Patient and Family Perspectives on Early Mobilization in Acute Cardiac Care

Najjar, Caroline; Dima, Diana; Goldfarb, Michael

doi:10.1016/j.cjco.2021.10.007

Cited by 8 publications

(10 citation statements)

References 20 publications

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“…That FCs received insufficient guidance on their relative's capacity for physical activity and how to support it parallels Najjar et al 's findings that few FCs receive information on how to support their relative's physical activity; FCs in that study indicated that their lack of knowledge was the greatest barrier in assisting their hospitalized relative to mobilize [8]. Our finding that FCs needed more information on the trajectory of their relative's recovery, and how physical activity figures into it, parallels other studies concluding that FCs need more information on their relative's health trajectory [23], what to expect at home [24], and how to support patients' physical functional needs after discharge [9].…”

Section: Discussionsupporting

confidence: 68%

“…Our finding that, in the absence of direction explicitly outlining how to support their relative’s physical activity, FCs relied on “common sense”, informed by the belief that too much physical activity threatens recovery, parallels Lim et al’s study which reported that FCs tend to emphasize the importance of rest to their hospitalized relative’s recovery [ 7 ]. Likewise, Najjar et al found that FCs were hesitant to have their relatives mobilize in hospital because of the potential health dangers [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…For example, in qualitative interviews with FCs of hospitalized patients, Lim and colleagues found that FCs recognized the need for their relative to mobilize but feared their relative might fall [ 7 ]. Similarly, in a survey of FCs, Najjar’s team found that FCs believed that their relative should regularly ambulate while in hospital but were concerned about the potential dangers of doing so [ 8 ]. We found only one study exploring FCs’ perspectives of their preparedness after hospital discharge; in that study, FCs reported feeling prepared to manage their relative’s physical functional needs but the study interviewed FCs 6 months following their relative’s hospital discharge, did not focus on FCs’ perspectives of supporting physical activity in the post discharge period, and all participants were receiving home care services before and following hospital discharge [ 9 ]; the transferability and relevance of the findings to FCs’ preparedness to support the physical activity of a recently hospitalized relative are thus questionable.…”

Section: Introductionmentioning

confidence: 99%

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Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Fox

Butler

Sidani

et al. 2022

BMC Health Serv Res

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Background Physical activity in the post-discharge period is important to maximize patient recovery and prevent hospital readmission. Healthcare providers have identified family caregivers as potential facilitators of patients’ engagement in physical activity. Yet, there is very little research on family caregivers’ perspectives on their preparedness to support the physical activity of patients, particularly those at risk for hospital readmission in rural communities. Accordingly, this study explored the challenges related to family caregivers’ preparedness to support the physical activity of a recently discharged, rural-dwelling relative at risk for hospital readmission. Methods In this interpretive descriptive study, semi-structured interviews were conducted by telephone with 16 family caregivers. Interview transcripts were analyzed using thematic analysis. Results Participants were predominantly women (n = 14; 87.5%) with an average age of 49 years (range 26–67) who were the primary caregivers of a relative who had been hospitalized for a medical illness (n = 12; 75%) and was at high risk for hospital readmission. Four themes were identified: 1) family caregivers generally felt unprepared to support their relative’s physical activity, 2) some family caregivers believed that rest was more important than physical activity to their relative’s recovery, 3) insufficient physical activity preparation led to family caregiver-relative conflicts, and 4) to defuse these conflicts, some family caregivers wanted healthcare providers to be responsible for promoting physical activity. Conclusions Despite assertions that family caregivers are a potential source of support for patient physical activity, our findings indicate that family caregivers are largely unprepared to assume that role and that more work needs to be done to ensure they can do so effectively. We suggest that healthcare providers be conscious of the potential for family caregiver-patient conflict surrounding physical activity, assess family caregivers’ ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly. Preparing family caregivers to support their relative’s physical activity is particularly important given the current emphasis on early discharge in many jurisdictions, and the limited formal healthcare services available in rural communities.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Fox

Butler

Sidani

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

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“…In terms of the practice of EM, only about 20% of ICUs performed EM for all eligible patients, and the EM assessment and implementation time of patients was generally after 48 h of ICU admission, or flexitively adjusted/determined by the personal experience of clinicians. There is, however, evidence that EM within the first 48 h, even 24 h, of ICU admission, is safe and feasible for the vast majority of ICU patients and results in improved outcomes 28–30 . Most of the ICUs in our study suffered from a lack of standardized protocols, collaborative teams, regular multidisciplinary rounds and even the absence of standardized medical orders.…”

