Towards "mobility is medicine": Socioecological factors and hospital mobility in older adults.

BACKGROUND: Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE: This qualitative study uses a socioecological framework to explore factors that influence hospital mobility in older adults. DESIGN: Qualitative research PARTICIPANTS: Semi-structured interviews and focus groups were conducted with medically-ill hospitalized older adults (n = 19) and providers (hospitalists, nurses, and physical and occupational therapists (n = 48) at two hospitals associated with an academic health system. APPROACH: Interview and focus group guides included questions on perceived need for mobility, communication about mobility, hospital mobility culture, and awareness of patients' walking activity. Data were analyzed thematically and mapped onto the constructs of the socioecological model. KEY RESULTS: A consistent theme among patients and providers was that "mobility is medicine." Categories of factors reported to influence hospital walking activity included intrapersonal factors (patients' health status, fear of falls), interpersonal factors (patient-provider communication about mobility), organizational factors (clarity about provider roles and responsibilities, knowledge of safe patient handling, reliance on physical therapy for mobility), and environmental factors (falls as a never event, patient geographical locations on hospital units). Several of these factors were identified as potentially modifiable targets for intervention. Patients and providers offered recommendations for improving awareness of patient's ambulatory activity, assigning roles and responsibility for mobility, and enhancing education and communication between patients and providers across disciplines. CONCLUSION: Patients and providers identified salient factors for future early mobility initiatives targeting hospitalized older adults. Consideration of these factors across all stages of intervention development and implementation will enhance impact and sustainability.

Rehabilitation following rotator cuff repair: A nested qualitative study exploring the perceptions and experiences of participants in a randomised controlled trial.

OBJECTIVE: To investigate acceptability, barriers to adherence with the interventions, and which outcome measures best reflect the participants' rehabilitation goals in a pilot and feasibility randomised controlled trial evaluating early patient-directed rehabilitation and standard rehabilitation, including sling immobilisation for four weeks, following surgical repair of the rotator cuff of the shoulder. DESIGN: Nested qualitative study. SETTING: Five English National Health Service Hospitals. SUBJECTS: Nineteen patient participants who had undergone surgical repair of the rotator cuff and 10 healthcare practitioners involved in the trial. METHOD: Individual semi-structured interviews. Data were analysed thematically. RESULTS: Four themes: (1) Preconceptions of early mobilisation; many participants were motivated to enter the trial for the opportunity of removing their sling and getting moving early. (2) Sling use and movement restrictions; for some, sling use for four weeks was unacceptable and contributed to their pain, rather than relieving it. (3) Tensions associated with early mobilisation; clinical tensions regarding early mobilisation and the perceived risk to the surgical repair were apparent. (4) Processes of running the trial; participants found the trial processes to be largely appropriate and acceptable, but withholding the results of the post-operative research ultrasound scan was contentious. CONCLUSION: Trial processes were largely acceptable, except for withholding results of the ultrasound scan. For some participants, use of the shoulder sling for a prolonged period after surgery was a reported barrier to standard rehabilitation whereas the concept of early mobilisation contributed tension for some healthcare practitioners due to concern about the effect on the surgical repair.

"I Have Everything to Win and Nothing to Lose": Patient Experiences of Mobilization Out of Bed Immediately After Abdominal Surgery.

OBJECTIVE: Early mobilization is advocated for patients going through abdominal surgery; however, little is known about the patient experience of being mobilized immediately after surgery. The purpose of this study was to explore patient experiences of mobilization immediately after elective abdominal cancer surgery. METHODS: This interview study used qualitative content analysis. With the use of purposeful sampling, a total of 23 participants who had been mobilized immediately after abdominal surgery were recruited at a university hospital in Stockholm, Sweden. Individual face-to-face interviews were conducted within 1 to 4 days after surgery and took place at the surgical ward where the participants were treated. A semi-structured guide was used. All interviews were audio recorded and transcribed verbatim. RESULTS: The content analysis revealed 3 categories that emerged into 1 overarching theme: "to do whatever it takes to get home earlier." The participants experienced that mobilization out of bed had an impact on their physical and mental well-being. Motivation and the experiences of themselves and others were factors that affected patient attitudes toward early mobilization. Preparation and competent caregivers were emphasized as important factors that enabled the patient to feel safe and confident during mobilization. CONCLUSIONS: Patients experienced mobilization as an important part of the care that had an impact on recovery and well-being, physically as well as mentally, both immediately and over time. IMPACT: As this is the first study to our knowledge to investigate patient experiences of mobilization immediately after abdominal surgery, this information can be used to support the development of early mobilization protocols in hospital settings.

Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry.

BACKGROUND: Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization. OBJECTIVES: To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care. METHODS: Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members' attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops. RESULTS: Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months. CONCLUSION: Participation in the workshops improved the staff's attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.

Factors associated with ABCDE bundle adherence in critically ill adults requiring mechanical ventilation: An observational design.

OBJECTIVE: To identify factors associated with the ABCDEF bundle (Assess, prevent, and manage pain, Both, spontaneous awakening and breathing trials, Choice of sedation/analgesia, Delirium assess, prevent and manage, Early mobility/exercise and Family engagement/empowerment) adherence, in critically ill patients during the first 96 hours of mechanical ventilation. DESIGN: Observational study using electronic health record data. SETTING: 15 intensive care units located in seven community hospitals in a western United States health system. PATIENTS: 977 adult patients who were on mechanical ventilation for greater than 24 hours and admitted to an intensive care unit over six months. MEASUREMENTS AND MAIN RESULTS: Multiple regression analysis was used to examine factors contributing to bundle adherence while adjusting for severity of illness, days on mechanical ventilation, hospital site and time elapsed. ABCDEF bundle adherence was higher in patients on mechanical ventilation for less than 48 hours (p = 0.01), who received continuous sedation for less than 24 hours (p < 0.001), admitted from skilled nursing facilities (p < 0.05), and over the course of the six-month study period (p < 0.01). Bundle adherence was significantly lower for Hispanic patients (p < 0.01). CONCLUSIONS: Our study identified potentially modifiable factors that could improve the team's performance of the ABCDEF bundle in patients requiring mechanical ventilation.

A multisite study of nurse-reported perceptions and practice of ABCDEF bundle components.

OBJECTIVES: ABCDEF bundle implementation in the Intensive Care Unit (ICU) is associated with dose dependent improvements in patient outcomes. The objective was to compare nurse attitudes about the ABCDEF bundle to self-reported adherence to bundle components. RESEARCH METHODOLOGY/DESIGN: Cross-sectional study. SETTING: Nurses providing direct patient care in 28 ICUs within 18 hospitals across the United States. MAIN OUTCOME MEASURES: 53-item survey of attitudes and practice of the ABCDEF bundle components was administered between November 2011 and August 2015 (n = 1661). RESULTS: We did not find clinically significant correlations between nurse attitudes and adherence to Awakening trials, Breathing trials, and sedation protocol adherence (rs = 0.05-0.28) or sedation plan discussion during rounds and Awakening and Breathing trial Coordination (rs = 0.19). Delirium is more likely to be discussed during rounds when ICU physicians and nurse managers facilitate delirium reduction (rs = 0.27-0.36). Early mobilization is more likely to occur when ICU physicians, nurse managers, staffing, equipment, and the ICU environment facilitate early mobility (rs = 0.36-0.47). Physician leadership had the strongest correlation with reporting an ICU environment that facilitates ABCDEF bundle implementation (rs = 0.63-0.74). CONCLUSIONS: Nurse attitudes about bundle implementation did not predict bundle adherence. Nurse manager and physician leadership played a large role in creating a supportive ICU environment.

Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU.

PURPOSE: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. MATERIALS AND METHODS: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). RESULTS: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (-0.8 for each additional year; P = 0.02). CONCLUSIONS: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.

Impact of Early Mobilization in the Intensive Care Unit on Psychological Issues.

Early mobilization is an intervention protocol that can be employed in the critically ill population to effectively reduce the risks and consequences normally associated with immobility in high-acuity patients. In turn, rate and quality of recovery are improved as well as overall patient outcomes. Although there are many challenges inherent to the implementation of an early mobilization program, success of such a program is achievable through structured education of staff and diligence in its application. As a result, staff and patient experience the benefits of medical treatment that addresses a patient's immediate needs without ignoring that treatment's long-term effect.

Mobility bridges a gap in care: Findings from an early mobilisation quality improvement project in acute care.

