Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Quality Improvement and Implementation Science
Objective(s) : The purpose of this systematic review is to understand strategies that can influence staff behavior to facilitate a culture of early mobility (EM) in the ICU.
Data Sources : Thorough computerized database searches were performed in July 2018. Search strategies incorporated a combination of controlled vocabulary and text words for intensive care units, health personnel, and mobility. Searches were limited to peer-reviewed studies.
Study Selection : Inclusion criteria: (a) publication in a peer-reviewed journal (b) description of intervention(s) to improve EM compliance in at least one adult ICU setting (c) reporting of ICU-specific data on EM compliance outcomes. Exclusion criteria: (a) studies not available in English (b) pediatric settings. 19 of an original 3619 articles were included.
Data Extraction : Researchers extracted specific change-related behaviors utilizing the 9 strategies described in the Behavior Change Wheel (BCW) (Michie et al, 2011) to categorize each intervention. The BCW is a tool utilized to characterize interventions that promote behavior change. Each article was appraised using Downs and Black’s checklist for measuring study quality of healthcare interventions (Downs & Black 1998). Additional data recorded includes: level of evidence, study design, professionals participating in intervention, and follow up.
Data Synthesis : Frequency of strategies utilized: education (89%), enablement (84%), training (63%), restriction (57%), persuasion (42%), environmental restructuring (42%), modeling (42%), incentivisation (31%), coercion (0%).
Conclusions : Interventions most frequently utilized for culture change focused on positive reinforcement such as education, enablement and training while interventions used the least on the BCW were incentivisation and coercion. The only form of restriction used were mobility protocols. ICUs looking to increase mobility can utilize these behavior-change interventions to facilitate culture change.
Todd Jarzenski– Occupational Therapy Clinical Lead, Alexian Brothers Rehabilitation Hospital, Mount Prospect, Illinois
Erin King– Occupational Therapist, Northwestern Memorial Hospital, CHICAGO, Illinois
Carson Becker– Occupational Therapist, Northwestern Memorial Hospital, Chicago, Illinois
Carissa Montague– Occupational Therapy Student, OTD 2020, Rush University, Chicago, Illinois
Samantha Cooper– Occupational Therapy Student, Rush University, Chicago, Illinois
Hannah Mulhausen– Occupational Therapy Student, Rush University, Chicago, Illinois
Q. Eileen Wafford– Research Librarian, Northwestern University, Chicago, Illinois
Kevin Pritchard– Occupational Therapist, UTMB, Galveston, Texas