training, education, and rounds; and involvement of physician champions. Systematic efforts to change ICU culture to prioritize early mobilization using an interprofessional approach and multiple targeted strategies are important components of successfully implementing early mobility in clinical practice.
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Implementing early mobilisation in the intensive care unit: An integrative review. Int J Nurs Stud 2017; 77:91-105. [PMID: 29073462 DOI: 10.1016/j.ijnurstu.2017.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The intensive care unit provides complex care for critically ill patients. Consequently, due to the nature of critical illness and the therapies administered in intensive care, patients are often on prolonged periods of bed rest with limited mobility. It has been recognised that mobilising critically ill patients is beneficial to patients' recovery, however implementing early mobility as a standard of care remains challenging in practice. OBJECTIVES To identify the key factors that underpin successful implementation and sustainability of early mobilisation in adult intensive care units. DESIGN Integrative Review. DATA SOURCE A systematic search strategy guided by SPICE framework (Setting, Perspective, Intervention, Comparison, Evaluation) was used to formulate the research question, identify study inclusion and exclusion criteria, and guide the database search strategy. Computerised databases were searched from August-September 2016. Quality improvement articles that identified project implementation of early mobilisation of mechanically ventilated adult intensive care patients were included. REVIEW METHODS After screening the articles, extracting project data and completing summary tables, critical appraisal of the quality improvement projects was completed using the Quality Improvement Minimum Quality Criteria Set. A modified version of the Cochrane Effective Practice and Organisation of Care taxonomy was used to synthesise the multifaceted implementation strategies the projects utilised to help bring about changes in clinician behaviour. RESULTS Thirteen articles, reflecting 12 projects meeting the inclusion criteria were included in the final analysis. Eleven projects were conducted in the United States, and one in the United Kingdom. Quality scores ranged from 6 to 15. A formal framework to guide the quality improvement process was used in 9 projects. The three most frequently used groups of implementation strategies were educational meetings, clinical practice guidelines and tailored interventions. Managing the change process through strong leadership, designing strategies and interventions to overcome barriers to implementation, multidisciplinary team collaboration and data collection and feedback underpinned successful and sustainable early mobility practice change. CONCLUSION The use of a quality improvement appraisal tool can help identify high quality projects when planning a similar mobility program. Even though projects were conducted in a variety of intensive care unit settings, and implementation frameworks and strategies varied, all began with strong leadership commitment to early mobilisation. This along with using the quality improvement process and multidisciplinary team approach ensured success and sustainability of mobilising ventilated patients.
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The MOVIN' project (Mobilisation Of Ventilated Intensive care patients at Nepean): A quality improvement project based on the principles of knowledge translation to promote nurse-led mobilisation of critically ill ventilated patients. Intensive Crit Care Nurs 2017; 42:36-43. [PMID: 28552258 DOI: 10.1016/j.iccn.2017.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/19/2017] [Accepted: 04/25/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Prospective quality improvement project to evaluate the impact of a training programme to promote nurse-led mobilisation of intubated critically ill patients. METHODS This project involved an educational programme to upskill nurses and overcome the barriers/challenges to nurse-led mobilisation. Initial strategies focused on educating and upskilling nurses to attain competency in active mobilisation. Subsequent strategies focused on positive reinforcement to achieve a culture shift. A pre- and post-intervention audit was used to evaluate its effectiveness. RESULTS A baseline audit showed that ∼9% of ventilated patients were mobilised. Several barriers were identified. Twenty-three nurses underwent training in actively mobilising ventilated patients. This increased their confidence levels and there was reduction in reported barriers. However, the rate of active mobilisation remained low (9.7%). Subsequently, a programme of positive reinforcement with rewards and visual reminders was introduced, which saw an increase in the number of nurse-led mobilisations of both ventilated patients (from 9.7% to 34.8%; p=0.0003), and non-ventilated patients (29.5% versus 62.9%; p=<0.0001). CONCLUSION It is safe and feasible to train nurses to perform active mobilisation of ventilated patients. However, to promote a culture change, training and competency must be combined with a multi-pronged approach including reminders, positive reinforcement and rewards.