AIMS AND OBJECTIVES: To qualitatively evaluate an early mobilisation quality improvement project implemented on a general medicine unit. BACKGROUND: Early mobility quality improvement projects show promising quantitative results yet have failed to collect data from patient and staff experience associated with physical activity during illness and the impact of this change in clinical practice. DESIGN: A mixed methods case study was used to evaluate a mobility quality improvement project. Quantitative results will be published separately. The qualitative evaluation used a phenomenological lens to explore the patient and staff experience. METHODS: Semi-structured interviews with twelve participants (four patients and eight staff) were performed during the project. Data were analysed using open coding, direct interpretation and then categorised into an overarching and four supporting themes. Findings are reported per the Standards for Reporting Qualitative Research. RESULTS: Participants reported that early mobilisation bridged a gap in care. Staff understood the benefits of early mobility. Patients expressed how mobility aligned with personal preferences and their need to prepare for hospital discharge. Greater functional independence and higher mobility levels in patients on the unit reduced staff level of care. When patients were consistently presented with opportunities to be mobile and active, they expected mobility to be a part of their daily care plan. CONCLUSIONS: Findings suggest that early mobility quality improvement projects have the potential to transform clinical practice and improve the quality of care for patients in acute care. RELEVANCE TO CLINICAL PRACTICE: All members of the healthcare team, including the patient, recognise the importance of maintaining mobility and function during hospitalisation yet focus on these needs are often delayed or missed. Early mobility quality improvement projects help to set patient expectations and build a culture that promotes patient mobility and function during acute illness.

Can the effects of the mobilization of vulnerable elders in Ontario (MOVE ON) implementation be replicated in new settings: an interrupted time series design.

BACKGROUND: Bed rest for older hospitalized patients places them at risk for hospital-acquired morbidity. We previously evaluated an early mobilization intervention and found it to be effective at improving mobilization rates and decreasing length of stay on internal medicine units. The aim of this study was to conduct a replication study evaluating the impact of the evidence-informed mobilization intervention on surgery, psychiatry, medicine, and cardiology inpatient units. METHODS: A multi-component early mobilization intervention was tailored to the local context at seven hospitals in Ontario, Canada. The primary outcome was patient mobilization measured by conducting visual audits twice a week, three times a day. Secondary outcomes were hospital length of stay and discharge destination, which were obtained from hospital decision support data. The study population was patients aged 65 years and older who were admitted to surgery, psychiatry, medicine, and cardiology inpatient units between March and August 2014. Using an interrupted time series design, the intervention was evaluated over three time periods-pre-intervention, during, and post-intervention. RESULTS: A total of 3098 patients [mean age 78.46 years (SD 8.38)] were included in the overall analysis. There was a significant increase in mobility immediately after the intervention period compared to pre-intervention with a slope change of 1.91 (95% confidence interval [CI] 0.74-3.08, P-value = 0.0014). A decreasing trend in median length of stay was observed in the majority of the participating sites. Overall, a median length of stay of 26.24 days (95% CI 23.67-28.80) was observed pre-intervention compared to 23.81 days (95% CI 20.13-27.49) during the intervention and 24.69 days (95% CI 22.43-26.95) post-intervention. The overall decrease in median length of stay was associated with the increase in mobility across the sites. CONCLUSIONS: MOVE increased mobilization and these results were replicated across surgery, psychiatry, medicine, and cardiology inpatient units.

PICU Early Mobilization and Impact on Parent Stress.

BACKGROUND 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 (rs [119] = 0.489; P ≤ .001) and overall parent stress (rs [110] = 0.272; P = .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.

Negotiated mobilisation: An ethnographic exploration of nurse-patient interactions in an intensive care unit.

