Physiologic Responses to Simulated Care Activities in Older Surgical Patients

描述（由申请人提供）：住院期间保持身体功能的重要性，特别是对于65岁及以上的成年人来说，是如此公认的临床护理活动，如翻身和走动是常规医院病房护理的一部分。然而，在重症监护病房（ICU），身体功能并没有得到很大的提升。无论患者的原发疾病是什么，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，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，特别容易受到身体机能丧失的影响，通常年龄较大，经常是术后患者，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，在模拟ICU环境中测量潜在ICU老年人的临床护理活动，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）的效用，这是一种同时测量运动和心率的活动仪，用于测量老年人住院接受选择性手术前的模拟临床护理活动。这一人群之所以成为研究目标，是因为手术患者在老年ICU患者中占很大比例，而且他们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、晃来晃去、移动、坐在椅子上和走动）期间的运动模式和心率；目的2：利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的活动水平；目的3：探讨在模拟临床护理活动中，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，该结果将为ActiHeart在ICU环境中的应用奠定基础，在ICU环境中存在许多额外的混杂变量。这项研究将启动一个旨在优化住院老年人身体功能的研究项目，尤其是慢性危重患者。该提案解决了国家护理研究所（NINR）的三个战略目标：整合生物学和行为科学，采用和适应新技术，改进护理科学方法。注重促进健康和预防疾病，增加老年慢性危重病人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，被确定为国家卫生研究所的四个机会研究领域之一。

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.