Intensive care unit nurses' knowledge, attitudes, and perceived barriers regarding early mobilization of patients

Abstract

Background: It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China. Aim: The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients. Design: A descriptive and cross-sectional design was used. Methods: A cross-sectional design was used, with an e-questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones. Results: As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%). Conclusions: Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain. Relevance to clinical practice: Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization.

What's in this issue

“…This may have been because of an increase in the number of patients being mobilized overall, resulting in decreased frequency and duration at the individual patient level. This finding may reflect a ceiling effect because of limited staffing, a barrier also identified by Wang et al 5 The authors concluded that protocolized early mobilization is safe and feasible. Further larger trials are needed to demonstrate an effect on patient outcomes, such as length of mechanical ventilation and delirium.…”

“…Our first paper by Wang et al examines nurses' knowledge, attitudes, and perceived barriers to early mobilization (EM) in Chinese ICUs. 5 Using a cross-sectional electronic survey of 227 nurses, they found that more than half of the nurses surveyed had good knowledge of, and a positive attitude towards, EM. However, 51% failed to understand the population that was eligible for EM, and many (39%) still did not support routine EM for critically ill patients.…”

“…The lack of protocols and of training were identified by both Wang et al and Chapman and McLuskey as barriers to early mobilization implementation. 5,10 These barriers were addressed by Nydahl and colleagues in their pilot stepped-wedge RCT of protocolized early mobilization in five German ICUs, enrolling 272 patients. 12 Staff at each site were trained to implement the intervention, which included a traffic light system indicating the risks vs benefits of mobilization, a physical examination, and pre-mobilization checklist.…”

Early mobilization of intensive care unit patients: It's not that simple but can be done

“…Therefore, it is promising that two studies in this edition have explored nurses' perceptions about early mobilization. Wang et al's findings show that, even though nurses had good knowledge about and positive attitudes towards early mobilization, challenges remained in implementing it in routine practice in the ICU 21 . Perhaps some strategies that we identified have been used successfully in quality improvement activities 19 could overcome the challenges identified in this paper.…”

“…Wang et al's findings show that, even though nurses had good knowledge about and positive attitudes towards early mobilization, challenges remained in implementing it in routine practice in the ICU. 21 Perhaps some strategies that we identified have been used successfully in quality improvement activities 19 could overcome the challenges identified in this paper. Furthermore, Chaplin and McLuskey's paper in this edition demonstrated inconsistency in nurses' knowledge of early mobilization and concludes that mobilization was still deemed to be a low priority.…”