Ambulation of patients who are mechanically ventilated: nurses’ views

Abstract

Aims Equipment and skills in intensive care have advanced dramatically, and early rehabilitation and ambulation for patients in intensive care units (ICUs) are part of their journey to recovery. The aim of this study is to understand better nurses' perspectives on ambulating mechanically ventilated patients, and to determine why this is not a routine part of ICU patient care. Method Interpretative phenomenological analysis was used to extract data from semi-structured interviews. The questions were piloted twice before being used in the main study. Results Two overarching themes, staff anxiety and organisational culture, were identified, within which there are several subthemes. The study also found that education and training programmes could increase staff confidence and consequently result in routine ambulation of mechanically ventilated patients. Conclusion The study identified that nursing staff are aware of the benefits of ambulation for patients in ICUs, but the personal satisfaction gained from undertaking this activity does not outweigh the anxiety it causes. This is compounded by the organisational culture of ICUs; for example, the hierarchical pyramid of leadership, which dictates that consultants decide when patients are ready to ambulate.

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

“…A full definition of EM-MV was evident in 15 of 76 studies [24, 35–48]. A partial definition of EM-MV was provided in 15 studies with two studies defining ‘early’ [49, 50] and 13 studies defining ‘mobilisation’ [51–63]. A total of 46 studies did not provide a definition.…”

“…Other authors used ICU length of stay to refer to ‘early’ as either 24 h after admission [42], below 14 days length of stay [49] or throughout the ICU stay [24, 38]. EM-MV commencement time was also reported in a non-time-bound manner including any period of time [51], during the recovery [39, 50] or acute stage of illness [40], patient’s ability to engage with the activities [36, 48] and the point at which the patients were deemed stable physiologically [24, 35, 36, 38, 50] and psychologically [50].…”

“…Considering that qualitative research could contribute to the insights into effective EM-MV delivery, this review highlights the urgency of the need for more qualitative studies. Some studies have attempted to explore the clinician’s perceptions of EM-MV [50, 61, 81, 88, 98, 99, 116], yet research into patients’ views of EM-MV is lacking as evidenced by only one study found in this review [91]. Exploring patient views is essential as they are the primary participants in EM-MV.…”

Mobilizing Ventilated Neurosurgery Patients: An Integrative Literature Review

“…Nine studies addressed nursing barriers to initiate or progress mobilization including patient safety concerns, untimeliness due to limited resources, unit culture, lack of nursing knowledge, and need for improved teamwork. 11,[13][14][15][18][19][20][21][22] Intensive care unit nurses expressed anxiety and fear of adverse events (falls and equipment failure), causing mobility omission. 13,14 Mobilization was also hindered because of hesitant nurses seeking provider confirmation and having lengthy premobilization preparation.…”

“…11,[13][14][15][18][19][20][21][22] Intensive care unit nurses expressed anxiety and fear of adverse events (falls and equipment failure), causing mobility omission. 13,14 Mobilization was also hindered because of hesitant nurses seeking provider confirmation and having lengthy premobilization preparation.…”