Perceived barriers to early mobilization of intensive care unit patients by nurses in hospitals affiliated to Jundishapur University of Medical Sciences of Ahvaz in 2019

Nurse-involved early mobilization in the intensive care unit: A systematic review and meta-analysis

BACKGROUND

Early mobilization is one proposed strategy for reducing complications and optimizing patient outcomes. Nurses play an essential role in patient monitoring and co-ordination.

AIMS

To assess the effects of a nurse-involved early mobilization programme on muscle strength and intensive care unit (ICU) length of stay and identify the components of an early mobilization programme.

STUDY DESIGN

A systematic review and meta-analysis were conducted. MEDLINE (PubMed), Embase, Cochrane and CINAHL databases were searched. Eligible studies included randomized controlled trials (RCTs) and non-randomized studies of adult ICU patients undergoing early mobilization. The studies were appraised using RoB 2.0 and ROBINS-I tools, and a meta-analysis was performed using Rstudio 2023.06.2.

RESULTS

Nine studies were selected from 943 studies. Four studies involved only ICU nurses, while five involved multidisciplinary teams. Concerns about bias were raised in four RCTs, and two non-randomized studies had moderate bias risk. Interventions involved progressive exercise steps, but none detailed the specific role of nurses. Early mobilization significantly decreased ICU length of stay (95% CI: -3.22, -0.11; p = .04), although it did not improve muscle strength (95% CI: -0.86, 0.99; p = .80).

CONCLUSIONS

Nurse-involved early mobilization was associated with a reduction in ICU stay, although it did not impact muscle strength. The nurses' roles were not specifically defined.

RELEVANCE TO CLINICAL PRACTICE

An analysis of relevant tasks is necessary to clarify the role of nurses in early mobilization and to provide optimal care. Including these roles is crucial in the development of standardized early mobilization.

Early mobilisation in Windhoek intensive care units: Practices, attitudes and barriers

Background

Early mobilisation (EM) of critically ill patients in intensive care units (ICUs) has gained significant attention because of its potential to improve patient outcomes. Despite the recognised benefits of EM, implementation remains inconsistent.

Objectives

To describe the knowledge, attitudes and practices of healthcare professionals regarding EM of critically ill patients in Windhoek.

Method

A descriptive, cross-sectional design using a self-administered survey was conducted in Windhoek, Namibia, targeting nurses, doctors and physiotherapists working in private ICUs.

Results

A total of 174 surveys were distributed, with a response rate of 24.1% (n = 42). Respondents included 21 nurses, 5 doctors and 13 physiotherapists. Most participants underestimated the incidence of ICU-acquired weakness and reported unfamiliarity with EM literature (n = 19, 51.4%). Furthermore, 25 respondents (67.6%) reported that patients were not automatically assessed for mobilisation, the majority reported requiring a doctor's referral (n = 31, 83.8%). Mobility practices were conservative, especially when patients were intubated or in the presence of radial and femoral catheters. Major patient-level barriers included medical instability (n = 24, 72.7%) and excessive sedation (n = 18, 54.5%); whereas institutional barriers were the requirement for a doctor's referral (n = 22, 64.7%) and no written guidelines or protocols for mobilisation (n = 16, 47.1%). Provider level barriers were that mobility is not perceived as important by some individuals (n = 18, 78.3%).

Conclusion

Our study revealed knowledge gaps, conservative mobility practices and numerous barriers to EM implementation at the patient, provider and institutional levels.

Clinical implications

The findings highlight the need for targeted education, training programmes, standardised mobility protocols and the establishment of a dedicated mobility champion to promote EM in Windhoek ICUs.

Challenges experienced by cardiac intensive care nurses during first out-of-bed patient mobilization after open-heart surgery: A descriptive phenomenological qualitative study

AIM

To investigate the potential challenges experienced by cardiac intensive care unit (ICU) nurses in the first out-of-bed patient mobilization after open-heart surgery and propose solutions.

DESIGN

A qualitative study design using the descriptive phenomenological approach.

METHODS

Individual face-to-face interviews were conducted via a widely used videoconferencing program between 28 July and 22 October 2022, in the tertiary cardiac ICU of a university hospital. Nurses who had at least 1 year of cardiac ICU experience and actively participating in patient care were included. The COREQ criteria and checklist were followed in this investigation and the data were analysed by using the ATLAS.ti 8.0.

FINDINGS

Nurses reported that they experience challenges when mobilizing patients, such as patients' fear, reluctance or resistance; nurses having insufficient experience, strength or lack of team members. Despite these challenges, they highlighted some positive outcomes of mobilization, such as feeling happy, reinforced team communication and nurse-patient relationship. The nurses also suggested some facilitators, such as patient motivation and an explanation of the process.

