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Barriers and perceived benefits of early mobilisation programmes in Dutch paediatric intensive care units
Barbara M Geven1, Jolanda M Maaskant2, Job B M van Woensel1
1Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam UMC Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Pediatric intensive care unit (PICU) staff see benefits in early mobilization for critically ill children, but face barriers like hemodynamic instability and concerns for specific patient groups. Addressing these barriers is key for successful implementation.
Area of Science:
- Pediatric critical care medicine
- Rehabilitation medicine
- Healthcare professional surveys
Background:
- Early mobilization is established as beneficial for critically ill adults.
- Its safety and feasibility are also recognized in critically ill children.
- Barriers and perceived benefits of early mobilization by pediatric intensive care unit (PICU) staff remain largely unknown.
Purpose of the Study:
- To explore barriers to early mobilization of critically ill children.
- To investigate perceived benefits of early mobilization by PICU staff.
- To understand staff perspectives on early mobilization implementation.
Main Methods:
- A cross-sectional survey was conducted among healthcare professionals in seven PICUs in the Netherlands.
- Questionnaires were distributed to assess staff perceptions of early mobilization.
- Response rate was 33.5% (215/641), including nurses, physicians, and physical therapists.
Main Results:
- Staff perceived early mobilization as beneficial for reducing mechanical ventilation duration, improving sleep-wake cycles, and shortening PICU length of stay.
- Significant reluctance was noted for mobilizing patients on extracorporeal membrane oxygenation (ECMO) and those with traumatic brain injury.
- Key perceived barriers included hemodynamic instability, risk of line/tube displacement, and sedation levels.
Conclusions:
- PICU staff recognize the potential benefits of early mobilization for critically ill children.
- Specific patient populations and practical barriers present challenges to implementation.
- Addressing identified barriers is crucial for successful early mobilization programs in PICUs.
Background:
Early mobilisation of critically ill adults has been proven effective and is safe and feasible for critically ill children. However, barriers and perceived benefits of paediatric intensive care unit (PICU) staff involvement in mobilising critically ill children are largely unknown.
Aim:
To explore the barriers and perceived benefits regarding early mobilisation of critically ill children as perceived by PICU staff.
Study Design:
A cross-sectional survey study among staff from seven PICUs in the Netherlands has been carried out.
Results:
Two hundred and fifteen of the 641 health care professionals (33.5%) who were invited to complete a questionnaire responded, of whom 159 (75%) were nurses, 40 (19%) physicians, and 14 (6%) physical therapists. Respondents considered early mobilisation potentially beneficial to shorten the duration of mechanical ventilation (86%), improve wake/sleep rhythm (86%) and shorten the length of stay in the PICU (85%). However, staff were reluctant to mobilise patients on extracorporeal membrane oxygenation (ECMO) (63%), and patients with traumatic brain injury (49%). Perceived barriers to early mobilisation were hemodynamic instability (78%), risk of dislocation of lines/tubes (74%), and level of sedation (62%). In total, 40.3% of PICU nurses stated that physical therapists provided enough support in their PICU, but 84.6% of the physical therapists believed support was sufficient.
Conclusion:
Participating PICU staff considered early mobilisation as potentially beneficial in improving patient outcomes, although barriers were noted in certain patient groups.
Relevance To Clinical Practice:
We identified barriers to early mobilisation which should be addressed in implementation research projects in order to make early mobilisation in critically ill children work.
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