Haughton Stacey, Saravanan Krisha, McDonald Luke A, Rose Joleen W, Berney Sue, Berlowitz David J, Rollinson Thomas C, Graco Marnie
Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.
Institute for Breathing and Sleep, Melbourne, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia.
Aust Crit Care. 2025 May;38(3):101162. doi: 10.1016/j.aucc.2024.101162. Epub 2025 Jan 31.
The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased number of patients with COVID-19-related respiratory failure requiring prone positioning. To reduce pressure on nursing and medical staff in the intensive care unit (ICU), a physiotherapy-led intensive prone positioning (PhLIP) service was implemented.
The aim of this study was to explore the acceptability of the PhLIP service from the perspective of nurses and doctors working in the ICU and the physiotherapists who delivered the service.
A qualitative evaluation was conducted using semistructured interviews and focus groups, guided by the theoretical framework of acceptability (TFA). Participants included doctors, nurses, and physiotherapists who interacted with or delivered the PhLIP service.
A total of 19 interviews (eight doctors and 11 physiotherapists) and four focus groups (13 nurses) were conducted. Eleven themes were identified within the eight domains of the TFA. Overall, the PhLIP team was highly valued and appreciated (TFA: affective attitude); enabled high-quality care and improved ICU efficiency (TFA: perceived effectiveness); reduced risks to patients and staff (TFA: perceived safety and risk); and was empowering for the clinicians involved (TFA: self-efficacy). Being in the PhLIP team was physically and mentally exhausting, and the service put strain on the physiotherapy department due to reallocation of staff (TFA: burden). Having trust in the physiotherapists leading the prone positioning service was a key influence on nursing and medical acceptance of the service.
The PhLIP team delivered an acceptable service that improved clinical care and efficiency during the COVID-19 pandemic. Other ICUs should consider the availability, skills, and confidence in the team selected to implement an intensive prone positioning service, should the need arise again. Researchers using the TFA to explore acceptability of healthcare innovations should also consider the recipients' trust in those delivering the intervention.
2019年冠状病毒病（COVID-19）大流行导致需要俯卧位的COVID-19相关呼吸衰竭患者数量增加。为减轻重症监护病房（ICU）护理和医务人员的压力，实施了一项由物理治疗师主导的强化俯卧位（PhLIP）服务。
本研究的目的是从在ICU工作的护士和医生以及提供该服务的物理治疗师的角度探讨PhLIP服务的可接受性。
在可接受性理论框架（TFA）的指导下，使用半结构化访谈和焦点小组进行定性评估。参与者包括与PhLIP服务互动或提供该服务的医生、护士和物理治疗师。
共进行了19次访谈（8名医生和11名物理治疗师）和4个焦点小组（13名护士）。在TFA的8个领域中确定了11个主题。总体而言，PhLIP团队受到高度重视和赞赏（TFA：情感态度）；实现了高质量护理并提高了ICU效率（TFA：感知有效性）；降低了患者和工作人员的风险（TFA：感知安全性和风险）；并增强了相关临床医生的能力（TFA：自我效能感）。加入PhLIP团队身心俱疲，由于人员重新分配，该服务给物理治疗部门带来了压力（TFA：负担）。对主导俯卧位服务的物理治疗师的信任是护理人员和医务人员接受该服务的关键影响因素。
在COVID-19大流行期间，PhLIP团队提供了一项可接受的服务，改善了临床护理和效率。其他ICU在必要时应考虑所选实施强化俯卧位服务团队的可用性、技能和信心。使用TFA探索医疗保健创新可接受性的研究人员也应考虑接受者对实施干预者的信任。
