Institut for Kommunikation og Kultur

TY - JOUR

T1 - Negotiated mobilisation

T2 - An ethnographic exploration of nurse–patient interactions in an intensive care unit

AU - Lærkner, Eva

AU - Egerod, Ingrid

AU - Olesen, Finn

AU - Toft, Palle

AU - Ploug Hansen, Helle

PY - 2019

Y1 - 2019

N2 - Aims and objectives: To explore nurse–patient interactions in relation to the mobilisation of nonsedated and awake, mechanically ventilated patients in the intensive care unit. Background: Lighter sedation has enabled the early mobilisation of mechanically ventilated patients, but little is known about the nurses' role and interaction with critically ill patients in relation to mobilisation. Design and methods: The study had a qualitative design using an ethnographic approach within the methodology of interpretive description. Data were generated in two intensive care units in Denmark, where a strategy of no sedation was applied. Participant observation was conducted during 58 nurse–patient interactions in relation to mobilisation between nurses (n = 44) and mechanically ventilated patients (n = 25). We conducted interviews with nurses (n = 16) and patients (n = 13) who had been mechanically ventilated for at least 3 days. The data were analysed using inductive, thematic analysis. The report of the study adhered to the COREQ checklist. Finding: We identified three themes: “Diverging perspectives on mobilisation” showed that nurses had a long-term and treatment-oriented perspective on mobilisation, while patients had a short-term perspective and regarded mobilisation as overwhelming in their present situation. “Negotiation about mobilisation” demonstrated how patients actively negotiated the terms of mobilisation with the nurse. “Inducing hope through mobilisation” captured how nurses encouraged mobilisation by integrating aspects of the patient's daily life as a way to instil hope for the future. Conclusions: Exploring the nurse–patient interactions illustrated that mobilisation is more than physical activity. Mobilisation is accomplished through nurse–patient collaborations as a negotiated, complex and meaningful achievement, which is driven by the logic of care, leading to hope for the future. Relevance to clinical practice: The study demonstrated the important role of nurses in achieving mobilisation in collaboration and through negotiation with mechanically ventilated patients in the intensive care unit.

AB - Aims and objectives: To explore nurse–patient interactions in relation to the mobilisation of nonsedated and awake, mechanically ventilated patients in the intensive care unit. Background: Lighter sedation has enabled the early mobilisation of mechanically ventilated patients, but little is known about the nurses' role and interaction with critically ill patients in relation to mobilisation. Design and methods: The study had a qualitative design using an ethnographic approach within the methodology of interpretive description. Data were generated in two intensive care units in Denmark, where a strategy of no sedation was applied. Participant observation was conducted during 58 nurse–patient interactions in relation to mobilisation between nurses (n = 44) and mechanically ventilated patients (n = 25). We conducted interviews with nurses (n = 16) and patients (n = 13) who had been mechanically ventilated for at least 3 days. The data were analysed using inductive, thematic analysis. The report of the study adhered to the COREQ checklist. Finding: We identified three themes: “Diverging perspectives on mobilisation” showed that nurses had a long-term and treatment-oriented perspective on mobilisation, while patients had a short-term perspective and regarded mobilisation as overwhelming in their present situation. “Negotiation about mobilisation” demonstrated how patients actively negotiated the terms of mobilisation with the nurse. “Inducing hope through mobilisation” captured how nurses encouraged mobilisation by integrating aspects of the patient's daily life as a way to instil hope for the future. Conclusions: Exploring the nurse–patient interactions illustrated that mobilisation is more than physical activity. Mobilisation is accomplished through nurse–patient collaborations as a negotiated, complex and meaningful achievement, which is driven by the logic of care, leading to hope for the future. Relevance to clinical practice: The study demonstrated the important role of nurses in achieving mobilisation in collaboration and through negotiation with mechanically ventilated patients in the intensive care unit.

KW - Conscious sedation, early mobilization, ethnography, intensive care, interview, mechanical ventilation, nursing care, qualitative research

KW - LEVEL

KW - MECHANICAL VENTILATION

KW - NO-SEDATION

KW - SAFETY

KW - THERAPY

KW - conscious sedation

KW - early mobilisation

KW - ethnography

KW - intensive care

KW - interview

KW - mechanical ventilation

KW - nursing care

KW - qualitative research

KW - Nurse's Role

KW - Humans

KW - Middle Aged

KW - Male

KW - Critical Care Nursing/methods

KW - Early Ambulation/nursing

KW - Aged, 80 and over

KW - Adult

KW - Female

KW - Intensive Care Units

KW - Respiration, Artificial/nursing

KW - Nurse-Patient Relations

KW - Denmark

KW - Aged

KW - Negotiating

KW - Critical Illness/nursing

UR - http://www.scopus.com/inward/record.url?scp=85062792817&partnerID=8YFLogxK

U2 - 10.1111/jocn.14828

DO - 10.1111/jocn.14828

M3 - Journal article

C2 - 30791156

AN - SCOPUS:85062792817

VL - 28

SP - 2329

EP - 2339

JO - Journal of Clinical Nursing

JF - Journal of Clinical Nursing

SN - 0962-1067

IS - 11-12

ER -