[The Early Mobilization Network]. / Netzwerk Frühmobilisierung.

BACKGROUND: Since its foundation in 2011, the German Network for Early Mobilization of mechanically ventilated intensive care patients delivered, among others, more than 90 monthly newsletters, 14 research projects, and 3 national conferences. PURPOSE: The aim of this online survey was to evaluate whether members of the Network perceived a professional benefit for themselves and their intensive cate units (ICU). METHODS: An interprofessional online survey of 303 clinicians of the Network in German speaking countries in July 2019 was undertaken. The survey included questions about newsletters, personal benefits, perceived improvements on their workplaces, and future expectations. RESULTS: The response rate was 48% (n = 145), mainly nurses and physiotherapists. The majority perceived the newsletter as good. Members reported that the network extended their professional knowledge and improved the quality of the ICUs regarding early mobilization, delirium management, and interprofessional goals. Participants expressed a wish for more workshops, case reports, webinars, and other educational possibilities. CONCLUSIONS: Members of the network Early Mobilization perceived a personal and professional benefit. The network supported quality improvements projects in ICUs. The progress of the network may serve as an example for development of other professional networks.

[Scientific development of critical care : Position paper]. / Wissenschaftliche Weiterentwicklung in der Intensivpflege : Positionspapier.

Demographic changes in Germany means that nursing and medical care is becoming increasingly complex. This is especially true for intensive care. Despite the closure of hospitals in Germany, the number of beds in intensive care units rose between 2002 from 23,113 to 26,162 in 2010. At the same time the number of patients treated in intensive care units increased by 148,989 to 2,049,888. The increasing complexity requires specific education for nurses in intensive care based on a model of advanced nursing practice (ANP). Nursing experts who fulfill an advanced practise nursing are competent to make decisions autonomously and accountably within complex care situations. This includes decisions such as artificial ventilation, weaning, nutrition management and the management of delirium, wounds and pain. Nursing experts are responsible for specific clearly defined areas of care and initiate nurse-led services and practice. Scientific and research based evidence are transferred directly into health care practice and can be implemented directly. The DGF demands a scientific and with it academic development of critical care as advanced nursing practice based on a master level qualification. This also includes the request for expansion of competencies and roles and the assignment of decision making authority within complex health care situations and an orientation on the Competencies for European Critical Care Nurses of the European Federation of Critical Care Nursing Associations (EfCCNa).

[Algorithms for early mobilization in intensive care units]. / Algorithmen zur Frühmobilisierung auf Intensivstationen.

Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.

[Early mobilization. Competencies, responsibilities, milestones]. / Frühmobilisierung. Zuständigkeiten, Verantwortungen, Meilensteine.

BACKGROUND: Early mobilization is an evident, interprofessional concept to improve the outcome of intensive care patients. It reduces psychocognitive deficits and delirium and attenuates a general deconditioning, including atrophy of the respiratory pump and skeletal muscles. In this regard the interdisciplinary approach of early mobilization, taking into account different levels of mobilization, appears to be beneficial. The purpose of this study was to explore opinions on collaboration and tasks between different professional groups. METHOD: During the 25th Bremen Conference on Intensive Medicine and Nursing on 20 February 2015, a questionnaire survey was carried out among the 120 participants of the German Early Mobilization Network meeting. RESULTS: In all, 102 questionnaires were analyzed. Most participants reported on the interdisciplinarity of the approach, but none of the tasks and responsibilities concerning early mobilization can be assigned to a single professional group. The practical implementation of mobilizing orally intubated patients may require two registered nurses as well as a physical therapist. Implementation in daily practice seems to be heterogeneous. CONCLUSIONS: There is no consensus regarding collaboration, competencies, and responsibilities with respect to early mobilization of intensive care patients. The approach to date has been characterized by a lack of interprofessional communication, which may lead to an inefficient use of the broad and varied base of knowledge and experienceof the different professions.

[Quality assurance concepts in intensive care medicine]. / Qualitätssicherungskonzepte in der Intensivmedizin.

