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Background A multicentre randomised trial demonstrated improved outcomes for intensive care unit (ICU) patients using early, goal-directed mobility implemented by nurses. Objectives The aim of the study was to evaluate barriers to nursing mobility, using a validated survey, during an ongoing quality improvement (QI) project (2019) in a medical ICU and determine changes from the pre-QI (2017) baseline. Methods Nurses, nurse practitioners, physician assistants, and clinical technicians completed the 26-item Patient Mobilization Attitudes and Beliefs Survey for the ICU (PMABS-ICU). An overall score and three subscale scores (knowledge, attitudes, behaviour), each ranging from 0 to 100, were calculated; higher scores indicated greater barriers. Results Seventy-five (93% response rate) nurses, eight (100%) nurse practitioners and physician assistants, and 11 (100%) clinical technicians completed the PMABS-ICU. For all respondents (N = 94), the mean (standard deviation) overall PMABS-ICU score was 32 (8) and the knowledge, attitudes and behaviour subscale scores were 22 (11), 33 (11), and 34 (8), respectively. Among all respondents completing the survey in both 2017 and 2019 (N = 46), there was improvement in the mean (95% confidence interval) overall score [−3.1 (−5.8, −0.5); p = .022] and in the knowledge [−5.1 (−8.9, −1.3); p = .010] and attitudes [−3.9 (−7.3, −0.6); p = .023] subscale scores. Among all respondents (N = 48) taking the PMABS-ICU for the first time in 2019 compared with those taking the survey before the QI project in 2017 (N = 99), there was improvement in the mean (95% confidence interval) overall score [−3.8 (−6.5, −1.1); p = .007] and in the knowledge [−6.9 (−11.0, –2.7); p = .001] and attitude [−4.3 (−8.1, –0.5); p = .027] subscale scores. Conclusions Using a validated survey administered to ICU nurses and other staff, before and during a structured QI project, there was a decrease in perceived barriers to mobility. Reduced barriers among those taking the survey for the first time during the QI project compared with those taking the survey before the QI project suggests a positive culture change supporting early, goal-directed mobility implemented by nurses.

Background Delirium in the intensive care unit is associated with poor patient outcomes. Recent studies support nonpharmacological therapy, including cognitive stimulation, to address delirium. Understanding barriers to cognitive stimulation implemented by nurses during clinical care is essential to translating evidence into practice. Objective To use qualitative methods through a structured quality improvement project to understand nurses’ perceived barriers to implementing a cognitive stimulation intervention in a medical intensive care unit. Methods Data were collected through semistructured interviews with nurses in a medical intensive care unit. Data were categorized into themes by using thematic analysis and the Consolidated Framework for Implementation Research. During cognitive stimulation, nurses reviewed with patients a workbook of evidence-based tasks (focused on math, alertness, motor skills, visual perception, memory, problem-solving, and language). Results The 23 nurses identified 62 barriers to and 26 facilitators of cognitive stimulation. These data were summarized into 12 barrier and 9 facilitator themes corresponding to the following Consolidated Framework for Implementation Research domains: Intervention Characteristics, Outer Setting, Inner Setting, and Characteristics of Individuals. Nurses also identified several facilitators within the Process domain. Patient-specific variables, including sedation, were the most frequently reported barriers. Other barriers included cognitive stimulation not being prioritized, nursing staff–related issues, documentation burden, and a lack of understanding of, or appreciation for, the evidence supporting cognitive stimulation. Conclusions Implementation of cognitive stimulation requires a multidisciplinary approach to address perceived barriers arising from the organization, context, and individuals associated with the intervention, as well as the intervention itself.

