1
|
DeMarco JT, Iennaco JD. AMPlifying metabolic screening for inpatients on antipsychotic medications with a nurse-driven protocol. Arch Psychiatr Nurs 2024; 49:113-117. [PMID: 38734446 DOI: 10.1016/j.apnu.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Patients on antipsychotic medications are at higher risk of developing metabolic syndrome; nevertheless, metabolic screening for patients on antipsychotics is suboptimal. METHODS This project developed and implemented AMP (Antipsychotic Metabolic screening Protocol), a nurse-driven protocol on inpatient psychiatric units that allowed nursing staff to collect all components of a metabolic screening. Nurses working on units with AMP were surveyed pre- and post-implementation on perception of AMP and empowerment. RESULTS AMP significantly increased overall metabolic screening as well as the most frequently missing component (lipid panel). The screening rates pre-intervention were similar to those found in the literature (on average, only two-thirds of patients were screened). However, AMP improved the rate such that nine out of every ten patients on the units were screened. Nurses had a negative perception and no change in empowerment from AMP implementation. CONCLUSIONS AMP can be used to increase metabolic screening for patients on antipsychotics. Further research is needed to better understand adoptability of nurse-driven protocols in the psychiatric inpatient setting as well as other applications, such as smoking cessation or safety sitters.
Collapse
Affiliation(s)
- James T DeMarco
- George Mason University, 4400 University Drive, MSN 3C4, United States of America.
| | | |
Collapse
|
2
|
Broadway K, Nuila CM. Implementation of an Interprofessional Mobility Program in a Neurosurgical Intensive Care Unit. J Neurosci Nurs 2023; 55:205-210. [PMID: 37738106 DOI: 10.1097/jnn.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
ABSTRACT BACKGROUND: Emerging research suggests the need for implementation of mobility protocols and consistent evaluation of the impact on patient outcomes. Standardized mobility guidelines may be a solution for promoting nurse-driven mobility efforts and influencing a shift in the culture of mobility among nursing teams. In a 36-bed neurosurgical intensive care unit, 2 key areas of opportunity were identified related to patient mobility: strengthening of frontline nursing engagement in mobility and accuracy of documented early and safe mobilization. METHODS: Using a plan-do-study-act performance improvement framework, an interprofessional team developed a comprehensive early patient mobility program. Defined criteria and mobility rounds assisted in identifying the patient's functional ability and level of assistance. Nursing staff received education in case study format to enhance understanding and improve practical application of the phases of mobility. Chart reviews served as continuous assessment of documented mobilizations within the appropriate phases of mobility, and surveys evaluated staff perceptions of program success. RESULTS: On a rating scale of 1 to 5, clinicians reported a rating of 4.32 in overall observation that patients are safely mobilized earlier and more frequently and 4.48 on overall improvement in the neurosurgical intensive care unit culture of mobility. CONCLUSION: An interprofessional mobility program focusing on safe and early mobilization may improve overall culture, confidence, and empowerment of the frontline clinicians.
Collapse
Affiliation(s)
- Katie Broadway
- Cristina M. Nuila, MSN RN CNL, is Manager, Quality and Performance Improvement, Houston Methodist Hospital, Houston, TX
| | | |
Collapse
|
3
|
Feasibility of an Enhanced Therapy Model of Care for Hospitalized Stroke Patients. Am J Phys Med Rehabil 2023; 102:S19-S23. [PMID: 36634326 DOI: 10.1097/phm.0000000000002140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The aim of this study was to determine the safety and feasibility of an enhanced therapy model for hospitalized stroke patients. METHODS This was a quasi-experimental cohort study of acute stroke patients from a single hospital. In the intervention group, all hospitalized patients on the acute stroke service were seen by at least two therapy disciplines daily in addition to routine stroke care. The comparison group consisted of all patients admitted to the same stroke service 1 year before who received the standard of care. The primary endpoint was the number of completed therapy sessions. Exploratory endpoints compared the length of hospital stay, hospital readmission rates, and degree of disability measured by the 90-day modified Rankin Scale score. RESULTS A total of 1110 records were analyzed with 553 subjects in the intervention group and 557 in the control group. The intervention group received a significantly higher number of therapy sessions. There was no significant difference in length of hospital stay. However, 30-day readmission rates were lower, and the percentage of patients who achieved a good functional outcome on the modified Rankin Scale was higher during the intervention period. CONCLUSION Increasing exposure to intensive multidisciplinary therapy comparable with that of acute inpatient rehabilitation in the hospital setting is feasible and may reduce both readmission rates and disability.
