| Objective1 To construct an early goal-directed mobilisation intervention program for patients with Continuous renal replacement therapy(CRRT);2 To investigate the effect of early goal-directed mobilisation on the self-care ability of patients on continuous renal replacement therapy(CRRT)and to evaluate its feasibility and safety.Methods1 Constructing an early goal-directed mobilisation programmeBased on the literature review,a first draft was formed using goal-directed and cluster theories as a guide,which was revised in conjunction with expert panel discussions and pre-testing to form the implementation draft of the intervention programme.2 Early goal-directed mobilisation Intervention StudyThis study used a class experimental study.According to the time of patient admission,140 patients who were treated with CRRT in a tertiary care nephrology hospital in Hebei province and met the inclusion and exclusion criteria were selected,of which 70 patients from October 2019 to December 2020 were set as the control group and 70 patients from January 2021 to February 2022 were set as the intervention group.The control group was given routine care with CRRT.Patients in the intervention group were given early goal-directed mobilisation intervention based on conventional care.The intervention consisted of daily assessment of the CRRT patients’ mobility by the nephrologist,setting activity goals according to the patients’ condition,and the CRRT patients in the intervention group were given functional activities including active and passive activities in bed,sitting up,standing,bedside sitting,and walking with the help of members of the early goal-directed mobilisation group,and all the above items were performed according to the doctor’s orders for goal-directed activities to perform the highest level of exercise.The intervention started from the first day of CRRT treatment,and early goal-directed activities were provided to the patients as early as possible.During the continuous CRRT,the patients were continuously intervened for 10 days.Collect patients’ activities before and after 3 days,after 7 days,10 days after activity data,including the general information of patients,nutrition index,ICU activity ability score,daily life of constipation in patients with self-care ability score,strength grade,and the service life of the filter,CRRT chance not under the plan,CRRT patients and adverse events in the process of intervention,and so on and so forth.T-test,chi-square test,rank-sum test and ANOVA were used for statistical analysis.Results1 Constructing an early goal-directed mobilistion programmeConstructing the intervention(1)programme: Intervention design:experimental-like study;(2)Intervention time: From the beginning of CRRT,the patients were continuously intervened for 10 days.According to the patient’s activity ability score,the daily cumulative intervention was 0.5-1.5 hours;(3)Intervention site:renal intensive care(4)unit;Intervention mode: individual(5)intervention;Intervention implementer: early goal-directed mobilisation(6)group;Intervention content: according to the intervention objectives,combined with the actual situation of patients’ condition and continuous renal replacement therapy,the Orientation activities were conducted;(7)Evaluation time and indicators: before the intervention,three days of intervention,seven days of intervention and ten days of intervention,indicators such as self-care ability and muscle strength and adverse events were collected from patients on continuous renal replacement therapy.2 Early goal-directed mobilisation intervention studyIn this study,2 patients were transferred to the department,and 2 patients fell off halfway.A total of 138 patients completed the intervention,including 69 patients in the intervention group and 69 patients in the control group.(1)Comparison of self-care ability,physical activity and muscle strength between the two groups before and after the intervention:(1)Patients in the intervention group had higher self-care ability scores on day 10 than the control group,with statistical differences(P<0.05);(2)Patients in the intervention group had higher muscle strength scores on day 7 and 10 than the control group,with statistical differences(P<0.05);(3)Patients in the intervention group had higher ICU activity scores on day 10 than the control group,with statistical differences(P<0.05).(4)Constipation in the intervention group was lower than that in the control group,and the difference was statistically significant(P<0.05).(2)The length of stay in the nephrology intensive care unit was shorter in the intervention group than in the control group,with a statistical difference in comparison(P<0.05).(3)Safety evaluation:(1)During the intervention process,there were no adverse events such as unplanned extubation of hemodialysis catheterization,patient fall,and bed fall;(2)After the intervention activities were given,the unplanned down chance rate did not increase in the intervention group,and the comparison was not statistically significant(P>0.05);the service life of the filter was not shortened,and the comparison was not statistically significant(P>0.05).(4)Patient satisfaction evaluation was higher in the intervention group than in the control group,with statistical difference in comparison(P<0.05).Conclusions1 Early goal-directed mobilisation promote improved self-care,muscle strength and physical mobility in CRRT patients,shorten the length of stay in the Renal Intensive Care Unit for CRRT patients and increase patient satisfaction with treatment and care.2 Early goal-directed mobilisation for CRRT patients are relatively safe and reliable... |
