What factors affect implementation of early rehabilitation into intensive care unit practice? - A qualitative study with clinicians

AuthorsParry, SM
Remedios, L
Denehy, L
Knight, LD
Beach, L
Rollinson, TC
Berney, S
Puthucheary, ZA
Morris, P
Granger, CL
TypeJournal Article (Original Research)
JournalJournal of Critical Care
PubMed ID27902947
Year of Publication2017
AbstractAbstractPurpose 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 semi-structured questions to explore attitudes, beliefs and experiences. Data were transcribed verbatim and thematic analysis was performed. Results Six themes emerged: 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 multi-disciplinary 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 healthcare system related factors. Research targeted at bridging this evidence-practice gap is required to improve provision of rehabilitation.


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