Selina M Parry1, Louisa Remedios2, Linda Denehy3, Laura D Knight4, Lisa Beach4, Thomas C Rollinson5, Sue Berney5, Zudin A Puthucheary6, Peter Morris7, Catherine L Granger8. 1. Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia. Electronic address: selina.parry@unimelb.edu.au. 2. Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia. 3. Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Bowen Centre, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Victoria, Australia. 4. Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan St, Parkville 3050, Victoria, Australia. 5. Department of Physiotherapy, Austin Hospital, 145 Studely Rd, Heidelberg 3084, Victoria, Australia. 6. Critical Care, University College Hospital, London, United Kingdom. 7. Department of Critical Care, University of Kentucky, Lexington, KY. 8. Department of Physiotherapy, The University of Melbourne, Level 7 Alan Gilbert Bldg, 161 Barry St, Parkville 3010, Victoria, Australia; Institute for Breathing and Sleep, Bowen Centre, Austin Hospital, 145 Studley Rd, Heidelberg 3084, Victoria, Australia; Department of Physiotherapy, Royal Melbourne Hospital, 300 Grattan St, Parkville 3050, Victoria, Australia.
Abstract
PURPOSE: To identify the barriers and enablers that influence clinicians' implementation of early rehabilitation in critical care. MATERIALS AND METHODS: Qualitative study involving 26 multidisciplinary participants who were recruited using purposive sampling. Four focus groups were conducted using semistructured questions to explore attitudes, beliefs, and experiences. Data were transcribed verbatim and thematic analysis was performed. RESULTS: Six themes emerged, as follows: (1) the clinicians' expectations and knowledge (including rationale for rehabilitation, perceived benefits, and experience), (2) the evidence for and application of rehabilitation (including beliefs regarding when to intervene), (3) patient factors (including prognosis, sedation, delirium, cooperation, motivation, goals, and family), (4) safety considerations (including physiological stability and presence of devices or lines), (5) environmental influences (staffing, resources, equipment, time, and competing priorities), and (6) culture and teamwork. Key strategies identified to facilitate rehabilitation included addressing educational needs for all multidisciplinary team members, supporting junior nursing staff, and potential expansion of physiotherapy staffing hours to closer align with the 24-hour patient care model. CONCLUSIONS: Key barriers to implementation of early rehabilitation in critical care are diverse and include both clinician- and health care system-related factors. Research targeted at bridging this evidence-practice gap is required to improve provision of rehabilitation.
PURPOSE: To identify the barriers and enablers that influence clinicians' implementation of early rehabilitation in critical care. MATERIALS AND METHODS: Qualitative study involving 26 multidisciplinary participants who were recruited using purposive sampling. Four focus groups were conducted using semistructured questions to explore attitudes, beliefs, and experiences. Data were transcribed verbatim and thematic analysis was performed. RESULTS: Six themes emerged, as follows: (1) the clinicians' expectations and knowledge (including rationale for rehabilitation, perceived benefits, and experience), (2) the evidence for and application of rehabilitation (including beliefs regarding when to intervene), (3) patient factors (including prognosis, sedation, delirium, cooperation, motivation, goals, and family), (4) safety considerations (including physiological stability and presence of devices or lines), (5) environmental influences (staffing, resources, equipment, time, and competing priorities), and (6) culture and teamwork. Key strategies identified to facilitate rehabilitation included addressing educational needs for all multidisciplinary team members, supporting junior nursing staff, and potential expansion of physiotherapy staffing hours to closer align with the 24-hour patient care model. CONCLUSIONS: Key barriers to implementation of early rehabilitation in critical care are diverse and include both clinician- and health care system-related factors. Research targeted at bridging this evidence-practice gap is required to improve provision of rehabilitation.
Authors: Kristin E Schwab; An Q To; Jennifer Chang; Bonnie Ronish; Dale M Needham; Jennifer L Martin; Biren B Kamdar Journal: J Intensive Care Med Date: 2019-07-22 Impact factor: 2.889