TY - JOUR
T1 - Facilitators & barriers and practices of early mobilization in critically ill burn patients
T2 - A survey
AU - Dikkema, Y.
AU - Mouton, L. J.
AU - Cleffken, B.
AU - de Jong, E.
AU - van Baar, M. E.
AU - Pijpe, A.
AU - Niemeijer, A. S.
AU - van der Schans, C. P.
AU - Scholten, S. M. J. H.
AU - van der Steen-Dieperink, M.
AU - Nieuwenhuis, M. K.
N1 - Funding Information: This study was financially supported by the Dutch Burns Foundation . Publisher Copyright: © 2022 The Authors
PY - 2023/2
Y1 - 2023/2
N2 - Background: Early mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM. Methods: A survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists). Results: Response rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained. Conclusion: Skin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.
AB - Background: Early mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM. Methods: A survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists). Results: Response rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained. Conclusion: Skin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.
KW - Burns
KW - Critical care
KW - Early mobilization
KW - Facilitators and barriers
KW - Health care providers
KW - Questionnaire
UR - http://www.scopus.com/inward/record.url?scp=85139216512&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.burns.2022.08.023
DO - https://doi.org/10.1016/j.burns.2022.08.023
M3 - Article
C2 - 36202684
SN - 0305-4179
VL - 49
SP - 42
EP - 54
JO - Burns
JF - Burns
IS - 1
ER -