AIMS AND OBJECTIVES: To explore nurse-patient interactions in relation to the mobilisation of nonsedated and awake, mechanically ventilated patients in the intensive care unit. BACKGROUND: Lighter sedation has enabled the early mobilisation of mechanically ventilated patients, but little is known about the nurses' role and interaction with critically ill patients in relation to mobilisation. DESIGN AND METHODS: The study had a qualitative design using an ethnographic approach within the methodology of interpretive description. Data were generated in two intensive care units in Denmark, where a strategy of no sedation was applied. Participant observation was conducted during 58 nurse-patient interactions in relation to mobilisation between nurses (n = 44) and mechanically ventilated patients (n = 25). We conducted interviews with nurses (n = 16) and patients (n = 13) who had been mechanically ventilated for at least 3 days. The data were analysed using inductive, thematic analysis. The report of the study adhered to the COREQ checklist. FINDING: We identified three themes: "Diverging perspectives on mobilisation" showed that nurses had a long-term and treatment-oriented perspective on mobilisation, while patients had a short-term perspective and regarded mobilisation as overwhelming in their present situation. "Negotiation about mobilisation" demonstrated how patients actively negotiated the terms of mobilisation with the nurse. "Inducing hope through mobilisation" captured how nurses encouraged mobilisation by integrating aspects of the patient's daily life as a way to instil hope for the future. CONCLUSIONS: Exploring the nurse-patient interactions illustrated that mobilisation is more than physical activity. Mobilisation is accomplished through nurse-patient collaborations as a negotiated, complex and meaningful achievement, which is driven by the logic of care, leading to hope for the future. RELEVANCE TO CLINICAL PRACTICE: The study demonstrated the important role of nurses in achieving mobilisation in collaboration and through negotiation with mechanically ventilated patients in the intensive care unit.

Qualitative, grounded theory exploration of patients' experience of early mobilisation, rehabilitation and recovery after critical illness.

RATIONALE: Physical rehabilitation (encompassing early mobilisation) of the critically ill patient is recognised best practice; however, further work is needed to explore the patients' experience of rehabilitation qualitatively; a better understanding may facilitate implementation of early rehabilitation and elucidate the journey of survivorship. OBJECTIVES: To explore patient experience of physical rehabilitation from critical illness during and after a stay on intensive care unit (ICU). DESIGN: Exploratory grounded theory study using semistructured interviews. SETTING: Adult medical/surgical ICU of a London teaching hospital. PARTICIPANTS: A purposive sample of ICU survivors with intensive care unit acquired weakness (ICUAW) and an ICU length of stay of >72 hours. ANALYSIS: Data analysis followed a four-stage constant comparison technique: open coding, axial coding, selective coding and model development, with the aim of reaching thematic saturation. Peer debriefing and triangulation through a patient support group were carried out to ensure credibility. MAIN RESULTS: Fifteen people were interviewed (with four relatives in attendance). The early rehabilitation period was characterised by episodic memory loss, hallucinations, weakness and fatigue, making early rehabilitation arduous and difficult to recall. Participants craved a paternalised approach to care in the early days of ICU.The central idea that emerged from this study was recalibration of the self. This is driven by a lost sense of self, with loss of autonomy and competence; dehumanised elements of care may contribute to this. Participants described a fractured life narrative due to episodic memory loss, meaning that patients were shocked on awakening from sedation by the discrepancy between their physical form and cognitive representation of themselves. CONCLUSIONS: Recovery from ICUAW is a complex process that often begins with survivors exploring and adapting to a new body, followed by a period of recovering autonomy. Rehabilitation plays a key role in this recalibration period, helping survivors to reconstruct a desirable future.

Early enforced mobilization after liver resection: A prospective randomized controlled trial.

OBJECTIVE: This randomized controlled study investigated the feasibility of early ambulation after liver resection and the effect of the amount of activity on postoperative recovery. METHODS: A total of 120 patients who underwent liver resection were randomly divided into two groups for the comparative analysis of the following factors: amount of activity, pain control, sleeping state, perioperative gastrointestinal function recovery, incidence of complications and postoperative hospital stay. RESULTS: Compared with the control group, patients undergoing liver resection performing early postoperative ambulation had faster gastrointestinal function recovery (First exhaust time 2.2 ±â€¯1.4 vs. 3.3 ±â€¯2.3 p < 0.01; First flatus time 2.3 ±â€¯1.7 vs. 3.1 ±â€¯2.5 p = 0.04) and shorter postoperative hospital stays (6.6 ±â€¯2.3 vs. 7.7 ±â€¯2.1 p = 0.01), with statistically significant differences. There was no significant difference in the incidence of postoperative complications between the two groups (p > 0.05). CONCLUSION: Early ambulation after liver resection is safe and feasible. It can reduce the patient's pain and economic burden, increase the patient's comfort, reduce the nursing workload, achieve rapid recovery, and improve patient satisfaction.

