1EARLY MOBILISATION IN ICU Table of Contents Introduction................................................................................................................................2 Rationale................................................................................................................................2 Discussion..................................................................................................................................2 Background............................................................................................................................2 Critical review question.........................................................................................................3 Search methodology...............................................................................................................4 Database and keywords..........................................................................................................4 Inclusion and exclusion principle...........................................................................................5 Literature justification and appraisal......................................................................................5 Literature review plan............................................................................................................6 Conclusion..................................................................................................................................6 References..................................................................................................................................7
2EARLY MOBILISATION IN ICU Introduction At present, intense research focuses on the early mobilisation and rehabilitation of patients in intensive care units (ICUs) with over 15 randomised controlled trials (RCTs) in the last decade. The various mobilisation techniques include active and passive mobilisation and transfer (Hodgson, Capell & Tipping, 2018). Early mobilisation of patients in the ICU presents several benefits such as lowered ICU delirium, the reduced period under mechanical ventilation, reduced time of stay in the ICU and muscle atrophy. However, early mobilisation also poses risks to patients, specifically post-operation adults as they present operation- relatedweaknessandcomplications.Thecommonlyidentifiedrisksincludefalls, dislodgment of tubes, several intravenous and arterial accesses and increased nursing care and interdisciplinary workforce (TEAM Study Investigators, 2015). Rationale The primary purpose of the study is to identify suitable evidence and outline an appropriate protocol to evaluate the impact of early mobilisation of post-operative adult patients in intensive care units (ICUs) in comparison to the current standards of complete bed rest and sedation for 12 months. Discussion Background The most common practice in all the ICUs across the globe is of complete bed rest and sedation, particularly for patients after undergoing an operation. Complete bed rest after operations in the ICU is associated with ICU-acquired weaknesses among the patients, which affects the quality of life of the patient and might also result in specific life-long morbidities
3EARLY MOBILISATION IN ICU (Hodgson, Capell & Tipping, 2018). Early mobilisation and rehabilitation is a proven solution to reducing ICU-acquired morbidities and facilitate rapid functional independence of the patients. Various researches and studies discuss the benefits of early mobilisation and have become a widely researched topic. With the consistency of early mobilisation is providing safe and feasibleICU outcomes, severalinternationalguidelineshave been suggested. The long-term advantages of early mobilisation, as reported by several studies include functional improvement and quality of life (Castro-Avilaet al., 2015). These advantages encourage intensive research on applying this method to all patients that have undergone operations to improve their overall quality of life. Critical review question After identifying the issue successfully, it is essential that the questionunder review be precise to infer the types and range of the available evidence relevant to the issue adequately. A well-structured research question is of utmost importance to emphasise the significance of the research and develop an effective protocol for the study to be undertaken. A known effective strategy is the PICO(T) framework. It stands for Population/Patient, Intervention, Comparison, Outcomes and Time frame (Robb & Shellenbarger, 2014). It is a suitable technique for evidence-based research and can be demonstrated as follows: PICO(T) table: PopulationPost-operative adult intensive care unit (ICU) patients InterventionEarly mobilisation ComparisonComplete bed rest OutcomeImproved patient outcome-functional status,
Paraphrase This Document
Need a fresh take? Get an instant paraphrase of this document with our AI Paraphraser
4EARLY MOBILISATION IN ICU mechanicalstrength,lengthofstayand quality of life Time12 months The review question based on the table is: In Intensive care units, is the early mobilisation of post-operative adult patients more advantageous over complete bed rest over 12 months? Search methodology Studies suggest that a precise research question is imperative to obtain the most relevant results. After finalising the research question, the researcher needs to expand their knowledge on the topic by identifying suitable articles discussing the issue (Baskarada, 2014). Both qualitative and quantitative studies can be used for research and analysing the patient experience. The step-wise evaluation of the review question including obtaining appropriate evidence,sampling,determiningitssizeandtheoverallevaluationisdetermined predominantly by the chosen research question. Database and keywords DatabaseKeywords/search terms ļ·Google Scholar ļ·PubMed ļ·MEDLINE ICU,earlymobilisation,bedrest,ICU patient,ICUsetting,post-operativeICU patients,rehabilitation,functionalstatus, patientoutcomes,lengthofhospitalstay, mechanical strength, quality of life.
