Impressions of Early Mobilization of Critically Ill Children—Clinician, Patient, and Family Perspectives*

Zheng, Katina; Sarti, Aimee; Boles, Sama; Cameron, Shona; Carlisi, Robert; Clark, Heather; Khawaji, Adeeb; Awladthani, S.; Al-Harbi, Samah; Choong, Karen

doi:10.1097/pcc.0000000000001547

Cited by 34 publications

(82 citation statements)

References 21 publications

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“…This highlights the importance of bedside nurse communication with families about mobilization therapies and is supported by other studies in which researchers examine collaboration between parents and staff during early mobilization. 17,29,30 Parent mobilization stress was correlated with parent preadmission and PICU-related stress. There is substantial morbidity for parents of children admitted to the PICU, including the development of not only parent stress but also PICS-p and psychiatric disorders.…”

Section: Discussionmentioning

confidence: 99%

“…10 A recent qualitative study of families of critically ill children revealed that families support early mobilization, and researchers highlight the importance of family engagement in these therapies. 17 In our PICU, we have had a goal-directed earlymobilization protocol in place for .3 years and have found that parent refusal is a barrier to mobilization in 10% of cases in which barriers contributed to protocol failure. 18 Researchers in previous studies have also listed parent refusal as a barrier to mobilization, 17 although several barriers to improving early mobilization exist at both the patient and institutional levels.…”

mentioning

confidence: 98%

“…17 In our PICU, we have had a goal-directed earlymobilization protocol in place for .3 years and have found that parent refusal is a barrier to mobilization in 10% of cases in which barriers contributed to protocol failure. 18 Researchers in previous studies have also listed parent refusal as a barrier to mobilization, 17 although several barriers to improving early mobilization exist at both the patient and institutional levels. 19,20 Parent refusal of therapies is potentially modifiable and may be particularly important in institutions with protocols in place to overcome other frequently identified systems barriers.…”

mentioning

confidence: 98%

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PICU Early Mobilization and Impact on Parent Stress

Colwell

Olufs

Zuckerman

et al. 2019

Hospital Pediatrics

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A B S T R A C TBACKGROUND AND OBJECTIVES: Early mobilization of critically ill children may improve outcomes, but parent refusal of mobilization therapies is an identified barrier. We aimed to evaluate parent stress related to mobilization therapy in the PICU. METHODS:We conducted a cross-sectional survey to measure parent stress and a retrospective chart review of child characteristics. Parents or legal guardians of children admitted for $1 night to an academic, tertiary-care PICU who were proficient in English or Spanish were surveyed. Parents were excluded if their child's death was imminent, child abuse or neglect was suspected, or there was a contraindication to child mobilization. RESULTS:We studied 120 parent-child dyads. Parent mobilization stress was correlated with parent PICU-related stress (r s [119] 5 0.489; P # .001) and overall parent stress (r s [110] 5 0.272; P 5 .004). Increased parent mobilization stress was associated with higher levels of parent education, a lower baseline child functional status, more strenuous mobilization activities, and mobilization therapies being conducted by individuals other than the children's nurses (all P , .05). Parents reported mobilization stress from medical equipment (79%), subjective pain and fragility concerns (75%), and perceived dyspnea (24%). Parent-reported positive aspects of mobilization were clinical improvement of the child (70%), parent participation in care (46%), and increased alertness (38%).CONCLUSIONS: Parent mobilization stress was correlated with other measures of parent stress and was associated with child-, parent-, and therapy-related factors. Parents identified positive and stressful aspects of mobilization therapy that can guide clinical care and educational interventions aimed at reducing parent stress and improving the implementation of mobilization therapies.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

mentioning

confidence: 98%

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PICU Early Mobilization and Impact on Parent Stress

Colwell

Olufs

Zuckerman

et al. 2019

Hospital Pediatrics

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“…The most common barriers to mobilizing children are lack of physiotherapy resources, lack of practice guidelines, and concerns for patient safety (14,16,24). In a recent publication by Zheng et al that conveys the results of post-mobilization interviews, both clinicians and parents expressed similar concerns that mobilization was not prioritized early in the ICU stay (25). Clinicians were primarily concerned for the safety of patients, whereas parents were more focused on prognosis of their child's illness.…”

Section: Early Mobilization: Definition Design and Implementationmentioning

confidence: 99%

Early mobilization in the pediatric intensive care unit

Walker¹,

Kudchadkar²

2018

Transl Pediatr

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Survivors of critical illness often experience multiple morbidities that start in the intensive care unit and impact their quality of life after discharge. Reduced physical function, cognitive decline, feeding disorders, and psychological stress are just a few of the potential complications. Many of these morbidities can lead to a reduced quality of life and lifelong impediments. Early mobilization, an intervention that is intended to maintain or restore musculoskeletal strength in the critically ill, has the potential to also yield positive psychological and cognitive benefits. In adults, early mobilization has been shown to be safe, decrease the incidence of delirium, and decrease length of stay. Early mobilization of the pediatric critically ill patient is still a novel topic with a growing body of research. This article will review the current literature on early mobilization of the pediatric critically ill patient.

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“…Some barriers have been reported to the clinical condition of the patient, such as clinical instability; difficulty in the clinical diagnosis and the severity of the disease; risk of displacement of devices (eg catheters and intra-tracheal cannula); excessive and/or inadequate analgesia dosage; physical constraints; obesity; inadequate nutritional status; lack of motivation in some children to participate in EM activities; among others 3,4 . However, current studies [3][4][5][6] show that multi-professional performance and family involvement contribute to the positive outcomes of EM as well as to minimize the mobilization barriers of sick children.…”

Section: The Early Mobilization For Children In Pediatric Intensive Carementioning

confidence: 89%