Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU

Abstract

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.

Questionnaires to Assess Facilitators and Barriers of Early Mobilization in Critically Ill Patients; Which One to Choose? A Systematic Review

“…In five questionnaires (Anekwe et al, 2017; Choong et al, 2013; Goodson et al, 2018; Koo et al, 2016; Taito et al, 2018) a definition of early mobilization was given (Table 1). In five other questionnaires (Bakhru et al, 2015; Castro et al, 2015; Jolley et al, 2014; Joyce et al, 2018; Kim et al, 2018) this was not the case, although a definition could be retrieved from the accompanying publications.…”

“…In the latter case, the words “as soon as possible” were often used without further specification. The activity aspect was in terms of concrete activities, for instance getting patients out of bed, sitting on the edge of the bed or walking (Castro et al, 2015; Goodson et al, 2018; Kim et al, 2018; Taito et al, 2018) or in more general terms such as the current mobility status of the patient or the series of exercises performed (Anekwe et al, 2017; Bakhru et al, 2015; Koo et al, 2016). In the latter case, these definitions were limited to physical therapy practices.…”

“…In the latter case, these definitions were limited to physical therapy practices. Five questionnaires provided a definition of early mobilization covering a broad range of activities, including nurse initiated activities related to patient mobility such as dangling, moving to a chair, or ambulating (Castro et al, 2015; Choong et al, 2013; Goodson et al, 2018; Jolley et al, 2014; Kim et al, 2018).…”

“…Most questionnaires were developed by a team consisting of researchers and medical professionals (Table 2), though often it was not described precisely who had been responsible for what. For six questionnaires (Anekwe et al, 2017; Choong et al, 2013; Dafoe et al, 2015; Goodson et al, 2018; Kim et al, 2018; Koo et al, 2016) the number of people involved in the development was given exactly, ranging from 3 to 89 (Table 2), with five of them (Anekwe et al, 2017; Choong et al, 2013; Goodson et al, 2018; Kim et al, 2018; Koo et al, 2016) including a focus group. Although some questionnaires had an extensive development phase, none described the time needed for development.…”

“…The main themes underlying the questionnaires varied between the questionnaires, though the themes, “attitude,” “knowledge,” and “behavior” regarding early mobilization were frequently mentioned (Anekwe et al, 2017; Choong et al, 2013; Goodson et al, 2018; Jolley et al, 2014; Kim et al, 2018; Koo et al, 2016). Furthermore, in three questionnaires (Al-Nassan et al, 2019; Bakhru et al, 2015; Malone et al, 2015) the themes “staffing patterns,” “practices,” and “protocols” were incorporated.…”