Early mobilization implementation for critical ill patients: A cross-sectional multi-center survey about knowledge, attitudes, and perceptions of critical care nurses

Nurse-involved early mobilization in the intensive care unit: A systematic review and meta-analysis

BACKGROUND

Early mobilization is one proposed strategy for reducing complications and optimizing patient outcomes. Nurses play an essential role in patient monitoring and co-ordination.

AIMS

To assess the effects of a nurse-involved early mobilization programme on muscle strength and intensive care unit (ICU) length of stay and identify the components of an early mobilization programme.

STUDY DESIGN

A systematic review and meta-analysis were conducted. MEDLINE (PubMed), Embase, Cochrane and CINAHL databases were searched. Eligible studies included randomized controlled trials (RCTs) and non-randomized studies of adult ICU patients undergoing early mobilization. The studies were appraised using RoB 2.0 and ROBINS-I tools, and a meta-analysis was performed using Rstudio 2023.06.2.

RESULTS

Nine studies were selected from 943 studies. Four studies involved only ICU nurses, while five involved multidisciplinary teams. Concerns about bias were raised in four RCTs, and two non-randomized studies had moderate bias risk. Interventions involved progressive exercise steps, but none detailed the specific role of nurses. Early mobilization significantly decreased ICU length of stay (95% CI: -3.22, -0.11; p = .04), although it did not improve muscle strength (95% CI: -0.86, 0.99; p = .80).

CONCLUSIONS

Nurse-involved early mobilization was associated with a reduction in ICU stay, although it did not impact muscle strength. The nurses' roles were not specifically defined.

RELEVANCE TO CLINICAL PRACTICE

An analysis of relevant tasks is necessary to clarify the role of nurses in early mobilization and to provide optimal care. Including these roles is crucial in the development of standardized early mobilization.

ICU nurses' practice and intention to implement early mobilization: A multi-centre cross-sectional survey

BACKGROUND

Early mobilization (EM) is acknowledged for its safety and benefits in the recovery of critically ill patients, yet its implementation in intensive care units (ICU) remains inconsistently aligned with established guidelines. This discrepancy highlights a gap between theoretical endorsement and practical application. While barriers to EM have been extensively studied, the intentions and perceived practices of ICU nurses towards EM, especially in certain geographical regions, have not been adequately understood.

AIM

The objective of this study is to assess the perceptions, actual practices and intentions of ICU nurses regarding the implementation of EM for patients in the ICU setting.

STUDY DESIGN

A cross-sectional, multi-centre, survey-based study.

RESULTS

The study collected data through an electronic questionnaire from 227 ICU nurses across eight hospitals in Beijing, China, concerning their experiences, practices and intentions related to EM. The survey response rate was 50% (114 of 227), indicating a moderate level of engagement by the target population. Among the surveyed participants, 68.7% (n = 156) reported having experience with EM for critically ill patients. Of these experienced nurses, 49.3% (n = 77) indicated they carried out EM less frequently than once per week, while only 29.5% (n = 46) reported dedicating more than 20 min to EM activities per patient. Only 24.2% (n = 55) of participants confirmed the presence of specific EM guidelines in their workplace. Notably, guideline adherence could be influenced by the patient's condition severity, which may affect how these protocols are applied. Notably, the approach and frequency of EM practices showed significant variation across different ICUs. A substantial majority (75%, n = 170) of participants expressed a strong intention towards implementing EM, correlating significantly with factors such as having a higher education level (bachelor's degree or higher), receiving departmental support, encountering fewer perceived barriers, and belonging to specific departments like respiratory (SICU) and surgery (RICU). The EM guidelines mentioned by participants were primarily focused on specific protocols and guidance, highlighting the emphasis on structured approaches to EM in their clinical settings.

CONCLUSIONS

Despite the recognized experience with EM among ICU nurses, there is a notable divergence between their practices and the recommendations outlined in EM guidelines. This study underscores the need for the establishment of clear, actionable guidelines, alongside the provision of targeted educational programmes and robust support systems, to foster the consistent and effective implementation of EM in ICU settings.

RELEVANCE TO CLINICAL PRACTICE

This study underscores the clinical relevance of EM in ICU settings, advocating for the development of precise EM guidelines to improve patient outcomes.

Implementation and Mixed-Methods Assessment of an Early Mobility Interprofessional Education Simulation

INTRODUCTION

Extended periods of bed rest and mechanical ventilation (MV) have devastating effects on the body.

BACKGROUND

Early mobility (EM) for patients in respiratory failure is safe and feasible, and an interprofessional team is recommended. Using simulation to train EM skills improves student confidence. The purpose of this study was to enable health care student collaboration as an interprofessional team in providing safe management and monitoring during an EM simulation for a patient requiring MV.

METHODS

Nursing (n = 33), respiratory (n = 7), occupational (n = 24), and physical therapist students (n = 55) participated in an EM interprofessional education (IPE) simulation experience. A mixed-methods analytic approach was used with pre/post quantitative analysis of the Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument and qualitative analysis of students' guided reflection papers.