Background. Plant-based foods are staple diets and main micronutrient sources of most rural Ghanaian households. The objective of this study was to determine the effect of Amaranthus cruentus and Solanum macrocarpon leafy vegetable flour on micronutrient intake and nutritional status of rural Ghanaian school children. Method. This study was a randomized controlled trial that consisted of baseline data collection and a three-month nutrition intervention feeding program. Two groups of 53 children, age 4–9 years, involved in the Ghana School Feeding Program took part in the study. An experimental group consumed Amaranthus cruentus and Solanum macrocarpon leaves flour (ACSMLVF) stews and soup. The control group consumed stews and soup without ACSMLVF. Haemoglobin and serum vitamin A concentrations were determined. Dietary and anthropometric data were collected and analysed. Participants were screened for malaria parasitaemia and hookworm. Results. Anaemia was present in 41.5% and 37.3%, respectively, of the intervention and control groups at baseline. It was present in 28.3% and 53.3%, respectively, at the end of the study. This was significantly different (p=0.024). There was a low vitamin A concentration in 66.0% and 64.7% at baseline and 20.8% and 23.4% at the end of the study in the intervention and control groups, respectively. The mean iron, zinc, and provitamin A (beta-carotene) intakes of the intervention group were 14.2 ± 7.1 mg, 5.7 ± 2.1 mg, and 214.5 ± 22.6 μg, respectively, at baseline. Those of the control were 13.7 ± 6.1 mg, 5.4 ± 2.1 mg, and 210.6 ± 20.1 μg, respectively. At the end of the study, the mean intake of iron, zinc, and beta-carotene for the intervention group was 24.1 ± 10.9 mg, 13.8 ± 8.2 mg, and 694.2 ± 33.1 μg, respectively. The intake of these micronutrients for the control at the end of the study was 14.8 ± 6.2 mg, 5.9 ± 2.3 mg, and 418.4 ± 34.7 μg, respectively. Conclusion. Consumption of ACSMLVF stews and soup increased iron, zinc, and beta-carotene intakes. Anaemia prevalence was lower in the intervention group at the end of the study.

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. Materials and Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). Results: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (−0.8 for each additional year; P = 0.02). Conclusions: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.

Background Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care. Objectives To report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit. Methods An interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis. Results During three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%). Conclusions Nurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.

Background Nutritional anaemia and vitamin-A deficiency are public health issues confronting Ghanaian children. Their adverse effects are likely pronounced during the dry season when green leafy vegetables, rich-sources of iron and provitamin-A are scarce. This study assessed the effect of dried green leafy vegetables on anaemia and vitamin-A status of Ghanaian school children. Method This was 3 months pretest, posttest nutrition intervention study. Children 4–9 years were randomized to receive or not receive supplement. High Performance Liquid Chromatography and Haemocue hemoglobinometer were used to determine vitamin-A and haemoglobin concentrations respectively. Malaria-parasitaemia and helminthes were examined by Giemsa-staining and Kato-Katz respectively. Nutritional status was assessed by anthropometry. Student’s t-test was used to establish significant differences between groups. Results At baseline, the mean haemoglobin concentrations of control and supplemental were 116.9 ± 9.9 g/l and 117.6 ± 12.7 g/l respectively. At end-line, it was 121.9 ± 13.5 g/l for supplemental and 113.4 ± 8.5 g/l for control, significant at p = 0.001. At baseline prevalence of anaemia was 37.3 and 41.5% in control and supplemental respectively. At end-line it was 33.3% in supplemental against 57.5% in control, significant at p = 0.024. At baseline mean retinol concentrations were 16.79 ± 8.74 μg/dl and 16.97 ± 7.74 μg/dl for control and supplemental respectively. Mean retinol concentrations for control and supplemental were 24.35 ± 5.50 μg/dl and 26.96 ± 6.86 μg/dl respectively at end-line. At end-line 60% of control against 64.0% of supplemental had low vitamin-A status. At end-line, anaemic-control had mean retinol concentration of 23.78 ± 5.23 μg/dl and anaemic-supplemental had 27.46 ± 7.28 μg/dl. Prevalence of low vitamin-A status was 64.3 and 84.2% in anaemic-control and anaemic-supplemental respectively at baseline but it became 23.1 and 21.1% respectively, at end-line. The mean haemoglobin concentrations of anaemic-control and supplemental were 105.7 ± 7.5 g/l and 113.6 ± 13.6 g/l respectively at end-line. The change in prevalence of anaemia between the anaemic groups was 12.2%, significant at p = 0.042. Conclusion Consumption of green leafy vegetables powder increased mean haemoglobin and retinol concentrations of the study participants. It had the potential to minimize prevalence of anaemia and low vitamin-A status of study participants.