Barriers and Facilitators to Early Physical Rehabilitation in Mechanically Ventilated Patients
Year: 2017
Type: dissertation
Abstract: Background: Physical rehabilitation strategies, when initiated in critically ill patients, may improve functional outcomes of survivors and may shorten duration of mechanical ventilation and ICU length of stay, although evidence is conflicting. Despite some conflicting evidence, it has been recommended in clinical practice guidelines, but not been consistently implemented in critical care units. The implementation of complex interventions in healthcare is challenging, but may be improved using theory to understand barriers and facilitators, and ultimately to design interventions. The Theoretical Domains Framework (TDF) is a framework based on health psychology that was designed to improve implementation of evidence based practice. Methods: This dissertation describes a series of projects, based on the TDF, and aimed at understanding barriers and facilitators to early physical rehabilitation in mechanically ventilated patients. First, a systematic review of the literature, using the TDF to synthesize barriers and facilitators was done. The following two research chapters describe a Delphi study of nurses, physical and occupational therapists, respiratory therapists and physicians. The first round of the Delphi consisted of semi-structured interviews. With the TDF, a theoretically driven topic guide was developed and interviews analyzed using a theory-driven content analysis. The following rounds of the Delphi consisted of agree/disagree questions with a Likert scale, based on Round 1 results that were reviewed and prioritized by the research group. Results: The systematic review of the literature found that there was a general lack of theory in assessing barriers and facilitators. Using the TDF to synthesize, we found a significant focus on the domains of Behavioural Regulation, Environmental Context and Resources and Beliefs about Consequences. The Dephi study confirmed these findings, although also found a focus on the domains of Skills, Social and Professional Role, Beliefs about Capabilities, Social Influences, Knowledge and Optimism.
Source: TSpace (University of Toronto)
Author: Shannon L. Goddard
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2958295482