NURSING PRACTICES OF IMPLEMENTING EARLY MOBILISATION ON PATIENTS WITH MECHANICAL VENTILATORS IN THE INTENSIVE CARE UNIT
DOI:
https://doi.org/10.31674/mjn.2022.v13i03.014Abstract
Background: Critically ill patients requiring mechanical ventilation might experience physical functional disabilities and are at risk in developing Intensive Care Unit (ICU)-acquired weakness. Early mobilisation reduces muscle weakness and improves recovery for mechanically ventilated patients in ICU. Although early mobilisation is safe and feasible for patients, there are barriers to its implementation Aim: The purpose of this study is to evaluate nursing practices of early mobilisation for mechanically ventilated patients in the ICU. Methods: Descriptive cross-sectional survey of simple random sampling using a structured questionnaire was conducted from 27 November 2019 to 31 January 2020 and completed by 145 critical care nurses from Hospital Raja Permaisuri Bainun, Ipoh and Pusat Perubatan Universiti Teknologi MARA. Results: Most nurses (n=142, 97.9%) practice mobilisation activities on mechanically ventilated patients. The majority of nurses performed in-bed activities to mechanically ventilated patients. There was a perceived barrier among nurses early mobilisation in the ICU with attitudes subscale (M=27.36, SD=3.7) were the highest mean for the subscale barrier score. Conclusion: This study shows that dedicated critical care nurses in the ICU were associated with increased early mobilisation practices among ICU patients undergoing mechanical ventilators. Future studies need to involve other health care professionals in the mobilisation team as implementation of early mobilisation requires interdisciplinary teamwork, commitment, and resource to promote mobilisation.
Keywords:
Early Mobilisation, Mechanical Ventilator, Critical Care Nurse, RehabilitationDownloads
References
Akinremi, A. A., Ogwu, S., & Sanya, A. O. (2020). Early Mobilization in the ICU: A Multicenter Survey of Clinicians’ Knowledge, Attitude and Practices in Resource-Limited Hospital Settings. Annals of Medical and Health Sciences Research, 10, 778–784.
Bakhru, R. N., McWilliams, D. J., Wiebe, D. J., Spuhler, V. J., & Schweickert, W. D. (2016). Intensive care unit structure variation and implications for early mobilization practices an international survey. Annals of the American Thoracic Society, 13(9), 1527–1537. https://doi.org/10.1513/AnnalsATS.201601-078OC.
Castro, E., Turcinovic, M., Platz, J., & Law, I. (2015). Early mobilization: Changing the mindset. Critical Care Nurse, 35(4), e1–e6. https://doi.org/10.4037/ccn2015512
Dafoe, S., Chapman, M. J., Edwards, S., & Stiller, K. (2015). Overcoming barriers to the mobilisation of patients in an intensive care unit. Anaesthesia and Intensive Care, 43(6), 719-727. https://doi.org/10.1177/0310057X1504300609
Dirkes, S. M., & Kozlowski, C. (2019). Early mobility in the intensive care unit: Evidence, barriers, and future directions. Critical Care Nurse, 39(3), 33–42. https://doi.org/10.4037/ccn2019654
Dubb, R., Nydahl, P., Hermes, C., Schwabbauer, N., Toonstra, A., Parker, A. M., Kaltwasser, A., & Needham, D. M. (2016). Barriers and strategies for early mobilization of patients in intensive care units. Annals of the American Thoracic Society, 13(5), 724–730. https://doi.org/10.1513/AnnalsATS.201509-586CME
Fontela, P. C., Forgiarini, L. A., & Friedman, G. (2018). Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Revista Brasileira de Terapia Intensiva, 30(2), 187–194. https://doi.org/10.5935/0103-507X.20180037
Fraser, D., Spiva, L., Forman, W., & Hallen, C. (2015). Original Research: Implementation of an Early Mobility Program in an ICU. American Journal of Nursing, 115(12), 49–58. https://doi.org/10.1097/01.NAJ.0000475292.27985.fc
