Organization of rehabilitation care in Portuguese intensive care units

Abstract

ObjectiveTo describe the different rehabilitation care models in practice in Portuguese adult intensive care units.MethodsA simple observational (cross-sectional) study was conducted through an online survey sent to the head nurses or individuals responsible for the 58 adult intensive care units that are part of the database of the Sociedade Portuguesa de Cuidados Intensivos.ResultsWe identified three models of organization of rehabilitation care: care provided by the staff of the intensive care unit (22.9%), care provided by specialized external teams (25.0%), and a mixture of the previous models, combining the two situations (52.1%). In the first model, the care was provided mainly by nurses with specialization in rehabilitation and, in the second model, the care was provided by physiotherapists. No significant differences were found between the models regarding the availability of care, in hours/day or days/week (p = 0.268 and 0.994, respectively), or results such as length of hospital stay in intensive care, ventilation time, or mortality rate in the unit (p = 0.418, 0.923, and 0.240, respectively).ConclusionThe organization of rehabilitation care in Portuguese intensive care units is unique and heterogeneous. Despite different care organization models, the availability of hours of care is similar, as are the overall results observed in patients.

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges

“…Musculoskeletal disorders and reduced muscle strength have been observed in critically ill patients with prolonged hospitalization due to three main possibilities: 1) muscle hypoxia, in which the inadequate systemic and peripheral muscle perfusion caused by the disease can increase anaerobiosis, raising lactate levels and impairing muscle function; 2) prolonged immobility, common in patients admitted to ICU, which is associated with marked reductions in muscle strength due to loss of functional units (sarcomeres) from lack of active movement, which in turn leads to postural instability, muscle shortening and contractures 9 , 15 , 41 , 44 ; 3) the use of steroids and neuromuscular blocking agents over a long-term period, which can lead to post-hospitalization polyneuropathy and myopathy 41 , 44 .…”

“…Moreover, the use of corticosteroids is indicated in patients with moderate to severe Covid-19 due to the severity of lung injury, further increasing muscle wasting and weakness 45 , 46 . Therefore, Covid-19 patients can develop a state of physical and functional impairment that can last over a long-term period beyond discharge, negatively affecting their quality of life and increasing the risk of mental disorders such as anxiety and depression 44 , 47 .…”

Evidências sobre modelos de gestão em enfermagem nos serviços hospitalares: revisão integrativa

“…São exemplos dessas teorias: teoria burocrática, das relações humanas, estruturalista, comportamentalista, de sistemas e contingencial, nas quais a eficiência da organização prescinde a lógica do processo de trabalho. (14) Alguns estudos relataram avanços na área da gestão hospitalar que incluíram novos incentivos financeiros para planos de saúde, a fim de criar modelos inovadores para prestação de cuidado, capazes de melhorar a eficiência operacional. (27,28) Um deles consiste no relato de experiência (3) de uma unidade de radiologia pediátrica que adotou os princípios do modelo da Disney para valorizar a ambiência e o bem-estar e promover felicidade a pacientes e trabalhadores.…”

Rehabilitation nursing care and emancipatory process

“…This is how the different cultures manifest themselves more, and the exchange of ideas is more dynamic and broadened, supported by the advancement in communications, with a rapid dissemination rate. Nowadays, information is disclosed to the entire world, in real time, regardless of where it occurs (Mendes, Nunes, Pinho, & Gonçalves, 2018). The whole world can be accessed from the mobile phone or laptop, infiltrating our homes, seemingly stripping several cultures, allowing for greater knowledge and approximation of people.…”