Collapse
|
4
|
LaRosa JM, Nelliot A, Zaidi M, Vaidya D, Awojoodu R, Kudchadkar SR. Mobilization Safety of Critically Ill Children. Pediatrics 2022; 149:e2021053432. [PMID: 35352118 PMCID: PMC9648104 DOI: 10.1542/peds.2021-053432] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children in PICUs experience negative sequelae of immobility; however, interprofessional staff concerns about safety are a barrier to early mobilization. Our objective was to determine the safety profile of early mobilization in PICU patients. METHODS We conducted a secondary analysis of a 2-day study focused on physical rehabilitation in 82 PICUs in 65 US hospitals. Patients who had ≥72-hour admissions and participated in a mobility event were included. The primary outcome was occurrence of a potential safety event during mobilizations. RESULTS On 1433 patient days, 4658 mobility events occurred with a potential safety event rate of 4% (95% confidence interval [CI], 3.6%-4.7%). Most potential safety events were transient physiologic changes. Medical equipment dislodgement was rare (0.3%), with no falls or cardiac arrests. Potential safety event rates did not differ by patient age or sex. Patients had higher potential safety event rates if they screened positive for delirium (7.8%; adjusted odds ratio, 5.86; 95% CI, 2.17-15.86) or were not screened for delirium (4.7%; adjusted odds ratio, 3.98; 95% CI, 1.82-8.72). There were no differences in potential safety event rates by PICU intervention, including respiratory support or vasoactive support. CONCLUSIONS Early PICU mobilization has a strong safety profile and medical equipment dislodgement is rare. No PICU interventions were associated with increased potential safety event rates. Delirium is associated with higher potential safety event rates. These findings highlight the need to improve provider education and confidence in mobilizing critically ill children.
Collapse
Affiliation(s)
| | - Archana Nelliot
- Johns Hopkins University School of Medicine, Baltimore,
Maryland
| | - Munfarid Zaidi
- Johns Hopkins University School of Medicine, Baltimore,
Maryland
| | | | - Ronke Awojoodu
- Departments of Anesthesiology and Critical Care
Medicine
| | - Sapna R. Kudchadkar
- Departments of Anesthesiology and Critical Care
Medicine
- Pediatrics
- Physical Medicine & Rehabilitation
| |
Collapse
|
5
|
Mukpradab S, Mitchell M, Marshall AP. An Interprofessional Team Approach to Early Mobilisation of Critically Ill Adults: An Integrative Review. Int J Nurs Stud 2022; 129:104210. [DOI: 10.1016/j.ijnurstu.2022.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
|
6
|
Nease B, Chen K, Hash PL. Interdisciplinary perceived barriers to exercise and mobility in acute care medical patients. Nurs Manag (Harrow) 2021; 52:48-54. [PMID: 34723886 DOI: 10.1097/01.numa.0000795624.91059.2b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Beth Nease
- Beth Nease is an assistant professor of nursing at Western Carolina University in Cullowhee, N.C., and a nurse scientist at Bon Secours Mercy Health in Cincinnati, Ohio. Kong Chen is a faculty research support specialist at Western Carolina University in Cullowhee, N.C. Pam L. Hash is the vice president of nursing professional practice, education, and research at Bon Secours Mercy Health in Cincinnati, Ohio
| | | | | |
Collapse
|
7
|
Physical Rehabilitation in Critically Ill Children: A Multicenter Point Prevalence Study in the United States. Crit Care Med 2021; 48:634-644. [PMID: 32168030 DOI: 10.1097/ccm.0000000000004291] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers. DESIGN National 2-day point prevalence study. SETTING Eighty-two PICUs in 65 hospitals across the United States. PATIENTS All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was prevalence of physical therapy- or occupational therapy-provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility-associated safety events, and barriers to mobility. The point prevalence of physical therapy- or occupational therapy-provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13-17 vs < 3 yr, 2.1; 95% CI, 1.5-3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61-0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1-0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1-0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1-6.6). CONCLUSIONS Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.
