Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit

Young, Daniel L.; Seltzer, Jason; Glover, Mary; Outten, Caroline; Lavezza, Annette; Mantheiy, Earl; Parker, Ann M.

doi:10.4037/ajcc2018368

Cited by 19 publications

(19 citation statements)

References 55 publications

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“…Bedside nurse‐led EM programmes have the potential to increase opportunities for mobilisation. The lack of time required for nurses to perform mobilisation activities has been cited as a barrier to nurse‐led EM (Young et al, ). There is evidence, however, that despite a busy clinical workflow, ICU nurses have the time available for mobilising patients and miss potential mobilisation activities during almost one‐fifth of the nursing shift (Hunter et al, ; Young et al, ).…”

Section: Discussionmentioning

confidence: 99%

Level of function mobility scale for nurse‐driven early mobilisation in people with acute cardiovascular disease

Dima

Valiquette

Berube-Dufour

et al. 2019

Journal of Clinical Nursing

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Background There are currently no validated tools that are reliable and easy to use for nurses to assess mobility in people with acute cardiovascular disease in the Cardiovascular Intensive Care Unit (CICU). Methods A multidisciplinary team at an academic tertiary care centre developed the Level of Function (LOF) Mobility Scale for use in a nurse‐driven early progressive mobilisation in the CICU. To determine inter‐rater reliability, the prehospital and admission LOF were assessed independently by two CICU nurses. Pairwise comparisons between raters were evaluated using Cohen's kappa statistic. To determine convergence validity, the LOF and Activity Measure for Post‐Acute Care 6‐Clicks score upon admission were compared with Spearman's correlation. To determine feasibility, a 9‐item mobility scale questionnaire was distributed to CICU nurses with and without experience using the LOF Mobility Scale. The STROBE reporting guidelines were used. Results The LOF Mobility Scale had good inter‐rater reliability for assessment of LOF prior to hospitalisation (N = 131, kappa = 0.66, p < .001) and at the time of CICU admission (N = 131, kappa = 0.71, p < .001). There was a moderate correlation (N = 79 observations; correlation coefficient = 0.525; p < .01) between the bedside nurses LOF and the 6‐Clicks score. All nurses surveyed (N = 54; 100%) thought that the LOF Mobility Scale was clear and unambiguous, the LOFs were well‐defined and the scale was an appropriate length. Nearly all of the nurses with experience using the scale (N = 22/24; 92%) felt that the scale took less than one minute to complete, compared with about half (N = 14/30; 47%) in the group of nurses without experience using the scale. Conclusion The LOF Mobility Scale is reliable and feasible for mobility assessment in a nurse‐driven early progressive mobilisation programme in patients with acute cardiovascular disease in the CICU. Relevance to clinical practice A nurse‐driven EM programme can be implemented in the CICU.

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Section: Discussionmentioning

confidence: 99%

Level of function mobility scale for nurse‐driven early mobilisation in people with acute cardiovascular disease

Dima

Valiquette

Berube-Dufour

et al. 2019

Journal of Clinical Nursing

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“…One of the most important roles of nurses is the continuous implementation of measures to prevent PICS, including the ABCDEFGH bundle. Nurses spend most of their time on direct patient care . In addition to optimal analgesia, nurses can support safe light sedation by staying near patients .…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, short‐term and high‐frequency rehabilitation and mobilization interventions can improve the functional ability of patients . Nurses facilitate patient mobility at all hours of the day and night and, therefore, could contribute to improving patient functional ability. The recovery process from PICS is a continuum .…”

Section: Introductionmentioning

confidence: 99%

Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

Inoue

Hatakeyama

Kondo

et al. 2019

Acute Medicine & Surgery

404

365

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Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long‐term prognoses. Post‐intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long‐term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS‐p) and the mental status of their family (PICS‐F). Intensive care unit‐acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow‐up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS.

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“…For instance, if a physical therapist focuses on strength and functionality, marching in place might be prioritized [ 38 ]. If a nurse focuses on a patient’s well-being, sitting in a chair together with family may be seen as sufficient [ 39 ]. Physicians may be more prone to have weaning as a target [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Berney explains these differences with varying responsibilities in the ICU team. Lack of nurses is an often-cited barrier, but nurses may oversee possibilities for mobilization [ 39 ]. Staff shortage and limited time resources, coupled with the broader responsibilities of caregivers, may favor the higher degree of patient mobilization by physical therapists.…”

Section: Discussionmentioning

confidence: 99%

Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Hermes¹,

Nydahl

Blobner

et al. 2020

PLoS ONE

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Background Mobilization of intensive care patients is a multi-professional task. Aim of this study was to explore how different professions working at Intensive Care Units (ICU) estimate the mobility capacity using the ICU Mobility Score in 10 different scenarios. Methods T en fictitious patient-scenarios and guideline-related knowledge were assessed using an online survey. Critical care team members in German-speaking countries were invited to participate. All datasets including professional data and at least one scenario were analyzed. Kruskal Wallis test was used for the individual scenarios, while a linear mixed-model was used over all responses. Results In total, 515 of 788 (65%) participants could be evaluated. Physicians (p = 0.001) and nurses (p = 0.002) selected a lower ICU Mobility Score (-0.7 95% CI -1.1 to -0.3 and -0.4 95% CI -0.7 to -0.2, respectively) than physical therapists, while other specialists did not (p = 0.81). Participants who classified themselves as experts or could define early mobilization in accordance to the “S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders” correctly selected higher mobilization levels (0.2 95% CI 0.0 to 0.4, p = 0.049 and 0.3 95% CI 0.1 to 0.5, p = 0.002, respectively). Conclusion Different professions scored the mobilization capacity of patients differently, with nurses and physicians estimating significantly lower capacity than physical therapists. The exact knowledge of guidelines and recommendations, such as the definition of early mobilization, independently lead to a higher score. Interprofessional education, interprofessional rounds and mobilization activities could further enhance knowledge and practice of mobilization in the critical care team.

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Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit

Cited by 19 publications

References 55 publications

Level of function mobility scale for nurse‐driven early mobilisation in people with acute cardiovascular disease

Level of function mobility scale for nurse‐driven early mobilisation in people with acute cardiovascular disease

Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

Assessment of mobilization capacity in 10 different ICU scenarios by different professions

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