Nurse
Lene Lehmkuhl
Department of Anestesiology and Intensive Care, Odense University Hospital
Projekt styring | ||
Projekt status | Planning | |
Data indsamlingsdatoer | ||
Start | 01.04.2019 | |
Slut | 31.03.2023 | |
Early mobilization has a positive effect on patients' rehabilitation. In this project, we develop a tool to support interdisciplinary cooperation and patient involvement, in order to optimize early mobilization in the intensive care unit (ICU).\n
In Denmark, 30.000 patients are treated in an ICU every year. An ICU admission can cause a variety of physical and psychological health challenges years after discharge. Early mobilization can improve muscle strength, physical function, walking ability and days alive and out of the hospital. Early mobilization is an achievable and safe procedure for patients, who are intubated and mechanical ventilated.
\nDespite positive effects, only 8-16% of the patients are mobilized early in the ICU, which indicates that current healthcare practice can be improved.
\nA change in medical treatment, towards less sedation of mechanically ventilated patients, is implemented in the ICU within the last decade. This makes it possible for patients to interact and participate in various activities according to their actual resources.
\nTo summarize, there is a need to support early mobilization in the ICU to improve the patient's rehabilitation. This can be done by facilitating cooperation and patient involvement in finding new tools and new ways of delivering and organizing healthcare.
\nThe overall purpose of the project is to optimize early and active mobilization in the ICU, by developing a supportive tool involving patients and relatives and facilitating interdisciplinary cooperation.
\nThe project consists of 3 research phases with the following objectives:
\nTo identify interactions and needs associated with early mobilization of involved patients, relatives and healthcare professionals; physicians, nurses and physiotherapists
\nTo design and develop a supportive tool for early active mobilization
\nTo test and evaluate the solution
\nThe project is based on a participatory design where an important cornerstone is user involvement and finding solutions to encounter the actual problems and needs of the users. The research process is explorative.
\nParticipatory design has succeeded including highly vulnerable patients with limited resources. In this study, we will be aware of to the vulnerable condition of the patients and relatives. The authorized healthcare professionals involved in the project will show sensitivity and empathy. The study will be carried out over a period of 4 years, to secure inclusion and data collection due to the patient's vulnerable condition. The project will be performed according to current scientific ethical guidelines.
\nThe project will contribute to a new understanding and development of our practice, where timing and organization of early and active mobilization supports the patients' needs, both physically and psychosocially. It will also highlight new knowledge about the involvement of patients and their relatives in a complex practice in the ICU with no-sedated mechanical ventilated patients.
\nThe project will give a voice to patients and show how to organize rehabilitation in interdisciplinary cooperation involving the end-user contributing to better use of healthcare resources.
\nAn early and well-established rehabilitation starting at the ICU requires continuous effort, leading to the implementation of a coordinated rehabilitation across the health sector in order to support patients with a variety of diseases, physical and psychosocial challenges to resume their everyday lives.
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The participants will be recruited among patients at ICU, their relatives and Healthcare professionals, at the Intensive Care Unit at OUH, Svendborg Hospital and at the Intensive Care Unit (ITA2) at Odense University Hospital in Odense.
\nInclusion criteria:
\nPatients over 18 years
\nEndotracheal intubated within the last 24 hours and expected time on ventilator > 24 hours
\nPatients where mobilization is possible according to guideline and medical prescription
\nRASS: -1 / + 1, CAM-ICU negative
\nRelatives present at the bedside together with the included patient and over 18 years
\nPhysicians, nurses and physiotherapist working at the included ICUs
\nExclusion criteria:
\nPatients defined as no-touch on medical indication e.g. unstable condition or inevitably dying
\nCognitive impairment (diagnosed with dementia, autism or mentally retarded)
\nPhysical obstruction e.g. para-/tetraplegia and
\nUnable to communicate in Danish or English
\nRelatives with cognitive impairment (diagnosed with dementia, autism or mentally retarded) and
\nUnable to communicate in Danish or English
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The project consists of 3 research phases where the following data is collected:
\nIn phase 1, field-observations in the ICU are conducted and interviews with 10-12 patients and their relatives and with healthcare professionals. This is supplied with accelometery to monitor the patient's movement pattern.
\nIn phase 2, a prototype of the tool is designed based on the findings in phase 1. The tool is tested and re-designed in a cooperative process involving representatives from all end-users and is organized in 3 workshops. The tool may end up as a communication tool, a shared decision-tool or a user-friendly digital platform supporting the coherence of the patient's life story from early mobilization to the functional level desired when everyday life is to be resumed.
\nIn phase 3, field-observations and interviews with 10-12 different patients and their relatives and with healthcare professionals are conducted, supplied with accelometery. Also a systematic evaluation of patient safety, clinical efficiency, patient-perspective, economic and organizational aspects are made.
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Department of Anesthesiology and Intensive Care Medicine, OUH Svendborg Hospital.
Department of Anesthesiology and Intensive Care Medicine, OUH Odense Universitetshospital
Department of Endocrinology, CIMT Center of Innovative Medical Technology, Odense University Hospital / Department of Clinical Research; SDU
Department of Rehabilitation, Odense University Hospital
Department of Intensive Care Medicine, Aarhus University Hospital and AU.
MedWare
Klinisk IT Odense University Hospital
Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, SDU