Perception of physiotherapy care in a surgical ICU : the patients' perspectives

[摘要] ENGLISH ABSTRACT: INTRODUCTION: Physiotherapy practice in the intensive care unit (ICU) is changing. Earlymobilisation programmes are included and prioritised. Methods and measures to assessphysiotherapy effectiveness in the ICU have often been geared to physiological data. It is unclear ifthe patients' perspectives and satisfaction regarding care in the ICU have been investigated,specifically with regard to physiotherapy.METHODS: A scoping review was undertaken with the aim of determining how patient perceptionand satisfaction regarding critical care is measured. Seven databases were searched usingvarious combinations of selected keywords for the process of identification. The review resultsinformed the planning of the primary study. A primary qualitative study was conducted to describepatients' perceptions and satisfaction with regard to physiotherapy care received during theirsurgical ICU stay. Patients were included via purposive sampling into the primary study.Audiotaped, semi-structured interviews of 25-60 minutes each were completed with the includedpatients. Data was transcribed and then analysed via inductive and interpretive content analysis.Trustworthiness of results was ensured through reflexivity, checking of transcriptions, peer reviewand member checking.RESULTS: A total of 1 631 hits were reduced to 28 studies, which were included into the scopingreview. Only two studies were conducted in Africa compared with ten in Europe and seven inNorthern America. Ten of the included studies investigated a particular service such as nursingcare, emergency care and physiotherapy with regard to patient perception and satisfaction. Onlyone article, published in 2008, investigated patient satisfaction in physiotherapy. Various outcomemeasures that measure perception and/or satisfaction were identified; however, there is currentlyno validated and reliable instrument to assess patient satisfaction with care in the ICU. Eighteenpatients, of which ten patients were male, were purposefully selected for the primary study. Themedian patient age was 44 years and the median ICU length of stay was six days. Twelve themesarose from the data analysis, including: 1) patient expectations and understanding; 2)physiotherapy activities and the implication of mobilisation; 3) physiotherapy benefits andprogression; 4) physiotherapy value; 5) interdisciplinary team; 6) the physiotherapist; 7) safety;8) tangebilities; 9) continuity of care; 10) satisfaction; 11) communication; and 12) patientperception and experience. These themes as well as key messages, future research andcontributions to literature were discussed. Barriers and facilitators for the relevant themes werealso discussed.CONCLUSION: While there is no gold standard for measuring patient perception and satisfactionregarding ICU care, it can and should be measured. With current and on-going changes to bothphysiotherapy and ICU care practices, patients can share their experiences of the ICU with greaterease. This thesis demonstrated that patients' perception of ICU physiotherapy is influenced bymany factors. While patients perceived ICU physiotherapy both positively and negatively, themajority of patients were satisfied with the care they received. Patient perception and satisfactionin the ICU can be evaluated and used to ensure quality of care and ultimately provide a componentto the development of evidence-based physiotherapy practice in the ICU.

[发布机构] Stellenbosch University