Staff Perceptions of the Barriers to Mobilizing ICU Patients

Purpose: Whilst early progressive mobilization is known to be safe and beneficial for patients in an intensive care unit (ICU), barriers still exist to its implementation. As part of a broader quality improvement project that had the overall aim of increasing the frequency of mobilization in our ICU, we conducted a survey of ICU staff to investigate their perceptions of the barriers to the early progressive mobilization of ICU patients. Method: A prospective survey of ICU staff in an Australian, tertiary care, public hospital ICU was undertaken. A total of 93 medical, nursing, and physiotherapy staff participated. A purpose-designed survey that investigated staff perceptions of the barriers to the early progressive mobilization of ICU patients was developed. The survey predominantly comprised closed statements requiring responses using a visual analogue scale. Barriers to early progressive mobilization were separated into three sections: patient-related, institutional-related, and other barriers. Results: Patient-related barriers were generally perceived as having the greatest influence on the mobilization of ICU patients, followed closely by institutional-related barriers. The factors that were perceived as most frequently preventing mobilization were hemodynamic instability, reduced level of consciousness, sedation, agitation, impending medical procedure, staff availability, and time constraints. Conclusions: ICU staff perceived that barriers to the early progressive mobilization of ICU patients were multifactorial and most frequently involved patients’ medical condition and resource limitations

The Effectiveness of Kinesiotaping for Patients with Fractured Ribs: A Single-subject Experimental Design

Purpose: Kinesiotape is an elastic, adhesive tape applied to the skin that has been used extensively to reduce pain associated with various musculoskeletal conditions. Its use in the setting of fractured ribs is less clear. The aim of this preliminary study was to investigate the effect of kinesiotaping for patients with rib fracture(s) on pain levels, pulmonary function, and mobility. Method: We prospectively evaluated five patients admitted with fractured ribs using a single-subject experimental ABAB design. Each phase lasted 24 hours with kinesiotape applied during B phases. All participants received usual medical, nursing, and allied health care. Outcome measures included pain levels (participant-rated), pulmonary function, and maximum mobility. The occurrence of skin irritation was tracked. Results: Considerable variability was seen between- and within-participants for pain levels. There was some evidence, albeit inconsistent, that pain levels were lower when the kinesiotape was in situ compared to when it was not. Pulmonary function and mobility levels showed no consistent pattern between intervention phases. Skin irritation occurred in one participant and another required escalation of medical therapy for pneumonia. Conclusions: Kinesiotaping may reduce pain for patients with fractured ribs but further research, preferably randomized controlled trials with homogenous samples and standardized medication regimens, is required to confirm its effectiveness in the acute care setting