Daniel L Young1, Jason Seltzer1, Mary Glover1, Caroline Outten1, Annette Lavezza1, Earl Mantheiy1, Ann M Parker1, Dale M Needham2. 1. Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University. 2. Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University. dale.needham@jhmi.edu.
Abstract
BACKGROUND: Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care. OBJECTIVES: To report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit. METHODS: An interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis. RESULTS: During three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%). CONCLUSIONS: Nurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.
BACKGROUND: Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care. OBJECTIVES: To report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit. METHODS: An interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis. RESULTS: During three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%). CONCLUSIONS: Nurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.
Authors: Polly Bailey; George E Thomsen; Vicki J Spuhler; Robert Blair; James Jewkes; Louise Bezdjian; Kristy Veale; Larissa Rodriquez; Ramona O Hopkins Journal: Crit Care Med Date: 2007-01 Impact factor: 7.598
Authors: Margaret S Herridge; Angela M Cheung; Catherine M Tansey; Andrea Matte-Martyn; Natalia Diaz-Granados; Fatma Al-Saidi; Andrew B Cooper; Cameron B Guest; C David Mazer; Sangeeta Mehta; Thomas E Stewart; Aiala Barr; Deborah Cook; Arthur S Slutsky Journal: N Engl J Med Date: 2003-02-20 Impact factor: 91.245
Authors: Margaret S Herridge; Catherine M Tansey; Andrea Matté; George Tomlinson; Natalia Diaz-Granados; Andrew Cooper; Cameron B Guest; C David Mazer; Sangeeta Mehta; Thomas E Stewart; Paul Kudlow; Deborah Cook; Arthur S Slutsky; Angela M Cheung Journal: N Engl J Med Date: 2011-04-07 Impact factor: 91.245
Authors: Peter Nydahl; Thiti Sricharoenchai; Saurabh Chandra; Firuzan Sari Kundt; Minxuan Huang; Magdalena Fischill; Dale M Needham Journal: Ann Am Thorac Soc Date: 2017-05
Authors: Stephen Douglas; Randi Cartmill; Roger Brown; Peter Hoonakker; Jason Slagle; Kara Schultz Van Roy; James M Walker; Matthew Weinger; Tosha Wetterneck; Pascale Carayon Journal: Nurs Res Date: 2013 Jan-Feb Impact factor: 2.381
Authors: Rolf Dubb; Peter Nydahl; Carsten Hermes; Norbert Schwabbauer; Amy Toonstra; Ann M Parker; Arnold Kaltwasser; Dale M Needham Journal: Ann Am Thorac Soc Date: 2016-05
Authors: David N Hager; Victor D Dinglas; Shilta Subhas; Annette M Rowden; Karin J Neufeld; O Joseph Bienvenu; Pegah Touradji; Elizabeth Colantuoni; Dereddi R S Reddy; Roy G Brower; Dale M Needham Journal: Crit Care Med Date: 2013-06 Impact factor: 7.598
Authors: Romina Wahab; Natalie H Yip; Subani Chandra; Michael Nguyen; Katherine H Pavlovich; Thomas Benson; Denise Vilotijevic; Danielle M Rodier; Komal R Patel; Patricia Rychcik; Ernesto Perez-Mir; Suzanne M Boyle; David Berlin; Dale M Needham; Daniel Brodie Journal: J Intensive Care Soc Date: 2015-09-21
Authors: Carrie M Goodson; Lisa Aronson Friedman; Earl Mantheiy; Kevin Heckle; Annette Lavezza; Amy Toonstra; Ann M Parker; Jason Seltzer; Michael Velaetis; Mary Glover; Caroline Outten; Kit Schwartz; Antionette Jones; Sarah Coggins; Erik H Hoyer; Kitty S Chan; Dale M Needham Journal: J Intensive Care Med Date: 2018-10-18 Impact factor: 3.510
Authors: Ann M Parker; Narges Akhlaghi; Albahi M Malik; Lisa Aronson Friedman; Earl Mantheiy; Kelsey Albert; Mary Glover; Sherry Dong; Annette Lavezza; Jason Seltzer; Dale M Needham Journal: Aust Crit Care Date: 2021-06-18 Impact factor: 3.265