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Hiser S, Mantheiy E, Toonstra A, Aronson Friedman L, Ramsay P, Needham DM. Physiotherapists' and Physiotherapy Assistants' Perspectives on Using Three Physical Function Measures in the Intensive Care Unit: A Mixed-Methods Study. Physiother Can 2022; 74:240-246. [PMID: 37325213 PMCID: PMC10262833 DOI: 10.3138/ptc-2020-0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Purpose: We sought to understand physiotherapists' and physiotherapist assistants' perspectives on using three physical function measures in the intensive care unit (ICU) setting: the Activity Measure for Post-Acute Care Inpatient Mobility Short Form, the Johns Hopkins Highest Level of Mobility scale, and the Functional Status Score for the Intensive Care Unit. Method: A six-item questionnaire was developed and administered to physiotherapists and physiotherapist assistants working in adult ICUs at one U.S. teaching hospital. A single semi-structured focus group was conducted with seven physiotherapists, recruited using purposive sampling to include participants with a range of clinical experience. Results: Of 22 potential participants, 18 physiotherapists and 2 physiotherapist assistants completed the questionnaire. Seven physiotherapists participated in the focus group. The questionnaire found favourable perspectives on the use of the three physical function measures in clinical practice, and the focus group identified five themes related to clinicians' experience with using them: (1) ease of scoring, (2) usefulness in inter-professional communication, (3) general ease of use, (4) responsiveness to change in physical function, and (5) generalizability across patients. Conclusions: The most frequently discussed themes in this study were ease of scoring and usefulness in inter-professional communication, highlighting their importance in designing and selecting physical function measures for clinical use in the ICU setting.
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Affiliation(s)
- Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Earl Mantheiy
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Amy Toonstra
- Department of Physical Therapy, Concordia University, St. Paul, Minnesota, United States
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Pam Ramsay
- School of Health Sciences, University of Dundee, Dundee, Scotland
| | - Dale M. Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Outcomes After Critical Illness and Surgery Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Parker AM, Akhlaghi N, Malik AM, Friedman LA, Mantheiy E, Albert K, Glover M, Dong S, Lavezza A, Seltzer J, Needham DM. Perceived barriers to early goal-directed mobility in the intensive care unit: Results of a quality improvement evaluation. Aust Crit Care 2021; 35:219-224. [PMID: 34154913 PMCID: PMC8683568 DOI: 10.1016/j.aucc.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND A multicentre randomised trial demonstrated improved outcomes for intensive care unit (ICU) patients using early, goal-directed mobility implemented by nurses. OBJECTIVES The aim of the study was to evaluate barriers to nursing mobility, using a validated survey, during an ongoing quality improvement (QI) project (2019) in a medical ICU and determine changes from the pre-QI (2017) baseline. METHODS Nurses, nurse practitioners, physician assistants, and clinical technicians completed the 26-item Patient Mobilization Attitudes and Beliefs Survey for the ICU (PMABS-ICU). An overall score and three subscale scores (knowledge, attitudes, behaviour), each ranging from 0 to 100, were calculated; higher scores indicated greater barriers. RESULTS Seventy-five (93% response rate) nurses, eight (100%) nurse practitioners and physician assistants, and 11 (100%) clinical technicians completed the PMABS-ICU. For all respondents (N = 94), the mean (standard deviation) overall PMABS-ICU score was 32 (8) and the knowledge, attitudes and behaviour subscale scores were 22 (11), 33 (11), and 34 (8), respectively. Among all respondents completing the survey in both 2017 and 2019 (N = 46), there was improvement in the mean (95% confidence interval) overall score [-3.1 (-5.8, -0.5); p = .022] and in the knowledge [-5.1 (-8.9, -1.3); p = .010] and attitudes [-3.9 (-7.3, -0.6); p = .023] subscale scores. Among all respondents (N = 48) taking the PMABS-ICU for the first time in 2019 compared with those taking the survey before the QI project in 2017 (N = 99), there was improvement in the mean (95% confidence interval) overall score [-3.8 (-6.5, -1.1); p = .007] and in the knowledge [-6.9 (-11.0, -2.7); p = .001] and attitude [-4.3 (-8.1, -0.5); p = .027] subscale scores. CONCLUSIONS Using a validated survey administered to ICU nurses and other staff, before and during a structured QI project, there was a decrease in perceived barriers to mobility. Reduced barriers among those taking the survey for the first time during the QI project compared with those taking the survey before the QI project suggests a positive culture change supporting early, goal-directed mobility implemented by nurses.
