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: 7477654
• 负责人: Colleen Marie Casey
• 金额: $ 2.95万
• 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 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7477654
• 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）：众所周知，住院期间保留身体功能的重要性，特别是对于 65 岁及以上的成年人来说，翻身和走动等临床护理活动已成为医院病房常规护理的一部分。然而，在重症监护病房（ICU）中，身体机能并没有得到那么多的改善。无论患者的原发病是什么，即使是短时间的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成为优先事项。慢性危重症患者被定义为需要 ICU 护理数周至数月的患者，特别容易出现身体状况不佳，而且往往年龄较大，经常接受术后治疗，死亡率、发病率和再入院的风险很高。这项描述性可行性研究将采用一种创新的、临床相关的、无创的方法，利用现有技术，对模拟 ICU 环境中的潜在 ICU 老年人群进行临床护理活动的测量，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。本研究旨在评估使用 ActiHeart(tm)（一种同时测量运动和心率的活动记录仪）在老年人住院进行择期手术之前测量模拟临床护理活动的效用。该人群之所以成为目标人群，是因为手术患者在 ICU 老年患者中占很大比例，而且患慢性危重疾病和卧床休息的风险很高。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（转身、晃动、转移、坐在椅子上和走动）期间的运动模式和心率；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；目标 3 - 在模拟临床护理活动期间探索年龄、疼痛、功能表现和状态以及发病率作为运动和心率数据的协变量。如果可行，结果将为 ActiHeart(tm) 在 ICU 环境中的使用奠定基础，因为那里存在许多其他混杂变量。该研究将启动一项研究计划，旨在优化住院老年人，尤其是慢性危重病人的身体机能。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、采用和适应新技术以及改进护理科学方法。这种对健康促进和疾病预防、增加老年慢性危重患者康复潜力和限制残疾的关注，代表了护理和公共卫生的核心价值，被确定为 NINR 的四个研究机会领域之一。