Feasibility and Perceptions of Health care Professionals Regarding the Implementation of Early Mobilization of Patients in Intensive Care Units.

Abstract

Background: Early mobilization in the intensive care unit (ICU) has gained significant attention over the past years. Many ICU survivors are left with considerable consequences from their ICU stay even if they recover from the acute phase of illness. Complications survivors suffer from include muscle weakness, self-care deficits, hospital readmissions and poor quality of life. Early mobilization helps patients recover faster with better outcomes. However, despite the benefits of mobilization, barriers impede its implementation at the level of the patient, provider and institution. Anecdotal evidence suggests that ICU patients are rarely mobilized, mainly in terms of getting them out of bed. No published studies are available on this issue in Lebanon.

Aim: The main purpose of this study was to assess the feasibility of early mobilization of patients in ICUs from the clinicians' perspective and associated factors.

Methods: A descriptive correlational study design was used. The study was conducted at the intensive care, neuro-intensive care and respiratory care units of the American University of Beirut Medical Center (AUBMC). The target population included all ICU clinicians, including registered nurses, critical care physicians, physiotherapists, respiratory therapists, nurse managers, clinical nurse coordinators, clinical leader, clinical nurse specialist and the clinical educator for the selected critical care units at AUBMC. The institutional review board (IRB) and AUBMC administration approvals to conduct the study were secured. An online survey was sent to the clinicians, including demographic questions and a modified version of the Mobility Survey Questionnaire by Koo et al. (2016). The mobility questionnaire includes 26 questions that ask about the importance of and barriers to early mobilization, its timing, eligibility and activities that ICU patients may engage in, in addition to knowledge and practices related to mobilization in intensive care, and an additional question about the feasibility of implementing it at AUBMC.

Analysis: Statistical analysis included descriptive statistics (means and standard deviations, and frequencies and percentages, depending on the level of measurement). Bivariate analyses included Spearman Rho correlation coefficient, t-tests and ANOVA to examine associations between variables. Multiple linear regression analysis was used to predict perceived feasibility of implementing early mobility in ICUs at AUBMC from the perspective of clinicians.

Results: The final sample included 49 participants (40% response rate). The majority of the sample were nurses (70.7%), with 2 physicians, 4 physiotherapists and 4 respiratory therapists. Most participants work in the ICU (83%), have a bachelor’s degree (63%), with up to 10 years of work experience (53%). Most clinicians (67%) perceived early mobility (EM) to be crucial or very important but 67% think that its implementation is only somewhat or not at all feasible. Participants identified medical instability, intubation, the risk of dislodgment of lines and devices and excessive sedation as the most common patient barriers to implementation of EM in ICU. Moreover, lack of equipment or space, the requirement of a medical order for EM and lack of a champion for EM were the most common institutional barriers. In addition, provider barriers that were most commonly reported were inadequate training in EM, safety concerns, limited staffing, as well as lack of communication and coordination about EM among clinicians. Over half the sample thought that mobility must be started as soon as possible in the ICU when the patient is conscious. However, when asked about activities done, participants mostly often reported range of motion or in bed activities as the most permissible or prescribed, with limited frequency and duration. The majority of participants (60%) reported lack of knowledge and training in EM, in addition to limited staffing and availability of physiotherapists, with a key role of nurses in assessing readiness for and participating in the mobilization of patients. Multivariate analysis showed that lack of equipment and lack of written guidelines predict the feasibility of implementing EM in the ICU.

Conclusion: The findings of this study suggest that the importance of implementation of early mobility is acknowledged and its implementation is feasible once the barriers are addressed. A multidisciplinary team led by a clinical nurse specialist can assess the physical and human resource needs for instituting EM and present a proposal for its implementation in intensive care to the administration at AUBMC.