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Affiliation(s)
- Ann M Parker
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Narges Akhlaghi
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Albahi M Malik
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Earl Mantheiy
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelsey Albert
- Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mary Glover
- Medical Intensive Care Unit, Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sherry Dong
- Medical Intensive Care Unit, Department of Nursing, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Seltzer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Outcomes After Surgery and Critical Illness Research Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Parker AM, Aldabain L, Akhlaghi N, Glover M, Yost S, Velaetis M, Lavezza A, Mantheiy E, Albert K, Needham DM. Cognitive Stimulation in an Intensive Care Unit: A Qualitative Evaluation of Barriers to and Facilitators of Implementation. Crit Care Nurse 2021; 41:51-60. [PMID: 33791762 DOI: 10.4037/ccn2021551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium in the intensive care unit is associated with poor patient outcomes. Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. Understanding barriers to cognitive stimulation implemented by nurses during clinical care is essential to translating evidence into practice. OBJECTIVE To use qualitative methods through a structured quality improvement project to understand nurses' perceived barriers to implementing a cognitive stimulation intervention in a medical intensive care unit. METHODS Data were collected through semistructured interviews with nurses in a medical intensive care unit. Data were categorized into themes by using thematic analysis and the Consolidated Framework for Implementation Research. During cognitive stimulation, nurses reviewed with patients a workbook of evidence-based tasks (focused on math, alertness, motor skills, visual perception, memory, problem-solving, and language). RESULTS The 23 nurses identified 62 barriers to and 26 facilitators of cognitive stimulation. These data were summarized into 12 barrier and 9 facilitator themes corresponding to the following Consolidated Framework for Implementation Research domains: Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals. Nurses also identified several facilitators within the Process domain. Patient-specific variables, including sedation, were the most frequently reported barriers. Other barriers included cognitive stimulation not being prioritized, nursing staff-related issues, documentation burden, and a lack of understanding of, or appreciation for, the evidence supporting cognitive stimulation. CONCLUSIONS Implementation of cognitive stimulation requires a multidisciplinary approach to address perceived barriers arising from the organization, context, and individuals associated with the intervention, as well as the intervention itself.
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Affiliation(s)
- Ann M Parker
- Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and a member of the Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, Maryland
| | - Louay Aldabain
- Louay Aldabain is an internal medicine resident, Medstar Health, Baltimore, Maryland
| | - Narges Akhlaghi
- Narges Akhlaghi is a postdoctoral research fellow, Division of Pulmonary and Critical Care Medicine, and a member of the OACIS Research Group, Johns Hopkins University
| | - Mary Glover
- Mary Glover is a lead clinical nurse in the medical intensive care unit, Johns Hopkins Hospital, Baltimore, Maryland
| | - Stephanie Yost
- Stephanie Yost is a bedside nurse in the intensive care unit, University of Vermont Medical Center in Burlington, Vermont
| | - Michael Velaetis
- Michael Velaetis is a critical care physician assistant in the medical intensive care unit, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University
| | - Annette Lavezza
- Annette Lavezza is the acute care therapy manager, Johns Hopkins Hospital, and a member of the OACIS Research Group, Johns Hopkins University
| | - Earl Mantheiy
- Earl Mantheiy is a senior clinical program coordinator, Critical Care Physical Medicine and Rehabilitation Program, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine
| | - Kelsey Albert
- Kelsey Albert is a research program assistant, Critical Care Physical Medicine and Rehabilitation Program, and a member of the OACIS Research Group, Johns Hopkins University
| | - Dale M Needham
- Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, School of Nursing, and a member of the OACIS Research Group, Johns Hopkins University
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Young DL, Seltzer J, Glover M, Outten C, Lavezza A, Mantheiy E, Parker AM, Needham DM. Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit. Am J Crit Care 2019; 27:186-193. [PMID: 29716904 DOI: 10.4037/ajcc2018368] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care. OBJECTIVES To report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit. METHODS An interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis. RESULTS During three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%). CONCLUSIONS Nurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.
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Affiliation(s)
- Daniel L Young
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Jason Seltzer
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Mary Glover
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Caroline Outten
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Annette Lavezza
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Earl Mantheiy
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Ann M Parker
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Dale M Needham
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University.
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Goodson CM, Friedman LA, Mantheiy E, Heckle K, Lavezza A, Toonstra A, Parker AM, Seltzer J, Velaetis M, Glover M, Outten C, Schwartz K, Jones A, Coggins S, Hoyer EH, Chan KS, Needham DM. Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU. J Intensive Care Med 2018; 35:1026-1031. [PMID: 30336716 DOI: 10.1177/0885066618807120] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. MATERIALS AND METHODS The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). RESULTS The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (-0.8 for each additional year; P = 0.02). CONCLUSIONS In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.
