Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit

Authors

Daniel L. Young PT, DPT, PhD, University of Nevada, Las VegasFollow
Jason Seltzer PT, DPT, Johns Hopkins Hospital
Mary Glover RN, Johns Hopkins Hospital
Caroline Outten RN, BSN, CCRN, Johns Hopkins Hospital
Annette Lavezza OTR/L, Johns Hopkins HospitalFollow
Earl Mantheiy, Johns Hopkins University
Ann M. Parker, Johns Hopkins University
Dale M. Needham, Johns Hopkins University; Johns Hopkins HospitalFollow

Document Type

Article

Publication Date

5-1-2018

Publication Title

American Journal of Critical Care

Volume

27

Issue

3

First page number:

186

Last page number:

193

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.

Keywords

Adult; Article; Content analysis; Documentation; Human; Intensive care unit; Language; Nurse; Patient care; Patient mobility

Disciplines

Physical Therapy

Language

English

Repository Citation

Young, D. L., Seltzer, J., Glover, M., Outten, C., Lavezza, A., Mantheiy, E., Parker, A. M., Needham, D. M. (2018). Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit. American Journal of Critical Care, 27(3), 186-193.
http://dx.doi.org/10.4037/ajcc2018368