Mechanical Ventilation Patients And Medical Staff Experience Of Early Active Mobilization On The Intensive Care Unit:A Qualitative Study

Objective（1）To understand the real experience of ICU mechanical ventilation patients after early active mobilization and explore their inner feelings,so as to provide a basis for taking targeted nursing measures and improving patients’ mobilization experience.（2）To understand the real experience of ICU medical staff implementing early active mobilization,analyze the existing problems in clinical practice of early active mobilization,and provide a basis for optimizing early active mobilization strategy and improving the quality of early active mobilization implementation.MethodsIn this study,descriptive phenomenological research method of qualitative research was adopted to select mechanical ventilation patients,nurses and doctors who met the admission criteria in comprehensive ICU of a tertiary A hospital in Lanzhou from March 2021 to December 2021 as the research objects by purpose sampling.The sample size was determined based on the principle of data saturation.This study has been reviewed by the Ethics Committee of Lanzhou University School of Nursing.After signing the informed consent form with the research subjects,semi-structured in-depth interviews were used to collect data,and the text was transcribed within 24 hours.Nvivo12 software and Colaizzi seven-step analysis were used to sort out and analyze the data,and the final themes are extracted.ResultsA total of 14 ICU mechanical ventilation patients,20 clinical nurses,and 11 doctors were interviewed in this study.The main results were as follows:（1）Results of patients with mechanical ventilation in ICU: Three themes and 10sub-themes were obtained through the analysis of the interview data of patients with mechanical ventilation in ICU: ①Obvious physical discomfort: weakness,foreign body sensation,pain,fatigue;② Complex psychological experience: perceived benefits of activities,negative self-perception,and diverse emotional experience;③Expectations for treatment: desire to accompany family members,set rehabilitation goals,and provide humanized care.（2）Results of ICU nurses: Through the analysis of interview data of ICU nurses,4 themes and 11 sub-themes were obtained: ① Multiple emotional experiences co-existed: positive emotional experience and negative emotional experience;②Sense of benefits from occupation: Realize professional value and promote self-development;③Difficulty in work implementation: increased workload,lack of rehabilitation resources,poor nurse-patient communication,and safety risks;④Suggestions and expectations: attach importance to family participation,provide psychological interventions,and strengthen multidisciplinary collaboration.（3）Results of ICU doctors: 5 themes and 13 sub-themes were drawn through the analysis of the interview data of ICU doctors: ① Perceive the need for early mobilization: the benefits of early mobilization,and as soon as possible to carry out;②The mobilization plan still needs to be improved: lack of personalized assessment,mobilization methods and equipments are single;③ Influencing factors for decision-making: patient factors,human resources,rehabilitation equipments,rehabilitation concepts;④ Professional role cognitions: The role of doctors is weakened,and nurses lead the implementation;⑤ Improve and enhance: to encourage family members participate,strengthen publicity and training,and strengthen the building of multidisciplinary teams.ConclusionsBased on in-depth interviews with 14 ICU patients on mechanical ventilation,20 ICU nurses and 11 ICU doctors,Colaizzi seven-step analysis method was used to comprehensively analyze the interview data,and the main conclusions were as follows:（1）Patients with mechanical ventilation in the ICU have obvious physical discomfort during the early active mobilization.Although they can perceive the benefits of early active mobilization,they still have complex psychological experiences,and desire more physical and psychological humanized care,which suggests that medical staff should pay attention to the physical and psychological experience of patients in their early active mobilization,and take targeted medical and nursing measures to improve their mobilization experience,improve patient compliance,and promote patients’ early recovery.（2）Positive experience and negative experience coexist when ICU nurses perform early active mobilization for patients,and there are certain limiting factors in the implementation process.Therefore,nurses put forward suggestions and expectations for the implementation of early active mobilization.It suggests that nursing managers should pay attention to the emotional experience and work needs of nurses during early active mobilization,provide assurance and support in various aspects of early active mobilization,and strengthen multidisciplinary communication and exchange,so as to provide better care for early active mobilization of patients with mechanical ventilation.（3）The team division of early active mobilization is not reasonable,the mobilization program has limitations,and the medical decisions are also affected by many factors such as patients,rehabilitation equipment,human resources and rehabilitation concept.It suggests that ICU doctors should improve the early active mobilization program according to the actual situation and characteristics of ICU,explore multi-disciplinary cooperation strategies,and hospitals should also provide a variety of resources to support.Actively promote the clinical development and continuous implementation of early active mobilization.