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Affiliation(s)
- Carrie M Goodson
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Aronson Friedman
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Earl Mantheiy
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Heckle
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Annette Lavezza
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amy Toonstra
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Ann M Parker
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jason Seltzer
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michael Velaetis
- Medical Intensive Care Unit, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mary Glover
- Medical Intensive Care Unit, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Caroline Outten
- Medical Intensive Care Unit, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kit Schwartz
- Respiratory Therapy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Antionette Jones
- Medical Intensive Care Unit, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sarah Coggins
- Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Erik H Hoyer
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kitty S Chan
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Kimawi I, Lamberjack B, Nelliot A, Toonstra AL, Zanni J, Huang M, Mantheiy E, Kho ME, Needham DM. Safety and Feasibility of a Protocolized Approach to In-Bed Cycling Exercise in the Intensive Care Unit: Quality Improvement Project. Phys Ther 2017; 97:593-602. [PMID: 28379571 DOI: 10.1093/ptj/pzx034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 03/16/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND In-bed, supine cycle ergometry as a part of early rehabilitation in the intensive care unit (ICU) appears to be safe, feasible, and beneficial, but no standardized protocol exists. A standardized protocol may help guide use of cycle ergometry in the ICU. OBJECTIVE This study investigated whether a standardized protocol for in-bed cycling is safe and feasible, results in cycling for a longer duration, and achieves a higher resistance. DESIGN A quality improvement (QI) project was conducted. METHODS A 35-minute in-bed cycling protocol was implemented in a single medical intensive care unit (MICU) over a 7-month quality improvement (QI) period compared to pre-existing, prospectively collected data from an 18-month pre-QI period. RESULTS One hundred and six MICU patients received 260 cycling sessions in the QI period vs. 178 MICU patients receiving 498 sessions in the pre-QI period. The protocol was used in 249 (96%) of cycling sessions. The QI group cycled for longer median (IQR) duration (35 [25-35] vs. 25 [18-30] minutes, P < .001) and more frequently achieved a resistance level greater than gear 0 (47% vs. 17% of sessions, P < .001). There were 4 (1.5%) transient physiologic abnormalities during the QI period, and 1 (0.2%) during the pre-QI period ( P = .031). LIMITATIONS Patient outcomes were not evaluated to understand if the protocol has clinical benefits. CONCLUSIONS Use of a protocolized approach for in-bed cycling appears safe and feasible, results in cycling for longer duration, and achieved higher resistance.
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Affiliation(s)
- Ibtehal Kimawi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University School of Medicine
| | - Bryanna Lamberjack
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Archana Nelliot
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine
| | - Amy Lee Toonstra
- OACIS Group, Johns Hopkins University School of Medicine, and Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital
| | - Jennifer Zanni
- OACIS Group, Johns Hopkins University School of Medicine; Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
| | - Minxuan Huang
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine
| | - Earl Mantheiy
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, and OACIS Group, Johns Hopkins University School of Medicine
| | - Michelle E Kho
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, and School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Dale M Needham
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 1830 E Monument St, 5th Floor, Baltimore, MD 21205 (USA); OACIS Group, Johns Hopkins University School of Medicine; and Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine
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Damluji A, Zanni JM, Mantheiy E, Colantuoni E, Kho ME, Needham DM. Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit. J Crit Care 2013; 28:535.e9-15. [PMID: 23499419 DOI: 10.1016/j.jcrc.2013.01.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 12/31/2012] [Accepted: 01/13/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Femoral catheters pose a potential barrier to early rehabilitation in the intensive care unit (ICU) due to concerns, such as catheter removal, local trauma, bleeding, and infection. We prospectively evaluated the feasibility and safety of physical therapy (PT) in ICU patients with femoral catheters. DESIGN, SETTING, AND PATIENTS We evaluated consecutive medical ICU patients who received PT with a femoral venous, arterial, or hemodialysis catheter(s) in situ. MEASUREMENTS AND MAIN RESULTS Of 1074 consecutive patients, 239 (22%) received a femoral catheter (81% venous, 29% arterial, 6% hemodialysis; some patients had >1 catheter). Of those, 101 (42%) received PT interventions, while the catheter was in situ, for a total of 253 sessions over 210 medical ICU (MICU) days. On these 210 MICU days, the highest daily activity level achieved was 49 (23%) standing or walking, 57 (27%) sitting, 25 (12%) supine cycle ergometry, and 79 (38%) in-bed exercises. During 253 PT sessions, there were no catheter-related adverse events giving a 0% event rate (95% upper confidence limit of 2.1% for venous catheters). CONCLUSIONS Physical therapy interventions in MICU patients with in situ femoral catheters appear to be feasible and safe. The presence of a femoral catheter should not automatically restrict ICU patients to bed rest.
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Damluji A, Mantheiy E, Colantuoni E, Kho M, Needham D. Safety and Feasibility of Femoral Catheters During Physical Rehabilitation in the ICU. Chest 2012. [DOI: 10.1378/chest.1389248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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