Impressions of Early Mobilization of Critically Ill Children-Clinician, Patient, and Family Perspectives.

OBJECTIVES: To understand patient, family caregiver, and clinician impressions of early mobilization, the perceived barriers and facilitators to its implementation, and the use of in-bed cycling as a method of mobilization. DESIGN: A qualitative study, conducted as part of the Early Exercise in Critically ill Youth and Children, a preliminary Evaluation (wEECYCLE) Pilot randomized controlled trial. SETTING: McMaster Children's Hospital PICU, Hamilton, ON, Canada. PARTICIPANTS: Clinicians (i.e., physicians, nurses, and physiotherapists), family caregivers, and capable patients age greater than or equal to 8 years old who were enrolled in a clinical trial of early mobilization in critically ill children (wEECYCLE). INTERVENTION: Semistructured, face-to-face interviews using a customized interview guide for clinicians, caregivers, and patients respectively, conducted after exposure to the early mobilization intervention. MEASUREMENTS AND MAIN RESULTS: Thirty-seven participants were interviewed (19 family caregivers, four patients, and 14 clinicians). Family caregivers and clinicians described similar interrelated themes representing barriers to mobilization, namely low prioritization of mobilization by the medical team, safety concerns, the lack of physiotherapy resources, and low patient motivation. Key facilitators were family trust in the healthcare team, team engagement, an a priori belief that physical activity is important, and participation in research. Increased familiarity and specific features such as the virtual reality component and ability to execute passive and or active mobilization helped to engage critically ill children in in-bed cycling. CONCLUSIONS: Clinicians, patients, and families were highly supportive of mobilization in critically ill children; however, concerns were identified with respect to how and when to execute this practice. Understanding key stakeholder perspectives enables the development of strategies to facilitate the implementation of early mobilization and in-bed cycling, not just in the context of a clinical trial but also within the culture of practice in a PICU.

"Pain relieved, but still struggling"-Critically ill patients experiences of pain and other discomforts during analgosedation.

AIMS AND OBJECTIVES: To explore how critically ill patients treated according to a strategy of analgosedation experience and handle pain, other discomforts and wakefulness. BACKGROUND: Patients experience both pain and discomfort while in the intensive care unit. International guidelines recommend focused pain treatment and light sedation. An analgosedation protocol favouring pain management, light sedation and early mobilisation was implemented in our university hospital medical and surgical intensive care unit in Norway in 2014. The analgosedation approach may affect patients' experiences of the intensive care unit stay. DESIGN: Exploratory, descriptive design using semi-structured interviews. METHOD: Eighteen adult patients treated in intensive care unit >24 hr and receiving mechanical ventilation were interviewed 1-9 days after intensive care unit discharge. Ten patients were re-interviewed after 3 months. Data were analysed using the "systematic text condensation" approach. FINDINGS: Four main categories emerged from the analysis: "In discomfort, but rarely in pain," "Struggling to get a grip on reality," "Holding on" and "Handling emotionally trapped experiences." "Pain relieved, but still struggling" was the overarching theme. Analgosedation provided good pain relief, but patients still described frequent physical and psychological discomforts, in particular related to mechanical ventilation, not understanding what was going on, and experiences of delusions. To come to terms with their intensive care unit stay, patients needed to participate, trust in others and endure suffering. After hospital discharge, patients described both repression of experiences and searching for recognition of what they had gone through. RELEVANCE TO CLINICAL PRACTICE: Despite good pain relief during analgosedation, other discomforts were commonly described. Critically ill patients still experience an intensive care unit stay as a traumatic part of their illness trajectory. Nurses need to attend carefully also to discomforts other than pain.

Overcoming nursing barriers to intensive care unit early mobilisation: A quality improvement project.