Collapse
|
8
|
Danielis M, Destrebecq ALL, Terzoni S, Palese A. Nursing care factors influencing patients' outcomes in the intensive care unit: Findings from a rapid review. Int J Nurs Pract 2021; 28:e12962. [PMID: 34002435 PMCID: PMC9286446 DOI: 10.1111/ijn.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/17/2021] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
Aims To examine the nursing care factors investigated regarding their influence on outcomes of critically ill patients. Background A large number of studies have considered patients' outcomes as sensitive to nursing practice in intensive care unit environments. However, no summary of nursing factors influencing these outcomes has been provided. Design Rapid review, following the seven‐stage process outlined by Tricco and colleagues. Data Sources Articles published up to March 2020 were identified in MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases. Review Methods Eligibility of studies was first assessed at the title and abstracts level. Study inclusion was then established by two researchers by analysing the full texts. Results A total of 93 studies were included, with a total of 21 nursing care factors documented. At the structural level, nursing factors have been investigated at the organizational and at the personnel level. At the process level, nurse‐led programmes, independent nursing interventions and nurse behaviours have been investigated to date. Conclusion The set of nursing factors that emerged can be used in future research to improve poorly developed areas and to accumulate further evidence through additional studies, both at managerial and practice levels. What is already known about this topic?
Thirty‐five nursing‐sensitive outcomes capable of being used to measure the quality of care in the intensive care unit have been identified to date. Several nursing care factors in structural and process dimensions have been documented as having an influence on the outcomes of critically ill patients.
What this paper adds:
Many interventions have been assessed in relation to nursing outcomes, more often at the process than at structural levels. Specifically, a total of 21 nursing factors have been studied to date in the context of intensive care units, divided into structure (organizational and personnel) and process (nurse‐led programmes, independent nursing interventions and behaviours) dimensions.
The implications of this paper
The set of nursing factors that emerged can be considered as a basis for further research, especially regarding poorly developed areas. Emergent nursing care factors can be used as a blueprint to design and develop educational programmes both at under‐ and postgraduate levels. At the managerial levels, both structure and process dimensions of nursing care are capable of affecting outcomes and could be used to inform decision‐making.
Collapse
Affiliation(s)
- Matteo Danielis
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,School of Nursing, Department of Medical and Biological Sciences, Udine University, Udine, Italy
| | | | | | - Alvisa Palese
- School of Nursing, Department of Medical and Biological Sciences, Udine University, Udine, Italy
| |
Collapse
|
9
|
Hernandez S, Kittelty K, Hodgson CL. Rehabilitating the neurological patient in the ICU: what is important? Curr Opin Crit Care 2021; 27:120-130. [PMID: 33395083 DOI: 10.1097/mcc.0000000000000804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To describe recent literature evaluating the effectiveness of early rehabilitation in neurocritical care patients. RECENT FINDINGS There is a drive for early rehabilitation within the ICU; however, there are unique considerations for the neurocritically ill patient that include hemiplegia, cognitive impairments and impaired conscious state that can complicate rehabilitation. Additionally, neurological complications, such as hemorrhage expansion and cerebral edema can lead to the risk of further neurological damage. It is, therefore, important to consider the effect of exercise and position changes on cerebral hemodynamics in patients with impaired cerebral autoregulation. There is a paucity of evidence to provide recommendations on timing of early rehabilitation postneurological insult. There are also mixed findings on the effectiveness of early mobilization with one large, multicenter RCT demonstrating the potential harm of early and intensive mobilization in stroke patients. Conversely, observational trials have found early rehabilitation to be well tolerated and feasible, reduce hospital length of stay and improve functional outcomes in neurological patients admitted to ICU. SUMMARY Further research is warranted to determine the benefits and harm of early rehabilitation in neurological patients. As current evidence is limited, and given recent findings in stroke studies, careful consideration should be taken when prescribing exercises in neurocritically ill patients.
