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

Van Nes, Michelle Beatriz (2016-03)

Thesis (MScPhysio)--Stellenbosch University, 2016.

Thesis

ENGLISH ABSTRACT: INTRODUCTION: Physiotherapy practice in the intensive care unit (ICU) is changing. Early mobilisation programmes are included and prioritised. Methods and measures to assess physiotherapy effectiveness in the ICU have often been geared to physiological data. It is unclear if the 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 perception and satisfaction regarding critical care is measured. Seven databases were searched using various combinations of selected keywords for the process of identification. The review results informed the planning of the primary study. A primary qualitative study was conducted to describe patients’ perceptions and satisfaction with regard to physiotherapy care received during their surgical 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 included patients. Data was transcribed and then analysed via inductive and interpretive content analysis. Trustworthiness of results was ensured through reflexivity, checking of transcriptions, peer review and member checking. RESULTS: A total of 1 631 hits were reduced to 28 studies, which were included into the scoping review. Only two studies were conducted in Africa compared with ten in Europe and seven in Northern America. Ten of the included studies investigated a particular service such as nursing care, emergency care and physiotherapy with regard to patient perception and satisfaction. Only one article, published in 2008, investigated patient satisfaction in physiotherapy. Various outcome measures that measure perception and/or satisfaction were identified; however, there is currently no validated and reliable instrument to assess patient satisfaction with care in the ICU. Eighteen patients, of which ten patients were male, were purposefully selected for the primary study. The median patient age was 44 years and the median ICU length of stay was six days. Twelve themes arose from the data analysis, including: 1) patient expectations and understanding; 2) physiotherapy activities and the implication of mobilisation; 3) physiotherapy benefits and progression; 4) physiotherapy value; 5) interdisciplinary team; 6) the physiotherapist; 7) safety; 8) tangebilities; 9) continuity of care; 10) satisfaction; 11) communication; and 12) patient perception and experience. These themes as well as key messages, future research and contributions to literature were discussed. Barriers and facilitators for the relevant themes were also discussed. CONCLUSION: While there is no gold standard for measuring patient perception and satisfaction regarding ICU care, it can and should be measured. With current and on-going changes to both physiotherapy and ICU care practices, patients can share their experiences of the ICU with greater ease. This thesis demonstrated that patients’ perception of ICU physiotherapy is influenced by many factors. While patients perceived ICU physiotherapy both positively and negatively, the majority of patients were satisfied with the care they received. Patient perception and satisfaction in the ICU can be evaluated and used to ensure quality of care and ultimately provide a component to the development of evidence-based physiotherapy practice in the ICU.

AFRIKAANSE OPSOMMING: INLEIDING: Fisioterapiepraktyk in die intensiewesorgeenheid (ISE) is aan die verander. Programme vir vroeë mobilisasie word ingesluit en geprioritiseer. Uitkomste om die doeltreffendheid van fisioterapie in die ISE te bepaal, is dikwels op fisiologiese data gegrond. Dit is onduidelik of pasiënte se sienings oor en tevredenheid met fisioterapeutiese ISE-sorg, al ondersoek is. METODES: ’n Ondersoekende literatuur oorsig is onderneem ten einde te bepaal hoe pasiënte se opvattings en tevredenheid met betrekking tot kritieke sorg gemeet word. Ter identifikasie is sewe databasisse met verskillende kombinasies gekose trefwoorde deursoek. Die oorsig resultate het die beplanning van die primêre studie gerig. ’n Primêre kwalitatiewe studie het pasiënte se opvattings oor en tevredenheid met fisioterapeutiese sorg, gedurende chirugiese ISE verblyf bepaal. Pasiënte is deur middel van doelbewuste steekproefneming by die primêre studie ingesluit. Semigestruktureerde onderhoude, 25-60 minute elk, is met pasiënte gevoer en op band geneem. Data is getranskribeer en daarná deur middel van induktiewe en vertolkende inhoudsanalise ontleed. Nadenke, die nagaan van transkripsies, portuurbeoordeling en ledekontrole het betroubaarheid van die resultate verseker. RESULTATE: Die soektog het 1 631 trefslae opgelewer. Hierdie trefslae is tot 28 studies verminder wat by die ondersoekende literatuur oorsig ingesluit is. Hiervan was slegs twee studies van Afrika, vergeleke met tien van Europa en sewe van Noord-Amerika. Tien van die ingeslote studies het pasiënte se opvattings en tevredenheid insake ’n bepaalde diens soos verpleegsorg, noodsorg en fisioterapie ondersoek. Slegs een van die tien artikels het pasiënttevredenheid met fisioterapie bestudeer. Verskillende uitkomsmetings wat opvattings en/of tevredenheid meet, is uitgewys. Ten spyte hiervan is daar tans geen gestaafde en betroubare instrument om pasiënttevredenheid met ISE-sorg te beoordeel nie. Agtien pasiënte, waarvan tien mans, is doelbewus vir die primêre studie gekies. Pasiënte was gemiddeld 44 jaar oud en het gemiddeld vir ses dae in die ISE gebly. Die dataontleding het 12 temas na vore gebring, naamlik 1) pasiënte se verwagtinge en begrip; 2) fisioterapieaktiwiteite en die implikasie van mobilisasie; 3) fisioterapievoordele en -vordering; 4) die waarde van fisioterapie; 5) die interdissiplinêre span; 6) die fisioterapeut; 7) veiligheid; 8) konkrete voordele/resultate; 9) sorgkontinuïteit; 10) tevredenheid; 11) kommunikasie; en 12) pasiënte se opvattings en ervarings. Hierdie temas sowel as kernboodskappe, toekomstige navorsing en bydraes tot die literatuur word bespreek. Versperrings en fasiliteerders vir die tersaaklike temas word ook uitgewys. GEVOLGTREKKING: Hoewel daar geen goue standaard vir die meting van pasiënte se opvattings oor en tevredenheid met ISE-sorg bestaan nie, kan en behoort dit gemeet te word. Met huidige en voortdurende verandering in sowel fisioterapie- as ISE-sorgpraktyke kan pasiënte hulle ervarings van die ISE makliker weergee. Hierdie tesis toon dat pasiënte se opvattings oor fisioterapie in die ISE deur verskeie faktore beïnvloed word. Hoewel pasiënte fisioterapie in die ISE positief sowel as negatief ervaar het, was die meeste pasiënte tevrede met die sorg wat hulle ontvang het. Pasiënte se opvattings en tevredenheid met betrekking tot die ISE kan beoordeel en gebruik word om gehalte sorg te verseker. Hierdie pasient perspektief is ’n noodsaaklik

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