Section: Discussionmentioning

confidence: 87%

Early mobilisation practice in intensive care units: A large‐scale cross‐sectional survey in China

Liu

Tian

Jiang

et al. 2023

Nursing in Critical Care

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Background: The field of early rehabilitation has developed slowly in mainland China and there are limited data on the implementation of early mobilisation (EM) practice in intensive care unit (ICUs) in China. Aims: To investigate the implementation of EM in ICUs in mainland China and to analyse its influencing factors. Study design: A cross-sectional electronic survey was conducted in 444 ICUs across 11 provinces in China. Head nurses provided data on institutional characteristics and EM practice in ICUs. Logistic regression models were used to identify factors associated with the implementation of EM. Results: In all, 56.98% (253/444) of ICUs implemented EM with comprehensive or complete implementation in 86 ICUs. Of the 191 ICUs that did not use EM, 136 planned to implement EM in the near future. Of the 253 ICUs that used EM, 21.34% of ICUs implemented EM for all eligible patients, while 24.90%would evaluate and carry out EM within 48 h after ICU admission, 39.13% had collaborative EM teams, 34.39% reported the use of EM protocols, 14.63% reported multidisciplinary rounds and 17.39% had medical orders and charging standards for all EM activities. Only 18.18% of ICUs conducted frequent professional training for EM, and abnormal events occurred in 15.41% of ICUs during EM practice. Multivariate logistic regression analysis revealed that an economically strong province, the presence of a dedicated therapist team, more ICU beds and a higher staff-to-bed ratio favoured the implementation of EM. Furthermore, multidisciplinary rounds, well-established medical orders and charging standards, and a high frequency of professional training can lead to the comprehensive promotion and development of EM practice in ICUs.Conclusions: Both the implementation rate and quality of EM practice for critically ill patients require improvement. EM practice in Chinese ICUs is still nascent and requires development in a variety of domains.

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“…Others, such as concerns about patient overexertion and pain exacerbation, managing work and family responsibilities, and sparking interpersonal conflict, have been established in the literature [59][60][61]. Prior research, for example, has found that FCs were hesitant for their ill hospitalized relative to mobilize because of potential health dangers [62] and FCs experienced competing family and work demands in managing their relative's physical functional needs after hospital discharge [45]. In using the physical activity intervention, healthcare providers should assess FCs' comfort reinforcing patient physical activity and tailor FCs' role accordingly.…”

Section: Discussionmentioning

confidence: 99%

Family caregivers’ perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study

et al. 2022

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Background There is a critical need for hospital-to-home transitional care interventions to prepare family caregivers for patients’ post-discharge care in rural communities. Four evidence-based interventions (named discharge planning, treatments, warning signs, and physical activity) have the potential to meet this need but family caregivers’ perspectives on the acceptability of the interventions have not been examined. This gap is significant because unacceptable interventions are unlikely to be used or used as designed, thereby undermining outcome achievement. Accordingly, this study examined the perceived acceptability of the four interventions to rural family caregivers. Materials and methods A multi-method descriptive design was used. The quantitative method entailed the administration of an established scale to assess the interventions’ perceived acceptability to family caregivers. The qualitative method involved semi-structured interviews to explore family caregivers’ perceived acceptability of the interventions in greater depth, including acceptable and unacceptable aspects, in the context of their own transitional care experience. Participants were the family caregivers of a relative who had been discharged home in a rural community from an acute care hospital in Ontario, Canada. Results The purposive sample included 16 participants who were mostly middle-aged women (n = 14; 87.5%) caring for a parent (n = 9; 56.3%) at high risk for hospital readmission. The mean scores on the acceptability measure were 3 or higher for all interventions, indicating that, on average, the four interventions were perceived as acceptable. In terms of acceptable aspects, four themes were identified: the interventions: 1) involve family caregivers and proactively prepare them for discharge, 2) provide clear, written, and detailed guidance, 3) place the onus on healthcare providers to initiate communication, and 4) ensure post-discharge follow-up. In terms of unacceptable aspects, one theme was identified: the physical activity intervention would be challenging to implement. Discussion The findings support implementing the four interventions in practice throughout the hospital-to-home transition. Healthcare providers should assess family caregivers’ comfort in participating in the physical activity intervention and tailor their role accordingly.

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Patient and Family Perspectives on Early Mobilization in Acute Cardiac Care

Cited by 8 publications

References 20 publications

Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Early mobilisation practice in intensive care units: A large‐scale cross‐sectional survey in China

Family caregivers’ perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study

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