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.

Mahbubeh Babazadeh,Tayebeh Poursangbor,Simin Jahani,Bahaman Cheraghian

doi:10.25122/jml-2019-0135

Mahbubeh Babazadeh, Tayebeh Poursangbor + Show 2 more

Open Access

https://doi.org/10.25122/jml-2019-0135

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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.

Highlights

In many intensive care units (ICUs), routine procedures, including a deep degree of sedation and bed rest, are carried out to manage critically ill patients [1]
Early mobilization (EM) benefits for ICU patients have been well documented in recent years, many intensive care units are not able to effectively implement and integrate EM in daily exercises of the patients [17]
Different studies have shown that compared to rehabilitation therapists, nurses reported the lack of trained staff as a major barrier to EM of the patient [15]. Consistent with these findings, the participants of the current study reported the lack of trained staff in EM implementation in ICU patients (Table 2) as a major barrier related to human resource limitation

Summary

Introduction

In many intensive care units (ICUs), routine procedures, including a deep degree of sedation and bed rest, are carried out to manage critically ill patients [1]. Patients in the ICU, especially mechanically ventilated patients, experience a lower degree of mobilization. This reduction can cause weak mobilization performance [2, 3]. Nurses perceived patient safety concerns, lack of education, or trained workforce as the significant barriers for EM more than other healthcare providers. Such a difference in recognition can lead to a gap in mobilization performance among other healthcare professionals [6]

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