School of Allied Health, Curtin University, Bentley, Western Australia, Australia.
School of Allied Health, WA Centre for Health & Ageing, The University of Western Australia, Crawley, Western Australia, Australia.
Burns. 2023 Nov;49(7):1688-1697. doi: 10.1016/j.burns.2023.02.011. Epub 2023 Feb 23.
Complex challenges face clinicians managing critically ill patients with burns, particularly in the context of enhancing outcomes after a stay in ICU. Compounding this, a dearth of research explores the specific and modifiable factors that impact early mobilization in the ICU environment.
To explore the barriers and enablers of early functional mobilization for patients with burns in the ICU from a multidisciplinary perspective.
A qualitative phenomenological study.
Semi-structured interviews supplemented by online questionnaires conducted with 12 multidisciplinary clinicians (four doctors, three nurses and five physical therapists) who previously managed burn patients at a quaternary level ICU. Data were thematically analysed.
Four main themes: patient, ICU clinicians, the workplace and the physical therapist were identified as impacting on early mobilization. Subthemes identified barriers or enablers to mobilization but all were strongly influenced by overarching theme of the clinician's "emotional filter." Barriers included high levels of pain, heavy sedation and low levels of clinician exposure to treating patients with burns. Enablers included higher levels of clinician's experience and knowledge about burn management and benefits of early mobilization; increased coordinated staff resources when undertaking mobilization; and, open communication and positive culture towards early mobilization across the multidisciplinary team.
Patient, clinician and workplace barriers and enablers were identified to influencing the likelihood of achieving early mobilization of patients with burns in the ICU. Emotional support for staff through multidisciplinary collaboration and development of structured burns training program were key recommendations to address barriers and strengthen enablers to early mobilization of patients with burns in the ICU.
对于管理危重症烧伤患者的临床医生来说，面临着诸多复杂的挑战，尤其是在提高 ICU 后患者预后方面。更复杂的是，几乎没有研究探讨影响 ICU 环境中早期活动的具体和可改变的因素。
从多学科角度探讨 ICU 烧伤患者早期功能活动的障碍和促进因素。
定性现象学研究。
对之前在四级 ICU 管理烧伤患者的 12 名多学科临床医生（4 名医生、3 名护士和 5 名物理治疗师）进行了半结构式访谈，并辅以在线问卷调查。对数据进行主题分析。
确定了四个主要主题：患者、ICU 临床医生、工作场所和物理治疗师，这些主题都对早期活动产生影响。确定了促进或阻碍活动的亚主题，但所有主题都受到临床医生“情绪过滤”的主导主题的强烈影响。障碍包括疼痛程度高、深度镇静和临床医生接触烧伤患者的机会少等；促进因素包括更高水平的临床医生对烧伤管理的经验和知识，以及早期活动的益处；在进行活动时增加协调的工作人员资源；以及多学科团队对早期活动的开放沟通和积极文化。
确定了影响 ICU 烧伤患者早期活动的患者、临床医生和工作场所障碍和促进因素。通过多学科合作为员工提供情感支持以及制定结构化的烧伤培训计划，是解决障碍和加强 ICU 烧伤患者早期活动的促进因素的关键建议。