Collapse
Affiliation(s)
- Sabrina Hernandez
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital
| | - Katherine Kittelty
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne
- Department of Physiotherapy, The Alfred Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Young D, Kudchadkar SR, Friedman M, Lavezza A, Kumble S, Daley K, Flanagan E, Hoyer E. Using Systematic Functional Measurements in the Acute Hospital Setting to Combat the Immobility Harm. Arch Phys Med Rehabil 2020; 103:S162-S167. [PMID: 33373600 DOI: 10.1016/j.apmr.2020.10.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022]
Abstract
Hospitalized patients often experience unnecessary immobility and inactivity leading to direct harms and poor outcomes. Despite growing evidence that early and regular mobility and activity are safe and helpful for patients in the hospital, there remains substantial room for improvement in clinical practice. Key to improvement is establishing an interdisciplinary approach to measurement and communication using a common language of function. Here we provide a framework for systematic functional measurement in the hospital. We also provide 3 specific examples of how this framework has been used to improve care: (1) targeting specialized rehabilitation providers to the patients most likely to need their services, (2) generating a daily mobility goal for all patients, and (3) identifying patients early who are likely to require postacute care.
Collapse
Affiliation(s)
- Daniel Young
- Department of Physical Therapy, University of Nevada, Las Vegas, Nevada; Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland.
| | - Sapna R Kudchadkar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland; Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eleni Flanagan
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| |
Collapse
|
11
|
A novel early mobility bundle improves length of stay and rates of readmission among hospitalized general medicine patients. J Community Hosp Intern Med Perspect 2020; 10:419-425. [PMID: 33235675 PMCID: PMC7671722 DOI: 10.1080/20009666.2020.1801373] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Inpatient early mobility initiatives are effective therapeutic interventions for improving patient outcomes and decreasing use of hospital resources among adult ICU and general medicine patients. To establish and demonstrate guidelines for early patient ambulation, we developed and implemented a novel multidisciplinary mobility bundle utilizing the JH-HLM (Johns Hopkins Highest Level of Mobility) scale for mobility classification, on a single adult general medicine unit of a community hospital. Our results show that patients admitted to the unit after implementation of the mobility bundle had improved mobility scores, reduced rates of 30-day hospital readmission, and a shortened length of hospital stay. This study emphasizes the importance of measuring mobility using a systematic method, easing workflow among unit practitioners, and allowing mobility initiatives to be jointly driven by nursing, physical therapy, and physicians.
