What Are the Barriers to Mobilizing Intensive Care Patients?

Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior

“…This is the first study that has applied a theoretical approach to identify replacement therapy are consistently cited [11,12,43], despite evidence of safety [3]. This study identified that barriers to uptake of mobilization in the ICU were largely not about lack of knowledge, but rather, concern about risks for some patients and practical issues such as workload and availability of equipment.…”

“…These cultural, teambased factors have not been described in the quantitative literature to date (Table 4), which has primarily included patient-related factors, such as haemodynamic instability, agitation and the presence of lines and tubes [6,9,11,12]. This difference is an interesting finding and highlights the importance between understanding behaviour and simply collecting stated reasons for it.…”

“…There are several potential reasons why mobilization may not occur, for example, low staff-to-patient ratios of nursing and physiotherapy staff; the presence of lines and tubes [3,11]; patient sedation practices resulting in high levels of sedation; patient refusal [12] and unit culture [13]. It is possible that the results of the meta-analyses [5] do not apply to the entire population of patients admitted to ICU, as trials to date have been conducted in highly selected populations (i.e.…”

“…Several studies examining enteral feeding and the promotion of nutrition intake in the critically ill via the application of theoretical frameworks have also recently been published [30][31][32]. However, most studies describing attitudes and barriers to mobilization, or the factors used in prescribing exercise in the ICU, have been based on observational audit or survey data [9][10][11]33]. Although several studies have reported efforts to implement evidence-based A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT 8 practice in this area, including the ABCDE bundle [34], none have used a structured theoretical framework [26,28].…”

Incorporating Function and Physical Activity Across All Settings

“…Medical factors limiting physical activity and contributing to functional decline include the tethering effects of such things as indwelling urinary catheters, sequential compression devices, continuous monitoring (e.g., cardiac; pulse oximetry) and intravenous infusions; prescribed bed rest; sedating medications; insufficient management of pain; and tests and procedures that limit food/fluid intake (Leditschke, Green, Irvine, Bissett, & Mitchell, 2012;Thomsen, Snow, Rodriguez, & Hopkins, 2008;Zelada, Salinas, & Baztan, 2007). The culture and philosophy of care in acute care further impacts patient activity.…”