What factors affect implementation of early rehabilitation into intensive care unit practice? A qualitative study with clinicians

Selina M. Parry, Louisa Remedios, Linda Denehy, Laura D. Knight, Lisa Beach, Thomas C. Rollinson, Sue Berney, Zudin A. Puthucheary, Peter Morris, Catherine L. Granger

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Purpose To identify the barriers and enablers that influence clinicians' implementation of early rehabilitation in critical care. Materials and methods Qualitative study involving 26 multidisciplinary participants who were recruited using purposive sampling. Four focus groups were conducted using semistructured questions to explore attitudes, beliefs, and experiences. Data were transcribed verbatim and thematic analysis was performed. Results Six themes emerged, as follows: (1) the clinicians' expectations and knowledge (including rationale for rehabilitation, perceived benefits, and experience), (2) the evidence for and application of rehabilitation (including beliefs regarding when to intervene), (3) patient factors (including prognosis, sedation, delirium, cooperation, motivation, goals, and family), (4) safety considerations (including physiological stability and presence of devices or lines), (5) environmental influences (staffing, resources, equipment, time, and competing priorities), and (6) culture and teamwork. Key strategies identified to facilitate rehabilitation included addressing educational needs for all multidisciplinary team members, supporting junior nursing staff, and potential expansion of physiotherapy staffing hours to closer align with the 24-hour patient care model. Conclusions Key barriers to implementation of early rehabilitation in critical care are diverse and include both clinician- and health care system–related factors. Research targeted at bridging this evidence-practice gap is required to improve provision of rehabilitation.

Original languageEnglish
Pages (from-to)137-143
Number of pages7
JournalJournal of Critical Care
Volume38
DOIs
StatePublished - Apr 1 2017

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Inc.

Keywords

  • Barriers
  • Implementation, recovery of function
  • Intensive care
  • Qualitative
  • Rehabilitation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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