Collapse
|
12
|
Dima D, Valiquette J, Berube‐Dufour J, Goldfarb M. Level of function mobility scale for nurse‐driven early mobilisation in people with acute cardiovascular disease. J Clin Nurs 2019; 29:778-784. [DOI: 10.1111/jocn.15124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/24/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Diana Dima
- Department of Nursing Jewish General Hospital McGill University Montreal QC Canada
| | - Julie Valiquette
- Department of Physiotherapy Jewish General Hospital McGill University Montreal QC Canada
| | - Joelle Berube‐Dufour
- Department of Occupational Therapy Jewish General Hospital McGill University Montreal QC Canada
| | - Michael Goldfarb
- Division of Cardiology Jewish General Hospital McGill University Montreal QC Canada
| |
Collapse
|
13
|
Danielis M, Palese A, Terzoni S, Destrebecq ALL. What nursing sensitive outcomes have been studied to-date among patients cared for in intensive care units? Findings from a scoping review. Int J Nurs Stud 2019; 102:103491. [PMID: 31862529 DOI: 10.1016/j.ijnurstu.2019.103491] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although many studies have considered mortality and adverse effects as outcomes sensitive to nursing practice, it seems that other outcomes of nursing care in intensive care units have been explored less commonly. OBJECTIVES To describe the state-of-science in research in the field of nursing sensitive outcomes in intensive care units and to synthesize outcomes that have been documented to date as being influenced by nursing care. DESIGN A scoping review study based on the framework proposed by Arksey and O'Malley, further refined by the Levac and Joanna Briggs Institute was performed in 2019. DATA SOURCES The Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, and Google Scholar electronic databases were searched. In addition, the reference list of included articles was screened. REVIEW METHODS Two researchers independently identified publications on the basis of the following criteria: (a) articles that reported nursing sensitive outcomes on critically-ill adult patients admitted to the intensive care unit, (b) as primary and secondary studies, (c) written in English, and (d) without any time frame limitation. RESULTS Of the 4,231 records, 112 fully met the inclusion criteria and were included. Publications were mainly authored in the US and Canada (n = 44, 39.2%), and the majority (n = 62, 55.3%) had an observational design. A total of 233 nursing sensitive outcomes emerged, categorized in 35 outcomes, with, on average, two per study included. The most often measured outcomes were pressure ulcers (20 studies) and ventilator-associated pneumonias (19 studies); the less studied outcomes were quality of life, secretion clearance, patient-ventilator dysynchrony, and post-extubation dysphagia. When categorizing outcomes, the ones concerning safety (n = 77, 33.1%) were represented the most, followed by those concerning the clinical (n = 72, 30.9%), functional (n = 70, 30.0%), and perceptual (n = 14, 6.0%) domains. The interdependent outcomes linked to multi-professional interventions (e.g., ventilator-associated pneumonias) were the most frequently studied nursing sensitive outcomes (n = 20, 57.1%), while independent outcomes resulting from autonomous interventions performed by nurses were less often studied (n = 8, 22.9%). CONCLUSIONS From a clinical point of view, a large heterogeneity of outcomes influenced by nursing care emerged. However, identified outcomes have been studied with different approaches and metrics, so that future efforts will need to establish homogeneous conceptual and operative definitions. Moreover, increasing efforts in establishing perceptual outcomes, or those close to the fundamentals of nursing care, are suggested in order to better depict the contribution of critical care nurses in the field.
Collapse
Affiliation(s)
- Matteo Danielis
- Department of Clinical Sciences and Community Health, University of Milan, Via Vanzetti 5, 20133 Milan, Italy; School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy.
| | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, University of Udine, Udine, Italy
| | - Stefano Terzoni
- School of Nursing, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | | |
Collapse
|
14
|
|
15
|
Physiotherapy in the neurotrauma intensive care unit: A scoping review. J Crit Care 2018; 48:390-406. [PMID: 30316038 DOI: 10.1016/j.jcrc.2018.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/20/2018] [Accepted: 09/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurological and/or traumatic injuries in the intensive care unit (ICU), identifies literature gaps and provides recommendations for future research. MATERIALS AND METHODS We searched five databases from inception to June 2, 2018. We included published retrospective studies, case studies, observation and randomized controlled trials describing physiotherapy interventions in ICU patients with neurotrauma injuries. Two reviewers reviewed the databases and independently screened English articles for eligibility. Data extracted included purpose, study design, population (s), outcome measures, interventions and results. Thematic analysis and descriptive numerical summaries are presented by intervention type. RESULTS 12,846 titles were screened and 72 met the inclusion criteria. Most of the studies were observational studies (44 (61.1%)) and RCTs (14 (19.4%)). Early mobilization, electrical stimulation, range of motion, and chest physiotherapy techniques were the most common interventions in the literature. Physiotherapy interventions were found to be safe with few adverse events. CONCLUSIONS Gaps in the literature suggest that future studies require assessment of long term functional outcomes and quality of life, examination of homogenous populations and more robust methodologies including clinical trials and larger samples.
Collapse
|