5EARLY MOBILISATION IN ICU Inclusion and exclusion principle Inclusion criteriaExclusion criteria Australia-based studiesNon-Australian studies Confined keywordsArticles not addressing the search terms The year 2014 to presentStudies older than the past five years Systematic reviews and meta-analysesNon-ICU settings Qualitative and Quantitative studiesPapers not in English or non-translatable to English Post-operative patientsNon-adult patient population Full-text articlesAbstract only articles Literature justification and appraisal The articles are classified according to the reliability and validity of the evidence. The various studies are explicitly sought based on peer-reviewed studies, systematic reviews and meta-analyses. The preference for selecting relevant articles will be given to systematic reviews as these provide data and information of the highest quality and are focused on the particular topic of research with predefines inclusion and exclusion settings. These articles consist of a rigorous review of available literature following appraisal and ranking foremost in the scale of reliability (Leung, Trevena & Waters, 2014). After systematic reviews and meta-analysis, study methods such as randomised controlled trials (RCTs) will be given the next priority and are considered secondary to systematic reviews and meta-analysis. The quality of the articles can be reviewed using the Critical Appraisal Skills Program (CASP) (MacLeanet al., 2017). However, randomised controlled trials are considered superior to the case or anecdotal studies.
6EARLY MOBILISATION IN ICU Literature review plan The earmarks of the literature review include assembling the known and discovering the gaps in research. The proposed strategy for the review consists of prioritising the obtained evidence, critical appraisal of the articles and summarizing the outcomes of each study. The National Health and Medical Research Council (NHMRC) provides the highest form of evidence by carefully evaluating the literature and ranking them in nationally accepted orders (Ingham-Broomfield, 2016). Conclusion A critical review of the relevant literature suggests that early mobilisation of adult intensive care unit (ICU) patients is an essential element in improving patient outcomes in terms of the lengthofstay,functionalstatus,mechanicalstrengthandqualityoflife.Available quantitative data suggests that early mobilisation is achievable and the qualitative data suggests that it is a safe option as well. Comprehensive research is required to identify full inclusion and exclusion principles regarding early mobilisation and the different models in performing early mobilisation to obtain the most accurate results.
Secure Best Marks with AI Grader
Need help grading? Try our AI Grader for instant feedback on your assignments.
7EARLY MOBILISATION IN ICU References Baskarada, S. (2014). Qualitative case study guidelines.BaÅ”karada, S.(2014). Qualitative case studies guidelines. The Qualitative Report,19(40), 1-25. Castro-Avila, A. C., SerĆ³n, P., Fan, E., Gaete, M., & Mickan, S. (2015). Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis.PloS one,10(7). Hodgson, C. L., Capell, E., & Tipping, C. J. (2018). Early mobilization of patients in intensive care: organization, communication and safety factors that influence translation into clinical practice.Critical Care,22(1), 77. Ingham-Broomfield, J. R. (2016). A nurses' guide to the hierarchy of research designs and evidence.Australian Journal of Advanced Nursing (Online),33(3), 38. Leung, K., Trevena, L., & Waters, D. (2014). Systematic review of instruments for measuring nurses' knowledge, skills and attitudes for evidenceābased practice.Journal of Advanced Nursing,70(10), 2181-2195. MacLean, S., Kelly, M., Geddes, F., & Della, P. (2017). Use of simulated patients to develop communication skills in nursing education: An integrative review.Nurse education today,48, 90-98. Robb, M., & Shellenbarger, T. (2014). Strategies for searching and managing evidence-based practice resources.The Journal of Continuing Education in Nursing,45(10), 461-466. TEAM Study Investigators. (2015). Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study.Critical Care,19(1), 81.