Goodson, C. M., Friedman, L. A., Mantheiy, E., Heckle, K., Lavezza, A., Toonstra, A., Parker, A. M., Seltzer, J., Velaetis, M., Glover, M., Outten, C., Schwartz, K., Jones, A., Coggins, S., Hoyer, E. H., Chan, K. S., & Needham, D. M. (2020). Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU. Journal of Intensive Care Medicine, 35(10), 1026–1031. https://doi.org/10.1177/0885066618807120
Grimm, J., Elmore-Silvestri, A., Grimm, E., Klinger, K., Nye, S., & Bhullar, J. (2019). Percieved barriers to early progressive mobilization in the ICU: Multidisciplinary perspectives in an underserved population. Journal of Nursing Education and Practice, 9(5), 102. https://doi.org/10.5430/jnep.v9n5p102
Hodgson, C., Bellomo, R., Berney, S., Bailey, M., Buhr, H., Denehy, L., Harrold, M., Higgins, A., Presneill, J., Saxena, M., Skinner, E., Young, P., & Webb, S. (2015). Early mobilization and recovery in mechanically ventilated patients in the ICU: A bi-national, multi-centre, prospective cohort study. Critical Care, 19(1), 81. https://doi.org/10.1186/s13054-015-0765-4
Jolley, S. E., Regan-Baggs, J., Dickson, R. P., & Hough, C. L. (2014). Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: A cross-sectional survey study. BMC Anesthesiology, 14(1), 1–9. https://doi.org/10.1186/1471-2253-14-84
Kim, C., Kim, S., Yang, J., & Choi, M. (2019). Nurses’ perceived barriers and educational needs for early mobilisation of critical ill patients. Australian Critical Care, 32(6), 451–457. https://doi.org/10.1016/j.aucc.2018.11.065
Kondo, Y., Fuke, R., Hifumi, T., Hatakeyama, J., Takei, T., Yamakawa, K., Inoue, S., & Nishida, O. (2017). Early rehabilitation for the prevention of postintensive care syndrome in critically ill patients: a study protocol for a systematic review and meta-analysis. BMJ Open, 7(3), e013828. https://doi.org/10.1136/bmjopen-2016-013828
Lee, C. M., & Fan, E. (2012). ICU-acquired weakness: What is preventing its rehabilitation in critically ill patients? BMC Medicine, 10(1), 10–15. https://doi.org/10.1186/1741-7015-10-115
Leong, Y. L., Chong, M. C., & Abdul Rahman, R. B. (2017). Patient early mobilization: A Malaysia’s study of nursing practices. Journal of Intensive and Critical Care, 3(3).
Ling, T. L., Cheng, T. C., Har, L. C., & bt Ismail, N. I. (2017). Malaysian Registry of Intensive Care Report for 2015. Kuala Lumpur, Malaysia: Malaysian Society of Intensive Care (MSIC).
Shalaby, G., Mahran, K., Abdelrahman, H. A., & Shawkat Abo-Elmagd, N. (2019). Current Practice Types of Early Mobilization in the Intensive Care Units and Challenges Faced by Nurses Attempting to Translate It into Practice. American Journal of Nursing Research, 7(1), 31–36. https://doi.org/10.12691/ajnr-7-1-5
Tadyanemhandu, C., van Aswegen, H., & Ntsiea, V. (2018). Early mobilisation practices of patients in intensive care units in zimbabwean government hospitals – A cross-sectional study. Southern African Journal of Critical Care, 34(1), 16–21. https://doi.org/10.7196/sajcc.2017.v34i1.343
Taito, S., Sanui, M., Yasuda, H., Shime, N., & Lefor, A. K. (2016). Current rehabilitation practices in intensive care units: A preliminary survey by the Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group. Journal of Intensive Care, 4(1). https://doi.org/10.1186/s40560-016-0190-z
Taito, S., Shime, N., Yasuda, H., Ota, K., Sarada, K., Lefor, A. K., & Sanui, M. (2018). Out-of-bed mobilization of patients undergoing mechanical ventilation with orotracheal tubes: A survey study. Journal of Critical Care, 47, 173–177. https://doi.org/10.1016/j.jcrc.2018.06.022
Zhang, Z., Chen, K., Ni, H., Zhang, X., & Fan, H. (2017). Sedation of mechanically ventilated adults in intensive care unit: a network meta-analysis. Scientific Reports, 7(1), 1-9. https://doi.org/10.1038/srep44979
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