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

Abstract

Early mobilization (EM) of patients in the intensive care unit (ICU) is a safe, feasible, and beneficial approach. However, the implementation of EM as a part of routine clinical care can be challenging. As a result, the present study aimed to identify the potential barriers to EM of ICU patients. The statistical population of this descriptive-analytical study included 107 critical care nurses working in hospitals affiliated with the Jundishapur University of Medical Sciences of Ahvaz. The participants were selected using the census method among the eligible critical care nurses, and the researcher-made questionnaire was used for data collection. This questionnaire included a demographic questionnaire and an inventory of barriers to EM. In total, 72% of the nurses had a highly positive attitude towards EM implementation, whereas relatively few had a slightly positive attitude. The major human-resource-related barriers included the lack of trained staff (76.6%), inadequate shift nurses (74%), and inadequate time for this procedure (57.9%). Approximately 88.9%, 82.2%, 62%, and 57.9% of the nurses reported coma or a deep degree of sedation, mobilization of obese patients, mobilization of patients with agitation, and pain, respectively, as the major patient-related barriers. The lack of EM implementation and recording according to the checklist (90.4%), the lack of an approved EM implementation protocol (88.8%), and inadequate equipment for the mobilization of mechanically ventilated patients (58%) were among the major equipment-related barriers. The participating nurses were aware of the EM advantages, and the majority of them had a highly positive attitude towards its implementation in the ICU. However, nurses believed that the actual EM implementation is associated with challenges such as human resources limitations, equipment-related barriers, and patient-related barriers.

Perceived barriers for early mobilization of patients admitted to the intensive care unit (ICU)

“…Early mobilization proved to be effective and safe in many studies, despite the evidence , many surveys and studies of early mobilization practice have shown limited penetration, particularly in patients undergoing MV, and EM is not implemented in the daily practice in many ICUs [16].Knowledge of environmental barriers and personal experiences is of utmost importance for innovating and implementing a new practice [13]. Furthermore, studying attitudes of ICU workers especially nurses, variation in ICU structure, patient and family culture may be most associated with (and hence most favorable for) implementing EM practice [17]. The present study aimed to assess barriers perceived by nurses in the 3 intensive care units (ICUs) at Beni-Suef University Therefore, special care should be provided to ensure patient safety [18].…”

Barreiras enfrentadas por fisioterapeutas para realizar a mobilização precoce em unidades de terapia intensiva

“…Nas Unidades de Terapia Intensiva (UTI) diversos procedimentos são conduzidos diariamente para o manejo clínico adequado, seguro e eficaz de pacientes com doenças graves 1 . O contexto que envolve o cuidado em UTI pode resultar em pacientes com baixo nível de mobilidade, em especial, aqueles em ventilação mecânica, prolongando o tempo de internação hospitalar [2][3][4] .…”

“…Babazadeh et al 1 evidenciam que o baixo (re) conhecimento de barreiras para MP por parte de profissionais da saúde pode levar a uma lacuna no desempenho da conduta. Alguns estudos 1,9 já buscaram descrever sobre barreiras para MP e destacam a baixa proporção de pessoal de enfermagem e fisioterapia nas unidades, ausência de treinamento, linhas e tubos arteriais, profundo grau de sedação, recusa informada etc. Porém até o presente momento nenhum estudo foi identificado com amostra de fisioterapeutas intensivistas com atuação no contexto de saúde do Ceará/Brasil.…”

Redundancy, quality appraisal, and discordance in the results of systematic reviews of early mobilization of critically ill adults. A meta-research protocol

“…Critically ill adult patients may present with various complications from hospitalization in an intensive care unit (ICU) stay [1,2]. Being on mechanical ventilation, sedation, neuromuscular blockade, and the mobility restrictions imposed by the context of critical illness, as well as barriers derived from invasive devices in critically ill patients [3][4][5], create an environment that can facilitate cognitive [6] and neuromusculoskeletal complications [7], among others.…”