OBJECTIVES: To increase adherence with intensive care unit mobility by developing and implementing a mobility training program that addresses nursing barriers to early mobilisation. DESIGN: An intensive care unit mobility training program was developed, implemented and evaluated with a pre-test, immediate post-test and eight-week post-test. Patient mobility was tracked before and after training. SETTING: A ten bed cardiac intensive care unit. MAIN OUTCOME MEASURES: The training program's efficacy was measured by comparing pre-test, immediate post-test and 8-week post-test scores. Patient mobilisation rates before and after training were compared. Protocol compliance was measured in the post training group. RESULTS: Nursing knowledge increased from pre-test to immediate post-test (p<0.0001) and pre-test to 8-week post-test (p<0.0001). Mean test scores decreased by seven points from immediate post-test (80±12) to 8-week post-test (73±14). Fear significantly decreased from pre-test to immediate post-test (p=0.03), but not from pre-test to 8-week post-test (p=0.06) or immediate post-test to 8-week post-test (p=0.46). Post training patient mobility rates increased although not significantly (p=0.07). Post training protocol compliance was 78%. CONCLUSION: The project successfully increased adherence with intensive care unit mobility and indicates that a training program could improve adoption of early mobility.

Getting Patients Walking: A Pilot Study of Mobilizing Older Adult Patients via a Nurse-Driven Intervention.

OBJECTIVES: To develop a system-based intervention including five components that target barriers to nurse-initiated patient ambulation. DESIGN: Pilot study of Mobilizing Older adult patients VIa a Nurse-driven intervention (MOVIN). SETTING: Twenty-six bed general medical unit. PARTICIPANTS: Nursing staff (registered nurses and certified nursing assistants) were recruited to participate in focus groups. MEASUREMENTS: Information on frequency and distance patients ambulated and nursing staff documentation of patient ambulation were retrieved from the electronic medical record. Regression discontinuity analysis was used to determine a difference between the preintervention and intervention periods in ambulation occurrence, ambulation distance, and percentage of numeric documentation of ambulation. Thematic analysis was used to analyze focus group interviews. RESULTS: A statistically significant increase in number of occurrences (t = 4.18, P = .001) and total distance (t = 2.75, P = .01) and a significantly higher positive slope in percentage of numeric documentation was found during the intervention than before the intervention. Thematic analysis identified three central categories (shifting ownership, feeling supported, making ambulation visible) that describe the effect of MOVIN on nursing staff behaviors and perceptions of the intervention. CONCLUSION: Decreasing loss of independent ambulation in hospitalized older adults requires new and innovative approaches to addressing barriers that prevent nurse-initiated patient ambulation. MOVIN is a promising system-based intervention to promoting patient ambulation and improving outcomes for hospitalized older adults.

[Pain and fear in the ICU]. / Dolor y miedo en la UCI.

Pain and fear are still the most common memories that refer patients after ICU admission. Recently an important politician named the UCI as the branch of the hell. It is necessary to carry out profound changes in terms of direct relationships with patients and their relatives, as well as changes in environmental design and work and visit organization, to banish the vision that our society about the UCI. In a step which advocates for early mobilization of critical patients is necessary to improve analgesia and sedation strategies. The ICU is the best place for administering and monitoring analgesic drugs. The correct analgesia should not be a pending matter of the intensivist but a mandatory course.

Management of pain induced by exercise and mobilization during physical therapy programs: views of patients and care providers.

BACKGROUND: The expectations of patients for managing pain induced by exercise and mobilization (PIEM) have seldom been investigated. We identified the views of patients and care providers regarding pain management induced by exercise and mobilization during physical therapy programs. METHODS: We performed a qualitative study based on semi-structured interviews with a stratified sample of 12 patients (7 women) and 14 care providers (6 women): 4 general practitioners [GPs], 1 rheumatologist, 1 physical medicine physician, 1 geriatrician, 2 orthopedic surgeons, and 5 physical therapists. RESULTS: Patients and care providers have differing views on PIEM in the overall management of the state of disease. Patients' descriptions of PIEM were polymorphic, and they experienced it as decreased health-related quality of life. The impact of PIEM was complex, and patient views were sometimes ambivalent, ranging from denial of symptoms to discontinuation of therapy. Care providers agreed that PIEM is generally not integrated in management strategies. Care providers more often emphasized the positive and less often the negative dimensions of PIEM than did patients. However, the consequences of PIEM cited included worsened patient clinical condition, fears about physical therapy, rejection of the physical therapist and refusal of care. PIEM follow-up is not optimal and is characterized by poor transmission of information. Patients expected education on how better to prevent stress and anxiety generated by pain, education on mobilization, and adaptations of physical therapy programs according to pain intensity. CONCLUSION: PIEM management could be optimized by alerting care providers to the situation, improving communication among care providers, and providing education to patients and care providers.