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Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive...
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Objectives:
This retrospective observational study investigated whether the degree of muscular echogenicity in patients admitted to the intensive care unit (ICU) could help with the early detection of ICU-acquired weakness (ICU-AW) and predict physical function at hospital discharge.
Methods:
Twenty-five patients who were mechanically ventilated...
Citations
... At the same time a situation-specific mobility plan to optimise the mobilisation of conscious and mechanically ventilated ICU patients must be maintained. (Clarissa et al., 2022;Laerkner et al., 2019) and physiotherapists (Corner et al., 2019). Thus, patients can become active participants, and not just the object of care and treatment (Bjurling-Sjöberg et al., 2017). ...
... The present finding of mobilisation practice understood in terms of an engaging relationship between HCPs and patients has been found in other studies as dynamic processes of negotiating mobilisation (Clarissa et al., 2022;Laerkner et al., 2019) or like a temporary desired paternalism (Corner et al., 2019). The relationship is asymmetrical based on dependency and an asymmetric power relation with the MV patient as the weak part, not being able to speak or move themselves. ...
... This study highlighted that the practice of mobilisation is embedded within an extensive effort of constant planning, flexibility, and re-planning in the interprofessional team. As recently described by Clarissa et al, mobilisation during MV was often unscheduled with a need of flexible timing because of the changing condition of ICU patients (Clarissa et al., 2022). Furthermore, lack of prioritising mobilisation due to other patient-or unit-related demands in ICU practice, unclear boundaries of responsibility , shift work and unclear team communication regarding an mobility plan (Krupp et al., 2018), also affect the planning of mobilisation. ...
Aim
To explore the practice of mobilisation of conscious and mechanically ventilated patients and the interaction between patients, nurses and physiotherapists.
Background
Long‐term consequences of critical illness can be reduced by mobilisation starting in Intensive Care Units, but implementation in clinical practice is presently sparse.
Design
A qualitative study with a phenomenological‐hermeneutic approach.
Methods
Participant observations in three Intensive Care Units involved twelve conscious mechanically ventilated patients, thirty‐one nurses and four physiotherapists. Additionally seven semi‐structured patient interviews, respectively at the ward and after discharge and two focus group interviews with healthcare professionals were conducted. The data analysis was inspired by Ricoeur's interpretation theory. The study adhered to the COREQ checklist.
Findings
Healthcare professionals performed a balance of support and guidance to promote mobilisation practice. The complexity of ICU mobilisation required a flexible mobility plan. Furthermore, interaction with feedback and humour was found to be ‘a leverage’ for patient's motivation to partake in mobilisation.
The practice of mobilisation found patients striving to cope and healthcare professionals promoting a ‘balanced standing by’ and negotiating the flexible mobility plan to support mobilisation.
Conclusion
The study revealed a need to clarify interprofessional communication to align expectations towards mobilisation of conscious and mechanically ventilated patients.
Relevance to Clinical Practice
The study demonstrated the important role of healthcare professionals to perform a stepwise and ‘balanced standing by’ in adequately supporting and challenging the mobilisation of mechanically ventilated patients. Furthermore, a synergy can arise when nurses and physiotherapists use supplementary feedback and humour, and cooperate based on a flexible situation‐specific mobility plan in intensive care.
... Altogether, this indicates a current gap between the perceived need to enhance the level of mobilisation in patients on MV and the actual implementation of mobilisation interventions into ICU routine care. Moreover, embracing the new paradigm of non-sedation during MV opens up a unique opportunity for patient interaction with ICU nurses (Laerkner et al., 2019) and physiotherapists, to achieve a balance between patients' preferences and the need to ensure safe practice (Clarissa et al., 2022). ...
Objective:
To gain an in-depth understanding of the phenomenon of mobilisation when conscious and mechanically ventilated patients are mobilised in the intensive care unit.
Design:
A qualitative study with a phenomenological-hermeneutic approach. Data were generated in three intensive care units from September 2019 to March 2020. Participant observations of twelve conscious mechanically ventilated patients, thirty-five nurses and four physiotherapists were performed. Furthermore, seven semi-structured patient interviews were conducted, both on the ward and after discharge.
Findings:
Mobilisation during mechanical ventilation in the intensive care unit followed a trajectory from a failing body to a growing sense of independence in getting the body back on track. Three themes were revealed: 'Challenging to move a failing body', 'Ambiguity of both resistance and willingness in the process of strengthen the body', and 'An ongoing effort in getting the body back on track'.
Conclusions:
Mobilisation when conscious and mechanically ventilated included support of the living body by physical prompts and ongoing bodily guidance. Resistance and willingness regarding mobilisation were found to be a way of coping with bodily reactions of comfort or discomfort, embedded in a need to feel bodily control. The trajectory of mobilisation promoted a sense of agency, as mobilisation activities at different stages during the intensive care unit stay supported the patients in becoming more active collaborators in getting the body back on track.
Implications for clinical practice:
Ongoing bodily guidance provided by healthcare professionals can promote bodily control and support conscious and mechanically ventilated patients in active participation in mobilisation. Furthermore, understanding the ambiguity of patients' reactions caused by loss of bodily control provides a potential to prepare mechanically ventilated patients for and assist them with mobilisation. In particular, the first mobilisation in the intensive care unit seems to influence the success of future mobilisation, as the body remembers negative experiences.