Intensive care medicine (ICM) is characterized by a high degree of complexity and requires intense communication and collaboration on interdisciplinary and multiprofessional levels. In order to achieve good quality of care in this environment and to prevent errors, a proactive quality and error management as well as a structured quality assurance system are essential. Since the early 1990s, German intensive care societies have developed concepts for quality management and assurance in ICM. In 2006, intensive care networks were founded in different states to support the implementation of evidence-based knowledge into clinical routine and to improve medical outcome, efficacy, and efficiency in ICM. Current instruments and concepts of quality assurance in German ICM include core intensive care data from the data registry DIVI REVERSI, quality indicators, peer review in intensive care, IQM peer review, and various certification processes. The first version of German ICM quality indicators was published in 2010 by an interdisciplinary and interprofessional expert commission. Key figures, indicators, and national benchmarks are intended to describe the quality of structures, processes, and outcomes in intensive care. Many of the quality assurance tools have proved to be useful in clinical practice, but nationwide implementation still can be improved.

[Quality assurance and quality management in intensive care]. / Qualitätssicherung und Qualitätsmanagement in der Intensivpflege.

Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.

[Tolerance of endotracheal tubes in patients on mechanical ventilation]. / Toleranz des endotrachealen Tubus bei beatmeten Intensivpatienten.

BACKGROUND: Modern concepts for sedation and analgesia and guidelines recommend light analgesia and sedation, so that patients on mechanically ventilation are more awake, compared to previous concepts. Hence, these patients are more alert and able to experience their situation on the ventilator and their endotracheal tube (ETT). PROBLEM: There is currently no convincing evidence of how patients tolerate the tube under present conditions, which interventions could help them, or whether they want to be sedated deeper because of the tube. Based upon our own observations, a broad range of reactions are possible. PURPOSE: The tolerance of the ETT in intensive care patients was explored. METHOD: A systematic literature research without time constraints in the databases PubMed and CINAHL was performed. Included were quantitative and qualitative studies written in German or English that investigated tolerance of the ETT in adult intensive care patients. Excluded were anesthetic studies including in- and extubation immediately before and after operations. RESULTS: Of the 2348 hits, 14 studies were included, including 4 qualitative studies about the experience of intensive care, 8 quantitative studies including 2 randomized controlled studies, and 2 studies with a mixed approach. Within the studies different aspects could be identified, which may in- or decrease the tolerance of an ETT. Aspects like breathlessness, pain during endotracheal suctioning and inability to speak decrease the tolerance. Information, the presence of relatives and early mobilization appear to increase the tolerance. CONCLUSION: Tolerance of the ETT is a complex phenomenon. A reflected and critical evaluation of the behavior of the patient with an ETT is recommended. Interventions that increase the tolerance of the ETT should be adapted to the situation of the patient and should be evaluated daily.

[Continuous fecal drainage systems in intensive care medicine]. / Kontinuierliches Stuhldrainagesystem im intensivtherapeutischen Bereich.

The relevance of nursing interventions for patients with fecal incontinence/defecation problems in intensive care medicine is very often underestimated. Fecal incontinence can either be a symptom of a disease, an epiphenomenon or a primary disease. Fecal incontinence negatively influences the ability of affected intensive patients to care for themselves. Fecal incontinence and diarrhea often occur together, which in return restricts the patient's mobility. Improperly treated fecal incontinence can result in infections (e.g., skin disorders, existing catheter sores), secondary healing can be delayed (e.g., bedsores, sores on the back or groin/genital area) and can also result in contamination of other areas (e.g., intestinal infection). In the past, many improvised techniques and materials have been used to drain feces for patients who are either immobile or critically ill with temporary or persistent fecal incontinence. Continuous and safe fecal drainage is often a problem. There is no basic standard nursing concept that can be recommended or verified. At present there are a number of continuous fecal drainage systems that have been launched on the market. Different indications and fields of application have been recommended when dealing with continuous fecal drainage. This article shows weaknesses and strengths of continuous fecal drainage, explains how each functions, and illustrates possible indications and contra-indications with each of these. Deployment options and limits are presented and summarized in an algorithm as a practical help for decision-making.