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Costa DK, White MR, Ginier E, Manojlovich M, Govindan S, Iwashyna TJ, Sales AE. Identifying Barriers to Delivering the Awakening and Breathing Coordination, Delirium, and Early Exercise/Mobility Bundle to Minimize Adverse Outcomes for Mechanically Ventilated Patients: A Systematic Review. Chest 2017; 152:304-311. [PMID: 28438605 DOI: 10.1016/j.chest.2017.03.054] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Improved outcomes are associated with the Awakening and Breathing Coordination, Delirium, and Early exercise/mobility bundle (ABCDE); however, implementation issues are common. As yet, no study has integrated the barriers to ABCDE to provide an overview of reasons for less successful efforts. The purpose of this review was to identify and catalog the barriers to ABCDE delivery based on a widely used implementation framework, and to provide a resource to guide clinicians in overcoming barriers to implementation. METHODS We searched MEDLINE via PubMed, CINAHL, and Scopus for original research articles from January 1, 2007, to August 31, 2016, that identified barriers to ABCDE implementation for adult patients in the ICU. Two reviewers independently reviewed studies, extracted barriers, and conducted thematic content analysis of the barriers, guided by the Consolidated Framework for Implementation Research. Discrepancies were discussed, and consensus was achieved. RESULTS Our electronic search yielded 1,908 articles. After applying our inclusion/exclusion criteria, we included 49 studies. We conducted thematic content analysis of the 107 barriers and identified four classes of ABCDE barriers: (1) patient-related (ie, patient instability and safety concerns); (2) clinician-related (ie, lack of knowledge, staff safety concerns); (3) protocol-related (ie, unclear protocol criteria, cumbersome protocols to use); and, not previously identified in past reviews, (4) ICU contextual barriers (ie, interprofessional team care coordination). CONCLUSIONS We provide the first, to our knowledge, systematic differential diagnosis of barriers to ABCDE delivery, moving beyond the conventional focus on patient-level factors. Our analysis offers a differential diagnosis checklist for clinicians planning ABCDE implementation to improve patient care and outcomes.
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Affiliation(s)
| | | | - Emily Ginier
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI
| | | | - Sushant Govindan
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Theodore J Iwashyna
- Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Anne E Sales
- VA Center for Clinical Management Research, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
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Parry SM, Knight LD, Connolly B, Baldwin C, Puthucheary Z, Morris P, Mortimore J, Hart N, Denehy L, Granger CL. Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med 2017; 43:531-542. [PMID: 28210771 DOI: 10.1007/s00134-017-4685-4] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify, evaluate and synthesise studies examining the barriers and enablers for survivors of critical illness to participate in physical activity in the ICU and post-ICU settings from the perspective of patients, caregivers and healthcare providers. METHODS Systematic review of articles using five electronic databases: MEDLINE, CINAHL, EMBASE, Cochrane Library, Scopus. Quantitative and qualitative studies that were published in English in a peer-reviewed journal and assessed barriers or enablers for survivors of critical illness to perform physical activity were included. Prospero ID: CRD42016035454. RESULTS Eighty-nine papers were included. Five major themes and 28 sub-themes were identified, encompassing: (1) patient physical and psychological capability to perform physical activity, including delirium, sedation, illness severity, comorbidities, weakness, anxiety, confidence and motivation; (2) safety influences, including physiological stability and concern for lines, e.g. risk of dislodgement; (3) culture and team influences, including leadership, interprofessional communication, administrative buy-in, clinician expertise and knowledge; (4) motivation and beliefs regarding the benefits/risks; and (5) environmental influences, including funding, access to rehabilitation programs, staffing and equipment. CONCLUSIONS The main barriers identified were patient physical and psychological capability to perform physical activity, safety concerns, lack of leadership and ICU culture of mobility, lack of interprofessional communication, expertise and knowledge, and lack of staffing/equipment and funding to provide rehabilitation programs. Barriers and enablers are multidimensional and span diverse factors. The majority of these barriers are modifiable and can be targeted in future clinical practice.
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Affiliation(s)
- Selina M Parry
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia.
| | - Laura D Knight
- Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Bronwen Connolly
- Guy's and St Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, London, UK
- Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claire Baldwin
- International Centre for Allied Health Evidence (iCAHE) and the Sansom Institute, University of South Australia, Adelaide, SA, Australia
| | - Zudin Puthucheary
- Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK
- Division of Critical Care, Institute of Sports and Exercise Health, University College Hospitals, London, UK
| | - Peter Morris
- Department of Critical Care, University of Kentucky, Lexington, USA
| | - Jessica Mortimore
- Guy's and St Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, London, UK
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Guy's and St Thomas' NHS Foundation Trust and King's College London National Institute of Health Research Biomedical Research Centre, London, UK
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Division of Asthma, Allergy and Lung Biology, King's College London, London, UK
| | - Linda Denehy
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia
| | - Catherine L Granger
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Level 7 Alan Gilbert Building, Parkville, Melbourne, VIC, 3010, Australia
- Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
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Yeung WWK. Post-operative care to promote recovery for thoracic surgical patients: a nursing perspective. J Thorac Dis 2016; 8:S71-7. [PMID: 26941973 DOI: 10.3978/j.issn.2072-1439.2015.10.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recovery, few strategies have been implemented including early mobilization, staff training and clinical audit. On the other hand, nursing case management approach was proved to be a cost-effective method in managing patients. It is also suitable for thoracic patients, especially for those who are suffering from thoracic neoplasm. It is believed that, the introduction of nursing case management approach would provide a better holistic care to the thoracic patients.
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Affiliation(s)
- Wilfred Wai Kit Yeung
- Division of Cardiothoracic Unit, Department of Surgery, Prince of Wales Hospital, Hong Kong, China
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