Physiologic Responses to Simulated Care Activities in Older Surgical Patients

老年手术患者对模拟护理活动的生理反应

• 批准号: 7331964
• 负责人: Colleen Marie Casey
• 金额: $ 3.52万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-01 至 2009-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7331964
• 关键词: Activities of Daily Living; Address; Adopted; Adult; Age; Area; Bed rest; Behavioral Sciences; Biological; Caring; Characteristics; Chronic; Clinical; Condition; Confounding Factors (Epidemiology); Critical Illness; Data; Devices; Discipline of Nursing; Disease; Dose; Elderly; Elective Surgical Procedures; Feasibility Studies; Foundations; Future; Goals; Health Promotion; Heart Rate; Hospitalization; Hospitals; Intensive Care Units; Intervention; Invasive; Measurement; Measures; Methods; Morbidity - disease rate; Motion; National Institute of Nursing Research; Nurses; Nursing Research; Operative Surgical Procedures; Outcome; Pain; Patients; Pattern; Performance; Performance Status; Physical Function; Physical activity; Physiological; Population; Postoperative Period; Public Health Nurses; Public Health Nursing; Recovery; Research; Research Activity; Rest; Risk; Science; Simulate; Sleep; Technology; Week; actigraphy; aged; clinically relevant; critical care nursing; disability; disorder prevention; functional status; hospital readmission; improved; innovation; monitoring device; mortality; new technology; patient safety; programs; response; simulation; tool; ward

DESCRIPTION (provided by applicant): The importance of preserving physical function during hospitalization, especially for adults aged 65 and older, is so well acknowledged that clinical care activities such as turning and ambulating are part of routine hospital ward care. However, physical functioning has not been promoted as much in the intensive care unit (ICU). Regardless of the patient's primary disease, even short periods of bed rest can reduce functional capacity. Consequently, clinical care activities that maintain physical function should be a priority even in the ICU. The chronically critically ill, defined as patients who require ICU care for weeks to months, are par- 'ticularly vulnerable to physical deconditioning and are often older, frequently postoperative, and at high risk for mortality, morbidity, and hospital readmissions. This descriptive feasibility study will apply an innovative, clinically relevant, noninvasive approach to measure clinical care activities in a simulated ICU setting using existing technology with a population of potential ICU elders as a first step towards systematically evaluating activity patterns and developing activity interventions for the critically ill. This study aims to evaluate the utility of using the ActiHeart(tm), a type of actigraph that measures motion and heart rate simultaneously, to measure simulated clinical care activities with older adults prior to their hospitalization for elective surgery. This population has been targeted because surgical patients represent a significant proportion of older ICU patients and are at high risk for both chronic critical illness and bed rest. The study's specific aims include: Aim 1- Describe the patterns of motion and heart rate during five different clinical care activities (turning, dangling, transferring, chair sitting, and ambulating); Aim 2-Compare clinical care activities using motion and continuous heart rate data to discriminate activity levels between five different clinical care activities; and Aim 3-Explore age, pain, functional performance and status, and morbidity as covariates of motion and heart rate data during the simulation of clinical care activities. If feasible, the results would lay the foundation for the ActiHeart's(tm) use in the ICU setting, where many additional confounding variables exist. The study will begin a program of research aimed at optimizing physical function in hospitalized elders, especially the chronically critically ill. This proposal addresses three of the National Institute of Nursing Research (NINR) strategic objectives: integrating biological and behavioral science, adopting and adapting new technologies, and improving nursing science methods. This focus on health promotion and disease prevention, increasing the potential for recovery and limiting disability in older chronically critically ill patients, represents a core value of nursing and public health, identified as one of NINR's four research areas of opportunity.

描述（由申请人提供）：住院期间保护身体功能的重要性，特别是对于65岁及以上的成年人，是众所周知的，临床护理活动，如转身和走动是常规医院病房护理的一部分。然而，在重症监护室（ICU）中，身体功能并没有得到很大的促进。无论患者的原发病是什么，即使是短期卧床休息也会降低功能能力。因此，即使在ICU中，维持身体功能的临床护理活动也应该是优先考虑的。慢性危重病患者，定义为需要ICU护理数周至数月的患者，特别容易受到身体失调的影响，并且通常年龄较大，经常术后，死亡率，发病率和再次入院的风险较高。这项描述性可行性研究将采用一种创新的、临床相关的、非侵入性的方法，利用现有技术在模拟ICU环境中测量临床护理活动，并将潜在的ICU老年人人群作为系统评估活动模式和为危重患者制定活动干预措施的第一步。本研究旨在评价使用ActiHeart（TM）（一种同时测量运动和心率的活动记录仪）在老年人住院接受择期手术前测量模拟临床护理活动的实用性。这一人群已成为目标，因为手术患者在老年ICU患者中占很大比例，并且处于慢性危重病和卧床休息的高风险中。该研究的具体目标包括：目标1-描述五种不同临床护理活动期间的运动和心率模式目标2-使用运动和连续心率数据比较临床护理活动以区分五种不同临床护理活动之间的活动水平;和目标3-探索年龄，疼痛，功能性能和状态，以及发病率作为临床护理活动模拟过程中运动和心率数据的协变量。如果可行的话，这些结果将为ActiHeart（tm）在ICU环境中的使用奠定基础，因为ICU环境中存在许多其他混杂变量。这项研究将开始一项旨在优化住院老年人身体功能的研究计划，特别是慢性危重病患者。该提案涉及国家护理研究所（NINR）的三个战略目标：整合生物和行为科学，采用和适应新技术，并改善护理科学方法。这种对健康促进和疾病预防的关注，增加了老年慢性重症患者的康复潜力和限制残疾，代表了护理和公共卫生的核心价值，被确定为NINR的四个研究领域之一。