A constructivist grounded theory of staff experiences relating to early mobilisation of mechanically ventilated patients in intensive care
Item statusRestricted Access
Embargo end date31/07/2022
This thesis presents a grounded theory study, exploring the experiences of staff relating to the early mobilisation of mechanically ventilated patients (EM-MV) in two Scottish Intensive Care Units (ICUs). Mechanically ventilated patients have been reported to develop muscle weakness within the first hours after intubation. Significantly, this muscle weakness commonly persists after ICU discharge alongside other health impairments known as post-intensive care syndrome (PICS). Furthermore, this ICU sequelae may contribute to the survivors’ prolonged recovery and reduce their quality of life. Given its immense impact, it is imperative to understand how to minimise PICS starting from patient admission to the ICU. EM-MV has been extensively researched by ICU experts worldwide and has been suggested to be an effective intervention in improving patient outcomes. However, research in this topic has mainly focused on the patient outcomes and research exploring different perspectives of interdisciplinary staff is lacking. Therefore, this study was designed to understand and explore staff experiences of EM-MV. A constructivist grounded theory approach guided the conduct of the study. Data were collected from four observations of early mobilisation activities, eleven individual staff interviews and two focus groups with interdisciplinary staff members. Constant comparative analysis was conducted to develop a middle-range theory grounded in the data. Managing Risks emerged as the core category that describes the experiences of staff regarding EM-MV in this study. Using the concept of risk, a middle-range theory was developed from this study suggesting that EM-MV process starts by defining patient status which can move back and forth to negotiating patient safety until a negotiation is reached and in turn enables performing accountable mobilisation within the dynamic context of the ICU setting. ICU staff continuously defined their patient status as suitable or not suitable for mobilisation by taking into account the potential risks. The negotiation of patient safety was initiated after the participants deemed that the benefits of mobilisation outweigh the risks. The recursive relationship between defining patient status and negotiating patient safety highlights the participants’ main concern of risks that should be addressed before performing accountable mobilisation. In summary, EM-MV is a complex intervention undertaken in a complex system of ICU involving multidisciplinary healthcare professionals and diverse types of patients and patient acuity. The presented middle-range theory provides a framework that can be used to understand and explain why many mechanically ventilated patients are either mobilised or not mobilised during their ICU admission.