Fernald Michelle M, Smyrnios Nicholas A, Vitello Joan
Michelle M. Fernald is a nurse manager in the medical intensive care unit, UMass Memorial Medical Center, Worcester, Massachusetts.
Nicholas A. Smyrnios is a professor, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, and Medical Director, medical intensive care unit, Division of Pulmonary, Allergy, and Critical Care Medicine, UMass Memorial Medical Center.
Crit Care Nurse. 2020 Aug 1;40(4):66-72. doi: 10.4037/ccn2020251.
Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization.
To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care.
Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members' attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops.
Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months.
Participation in the workshops improved the staff's attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.
活动受限会给重症患者带来诸多不良影响。早期进行渐进性活动可减轻这些负面后果，但尚未得到广泛实施。肯定性探究是一种质量改进方法/变革理念，它基于组织中运行良好的方面。
探讨肯定性探究是否能重振医学重症监护病房的早期渐进性活动倡议，并提高和维持工作人员在床边提供定期活动治疗的积极性。次要目标是补充关于医疗保健领域肯定性探究的文献，并确定其是否可应用于重症监护。
工作人员参加了由经过培训的主持人主持的肯定性探究工作坊，并按照肯定性探究的4-D循环进行组织。在工作坊前后评估工作人员对早期渐进性活动的态度和知识。记录工作坊前、工作坊后3个月和10个月时早期渐进性活动的执行情况。
67名参与者完成了该项目。他们认为工作坊成功帮助他们理解了早期渐进性活动的重要性（98%），明确了他们在改善患者预后方面的责任（98%），并增强了对患者和组织的责任感（96%）。在活动治疗方面，3个月时医嘱从62%提高到了88%；记录从52%提高到了89%；观察从39%提高到了87%。这些改善在10个月时得以维持。
参与工作坊改善了工作人员对活动治疗的态度和表现。肯定性探究可能是基于问题的质量改进技术的一种补充。