CONCLUSION

Nurses experience various patient-related and nurse-related challenges during the first out-of-bed mobilization of the patient after open-heart surgery. It is recommended that healthcare institutions should implement effective strategies to address the staffing shortages and to support nurse motivation to ensure adequate nursing care.

IMPACT

This study provides valuable insights into the existing literature by examining the potential challenges and strategies of the first out-of-bed patient mobilization in the cardiac ICU. It shows that patient education and organizational adaptations are effective ways to overcome the challenges. It also suggests that motivating and informing patients before the mobilization can make the process easier. Moreover, it reveals that successful patient mobilization makes nurses happy, improves team communication and strengthens nurse-patient relationship.

PATIENT AND PUBLIC INVOLVEMENT AND ENGAGEMENT

No patient or public contribution.

Perceived Barriers of Clinical Roles Towards Intensive Care Unit Mobility

Background: There is overwhelming evidence of improved patient outcomes as a result of early mobilization in the intensive care unit (ICU). However, several barriers of ICU mobility remain understated with reference to clinical roles. The purpose of this study is to investigate the perceived barriers of early mobility of critically ill patients among ICU healthcare providers. Methods: In this cross-sectional study, the Mobilization Attitudes and Beliefs Survey (PMABS-ICU) was administered to ICU healthcare providers using an online survey. The study investigated barriers related to knowledge, attitudes, and behaviors regarding ICU mobility practices. These barriers were compared among different ICU clinical roles. Results: The survey yielded a total number of 214 healthcare providers with 41% female and 59% male. Respiratory therapists reported the highest perceived barriers to ICU mobility (M 39, IQR 36, 43) % compared to physical therapists (who reported the lowest barriers), occupational therapists, nurses, and physicians (p ≤ 0.05). ICU healthcare providers' behavior towards ICU mobility such as perceived benefits and safety is ranked as the primary barrier (M 49, IQR 42, 52) %. Professional experience did not significantly vary among all groups. Conclusion: Our findings highlight that ICU healthcare providers' perceptions, including both potential benefits and safety concerns regarding mobility, are significant barriers to implement mobility practices. ICU mobility barriers should be tackled by providing education and training. A focused effort to include RTs and nurses could advance interdisciplinary ICU mobility practice and reduce associated barriers.

Overcoming patient safety concerns and integrating early mobility into pediatric intensive care unit nursing practice

PURPOSE

Early Mobilization (EM) in Pediatric Intensive Care Units (PICU) is safe, feasible and improves outcomes for PICU patients, yet patient safety concerns persist among nurses which limits EM adoption. The purpose of this study was to explore how nurses incorporate EM into practice and balance their concerns for patient safety with the benefits of EM.

DESIGN & METHODS

This focused ethnographic study included 15 in-depth interviews with 10 PICU nurses. Data were analyzed using thematic analysis.

RESULTS

Two major categories were found which describe the clinical judgement and decision-making of PICU nurses regarding EM. The nurses' concerns for patient safety was the first major category. This included patient-level factors: hemodynamic stability, devices attached, patient's strength, and risk for falls and size. In the second major category, these safety concerns were overcome by applying a multiple step process which resulted in nurses performing EM despite their concerns. That process included: gaining comfort through experience, performing patient safety checks, working with therapists, learning from adverse events, and understanding existing evidence about the benefits of EM.

CONCLUSIONS

The overarching theme was nurses' determination to preserve patient safety while ensuring patients could receive the benefits of EM. This theme describes the decisions, behaviors and processes that nurses enact to become more comfortable with EM despite their concerns for patient safety and potential adverse events while performing mobility activities.

PRACTICE IMPLICATIONS

Creating opportunities for nurses to participate in EM may increase their willingness to overcome safety concerns and engage in these activities.

Assessment of redundancy, methodological and reporting quality, and potential discrepancies of results of systematic reviews of early mobilisation of critically ill adults: a meta-research protocol

INTRODUCTION

Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients.

METHODS AND ANALYSIS

A meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the 'Evidence-Based Research' framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation.

ETHICS AND DISSEMINATION

As meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology.

TRIAL REGISTRATION NUMBER

osf.io/kxwq9.

Clinicians' knowledge and attitude towards early mobilization in intensive care units in Ethiopian tertiary hospitals: A multi-centre study

Objectives

To assess clinicians' knowledge, attitude and associated factors towards patients' early mobilization in intensive care units in the tertiary hospitals in Northwest Ethiopia.

