Department of Anaesthesiology and Intensive Care, OUH Svendborg Hospital, Svendborg, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
J Clin Nurs. 2024 Apr;33(4):1493-1505. doi: 10.1111/jocn.16950. Epub 2023 Dec 27.
To explore the practice of mobilisation of conscious and mechanically ventilated patients and the interaction between patients, nurses and physiotherapists.
Long-term consequences of critical illness can be reduced by mobilisation starting in Intensive Care Units, but implementation in clinical practice is presently sparse.
A qualitative study with a phenomenological-hermeneutic approach.
Participant observations in three Intensive Care Units involved twelve conscious mechanically ventilated patients, thirty-one nurses and four physiotherapists. Additionally seven semi-structured patient interviews, respectively at the ward and after discharge and two focus group interviews with healthcare professionals were conducted. The data analysis was inspired by Ricoeur's interpretation theory. The study adhered to the COREQ checklist.
Healthcare professionals performed a balance of support and guidance to promote mobilisation practice. The complexity of ICU mobilisation required a flexible mobility plan. Furthermore, interaction with feedback and humour was found to be 'a leverage' for patient's motivation to partake in mobilisation. The practice of mobilisation found patients striving to cope and healthcare professionals promoting a 'balanced standing by' and negotiating the flexible mobility plan to support mobilisation.
The study revealed a need to clarify interprofessional communication to align expectations towards mobilisation of conscious and mechanically ventilated patients.
The study demonstrated the important role of healthcare professionals to perform a stepwise and 'balanced standing by' in adequately supporting and challenging the mobilisation of mechanically ventilated patients. Furthermore, a synergy can arise when nurses and physiotherapists use supplementary feedback and humour, and cooperate based on a flexible situation-specific mobility plan in intensive care.
探索对有意识和机械通气患者进行身体活动的实践，以及患者、护士和物理治疗师之间的相互作用。
通过在重症监护病房开始进行身体活动，可以减少重症后长期遗留的问题，但目前在临床实践中的实施情况仍然很少。
一项采用现象学-解释学方法的定性研究。
在三个重症监护病房进行参与者观察，涉及 12 名有意识和机械通气的患者、31 名护士和 4 名物理治疗师。此外，还对 7 名分别在病房和出院后的患者进行了半结构式访谈，并对医护人员进行了 2 次焦点小组访谈。数据分析受到了 Ricoeur 解释理论的启发。该研究符合 COREQ 清单。
医护人员在促进身体活动实践中进行了支持和指导的平衡。重症监护室身体活动的复杂性需要灵活的活动计划。此外，发现与反馈和幽默的互动是患者参与身体活动的动机的“杠杆”。身体活动实践发现患者努力应对，医护人员提倡“平衡的支持”，并协商灵活的活动计划以支持身体活动。
该研究揭示了澄清跨专业沟通的必要性，以协调对有意识和机械通气患者进行身体活动的期望。
该研究表明，医护人员在充分支持和挑战机械通气患者的身体活动方面发挥着重要作用，需要逐步采取“平衡的支持”。此外，当护士和物理治疗师使用补充反馈和幽默，并根据重症监护的具体情况灵活制定合作计划时，可以产生协同作用。
