A Constructivist Grounded Theory of Staff Experiences Relating to Early Mobilisation of Mechanically Ventilated Patients in Intensive Care

Abstract

Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive care units were collected to understand healthcare staff experiences relating to early mobilisation in mechanical ventilation. Data included observations of mobilisation activities, individual staff interviews and two focus groups with multidisciplinary staff. Managing Risks emerged as the core category and was theorised using the concept of risk. The middle-range theory developed in this study suggests that the process of early mobilisation starts by staff defining patient status and includes a process of negotiating patient safety, which in turn enables performing accountable mobilisation within the dynamic context of an intensive care unit setting.

Mobilisation during mechanical ventilation: A qualitative study exploring the practice of conscious patients, nurses and physiotherapists in intensive care unit

“…The present finding of mobilisation practice understood in terms of an engaging relationship between HCPs and patients has been found in other studies as dynamic processes of negotiating mobilisation (Clarissa et al., 2022; Laerkner et al., 2019) or like a temporary desired paternalism (Corner et al., 2019). The relationship is asymmetrical based on dependency and an asymmetric power relation with the MV patient as the weak part, not being able to speak or move themselves.…”

“…At the same time a situation-specific mobility plan to optimise the mobilisation of conscious and mechanically ventilated ICU patients must be maintained. patients to participate in mobilisation activities and to interact with the nurses (Clarissa et al, 2022;Laerkner et al, 2019) and physiotherapists (Corner et al, 2019). Thus, patients can become active participants, and not just the object of care and treatment (Bjurling-Sjöberg et al, 2017).…”

“…A recent observational study, monitoring daily variation of physical activity during MV, showed mobilisation activities taking place both day and evening, thus related to both physiotherapy‐ and nursing‐initiated activities (Lehmkuhl et al., 2023). The recommendation towards minimal patient sedation in combination with early mobilisation in ICU (Devlin et al., 2018; Girard et al., 2017) opens up a unique possibility for patients to participate in mobilisation activities and to interact with the nurses (Clarissa et al., 2022; Laerkner et al., 2019) and physiotherapists (Corner et al., 2019). Thus, patients can become active participants, and not just the object of care and treatment (Bjurling‐Sjöberg et al., 2017).…”

Recovery after intensive care—A critical commentary on Dear ICU Survivor by Mark Hudson

“…Balancing risk and patients' autonomy remains a challenge reported by staff. 11 Patients might understand the importance of rehabilitation but unwilling to engage due to various reasons such as fatigue, pain or confusion. 12,13 However, we know that ICU rehabilitation has been shown to improve patient outcomes.…”

“…The second point highlighted by Mark is related to the reality of ICU rehabilitation delivery, which is not always smooth and easy. Balancing risk and patients' autonomy remains a challenge reported by staff 11 . Patients might understand the importance of rehabilitation but unwilling to engage due to various reasons such as fatigue, pain or confusion 12,13 …”