Abstract
Mobilization is a key component in the recovery of those admitted to critical care. However, previous research has demonstrated challenges in the implementation of mobilization within critical care, including staff knowledge, attitudes, and behaviours. The aim of the current study was to explore the perceived barriers and limitations to mobilization from the perspective of nursing staff, and to compare these with physiotherapists. Single-site service evaluation utilizing the patient mobilizations attitudes and beliefs survey for ICU and locally developed barriers to rehabilitation questionnaire. About 135 participants (126 nurses and 9 physiotherapists) were invited to anonymously complete the questionnaires (either paper or electronic), with a response rate of 73.0% (n=92) for nursing staff and 100% for physiotherapists. Nursing staff reported significantly higher perceived barriers to rehabilitation on both questionnaires when compared with physiotherapy staff, which was not associated with years of experience within critical care. Behavioural barriers were most frequent in both professions which included items such as time availability and presence of perceived contra-indications to mobilization. Nursing staff reported greater perceived barriers to rehabilitation when compared with physiotherapists. Further quality improvement projects are now required to reduce these barriers and assist the implementation of mobilization as part of the rehabilitation process. Rehabilitation is an essential element of practice within critical care. Understanding the system, local and personal barriers will allow for improvement projects to enhance the delivery of care and improve clinical outcomes.
Highlights
Mobilization is a key component in the recovery of those admitted to critical care
The National Institute for Health and Care Excellence emphasized the extent of this problem in their guideline “Rehabilitation after critical illness”[2] and is supported by a number of studies examining the role of rehabilitation starting within critical care.[3,4,5]
Mobilization is a key component of any rehabilitation program and follows common themes, with “sitting on the edge of the bed (SOEOB)” a key milestone within any mobilisation programme.[6,7]
Summary
Previous research has demonstrated challenges in the implementation of mobilization within critical care, including staff knowledge, attitudes, and behaviours. The aim of the current study was to explore the perceived barriers and limitations to mobilization from the perspective of nursing staff, and to compare these with physiotherapists. Nursing staff reported significantly higher perceived barriers to rehabilitation on both questionnaires when compared with physiotherapy staff, which was not associated with years of experience within critical care. Stiller and Phillips[8] outlined a series of safety considerations based on a wide range of physiological factors These included analysis of past medical history, cardio-vascular reserve (resting heart rate, blood pressure, ECG), respiratory reserve (oxygen saturations, respiratory pattern and PaO2/FiO2) as well as 15 haematological and orthopaedic considerations. In similarity to Stiller and Phillips,[8] the expert consensus detailed a significant number of physiological factors which may impact on a person's ability to undergo rehabilitation
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