Methods

A multi-centre, cross-sectional study was conducted at the tertiary hospitals in Northwest Ethiopia from April to June, 2022. Data were collected by using self-administered, structured questionnaire; ordinal logistic regression analysis was performed and associations were described in adjusted odds ratios.

Results

A total of 304 clinicians were included (response rate of 89.7%). The proportions of poor, fair and good knowledge towards early mobilization in intensive care unit among clinicians were 16.8%, 57.9% and 25.3%, respectively; while that of negative, fair and positive attitude were 16.4%, 60.2% and 23.4%, respectively. Factors associated with better knowledge were being a physiotherapist (adjusted odds ratio = 2.9, confidence interval = 1.2-6.7), having a total work experience >5 years (adjusted odds ratio = 4.6, confidence interval = 1.7-12.1), having an intensive care unit work experience >5 years (adjusted odds ratio = 2.8, confidence interval = 1.1-6.8), previous in-service training (adjusted odds ratio = 1.8, confidence interval = 1.1-3.0) and reading guidelines (adjusted odds ratio = 1.9, confidence interval = 1.1-3.2). Better attitude was associated with in-service training (adjusted odds ratio = 1.9, confidence interval = 1.2-3.1), attending early mobilization courses (adjusted odds ratio = 1.8, confidence interval = 1.1-3.0), presence of mobilization advocators (adjusted odds ratio = 1.7, confidence interval = 1.0-2.8), good knowledge (adjusted odds ratio = 2.6, confidence interval = 1.2-5.8) and fair knowledge (adjusted odds ratio = 2.5, confidence interval = 1.3-4.8).

Conclusion

Most of the clinicians had demonstrated fair knowledge and attitude towards early mobilization in intensive care unit. However, there were significant proportion of clinicians who had poor knowledge and negative attitude. We recommended active engagement of physiotherapists and experienced clinicians in intensive care units. Clinicians need to have self-learning habits and attend regular training/courses related to early mobilization in intensive care unit.

Predictors of sedation period for critical illness patients focusing on early rehabilitation on the bed

There are various interventions of rehabilitation on the bed, but these are time-consuming and cannot be performed for all patients. The purpose of this study was to identify the patients who require early mobilization based on the level of sedation. We retrospectively evaluated the data of patients who underwent physical therapy, ICU admission of > 48 h, and were discharged alive. Sedation was defined as using sedative drugs and a Richmond Agitation-Sedation Scale score of < - 2. Multiple regression analysis was performed using sedation period as the objective variable, and receiver operating characteristic (ROC) curve and Spearman's rank correlation coefficient were performed. Of 462 patients admitted to the ICU, the data of 138 patients were analyzed. The Sequential Organ Failure Assessment (SOFA) score and non-surgery and emergency surgery cases were extracted as significant factors. The ROC curve with a positive sedation period of more than 3 days revealed the SOFA cutoff score was 10. A significant positive correlation was found between sedation period and the initial day on early mobilization. High SOFA scores, non-surgery and emergency surgery cases may be indicators of early mobilization on the bed in the ICU.

Knowledge, Attitude, and Perceived Barriers of Newly Graduated Registered Nurses Undergoing Standardized Training in Intensive Care Unit Toward Early Mobilization of Mechanically Ventilated Patients: A Qualitative Study in Shanghai

Aim: To explore the knowledge and attitudes of newly graduated registered nurses, who have undergone standardized training in the intensive care unit, about the early mobilization of mechanically ventilated patients and identify perceived barriers to the application of early mobilization.

Background: Early mobilization of mechanically ventilated patients has been gradually gaining attention, and its safety and effectiveness have also been verified. Nurses in intensive care units are the implementers of early mobilization, and the quality of their care is closely related to patient prognosis. However, the knowledge and attitude of newly graduated registered nurses undergoing standardized training, in intensive care units, on the early mobilization of mechanically ventilated patients and the obstacles they face in clinical implementation are still unclear.

Methods: This qualitative study utilized the phenomenological method to explore the experiences of 15 newly graduated registered nurses undergoing standardized training in intensive care units in a 3rd hospital in Shanghai, China. Semi-structured face-to-face interviews were conducted in June 2020. The Colaizzi seven-step framework was used for data analysis.

Findings: A total of 15 new nurses comprised the final sample after data saturation. Three main themes emerged from the analysis and seven subthemes: perceived importance, low implementation rate, and perceived barriers.

Conclusions: Newly graduated registered nurses undergoing standardized training in intensive care units have a high level of awareness of the importance of early mobilization of mechanically ventilated patients and are willing to implement it. However, there is a lack of relevant knowledge and other obstacles that restrict clinical implementation. Early mobilization should be included in the standardized training of new nurses in intensive care units.