RESULTS

Pre/post surveys completion rate was 39.5% (n = 47). The Student Perceptions of Interprofessional Clinical Education-Revised, Version 2 instrument indicated a significant improvement (P = .037) in students' perceptions of interprofessional collaborative practice. Qualitative data showed a positive response to the EM simulation IPE. Themes reflected all 4 Interprofessional Education Collaborative competencies.

DISCUSSION

This study demonstrated improved perception of interprofessional collaborative practice and better understanding of the Interprofessional Education Collaborative competencies.

CONCLUSION

Students collaborated in the simulation-based IPE to provide EM for a patient requiring MV and reported perceived benefits of the experience.

Translation and validation of the Chinese version of the maternal postpartum stress scale

OBJECTIVE

To translate the Maternal Postpartum Stress Scale (MPSS) into Chinese and validate its psychometric properties in postpartum women.

METHODS

A total of 406 postpartum women were recruited from six hospitals in Nantong, Jiangsu Province, China. Cronbach's α co-efficient, split-half reliability, and test-retest reliability were used to evaluate the reliability of the translated scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The Edinburgh Postnatal Depression Scale, Depression Anxiety Stress Scale-21 anxiety dimension, and Perceived Stress Scale were used as calibration scales to measure the correlation of MPSS. All data were analyzed using SPSS 25.0 and Amos 24.0.

RESULTS

The Cronbach's α co-efficient of the Chinese version of MPSS and its three dimensions were 0.940 and 0.882-0.911, respectively. The split-half reliability was 0.825, and the test-retest reliability was 0.912. The scale's content validity index was 0.926. Three common factors were extracted from the EFA. The CFA validated the explored 3-factor structure, and the indicators were fitted well (χ2/Df = 2.167, comparative fit index = 0.918, Tucker-Lewis index = 0.907, incremental fit index = 0.919, and root mean square error of approximation = 0.075).

CONCLUSION

The translated Chinese version of MPSS had suitable reliability and validity in assessing postpartum stress in Chinese women. The translated scale can also help with the early identification of postpartum stress and provide a scientific basis for the formulation of early personalized intervention measures. Overall, the scale has certain clinical value and practical significance for enhancing the physical and mental health of postpartum women. However, future studies including large, diverse populations are warranted.

Knowledge, attitudes and practices regarding children with ICU-acquired weakness in pediatric intensive care unit among chinese medical staff: a cross-sectional survey

BACKGROUND

ICU-AW (Intensive Care Unit Acquired Weakness) is characterized by significant muscle weakness and can be caused by a variety of factors, including immobility, medication use, and underlying medical conditions.ICU-AW can affect critically ill children who have been hospitalized in the PICU for an extended period of time.The knowledge, attitude and practice level of ICU-AW of PICU medical staff directly affect the treatment of critically ill children with ICU-AW.The aim to this study was to explore the knowledge, attitudes, and practices of Chinese medical staff regarding critically ill children with intensive care unit-acquired weakness (ICU-AW) and related factors.

METHODS

A Knowledge, Attitudes, and Practices (KAP) Questionnaire regarding critically ill children with ICU-AW was distributed to a stratified sample of 530 pediatric intensive care unit (PICU) healthcare workers. The questionnaire consisted of 31 items-with scores of 45, 40, and 40 for each dimension and a total score of 125.

RESULTS

The mean total score of Chinese PICU healthcare workers for the KAP questionnaire regarding children with ICU-AW was 87.36 ± 14.241 (53-121), with mean total knowledge, attitudes, and practices scores of 30.35 ± 6.317, 30.46 ± 5.632, and 26.54 ± 6.454, respectively. The population distribution indicated that 50.56%, 46.04%, and 3.4% of healthcare workers had poor, average, and good scores, respectively. Multiple linear regression showed that gender, education, and hospital level classification influenced the KAP level of PICU healthcare workers regarding critically ill children with ICU-AW.

CONCLUSIONS

Overall, PICU healthcare workers in China have an average KAP level about ICU-AW, and the gender and education level of PICU healthcare workers, as well as the classification of hospitals where they work, predict the KAP status of healthcare workers regarding children with ICU-AW. Therefore, healthcare leaders should plan and develop specific training programs to improve the KAP level of PICU healthcare workers.

Clinicians' knowledge and attitude towards early mobilization in intensive care units in Ethiopian tertiary hospitals: A multi-centre study

Objectives

To assess clinicians' knowledge, attitude and associated factors towards patients' early mobilization in intensive care units in the tertiary hospitals in Northwest Ethiopia.

Methods

A multi-centre, cross-sectional study was conducted at the tertiary hospitals in Northwest Ethiopia from April to June, 2022. Data were collected by using self-administered, structured questionnaire; ordinal logistic regression analysis was performed and associations were described in adjusted odds ratios.

Results

A total of 304 clinicians were included (response rate of 89.7%). The proportions of poor, fair and good knowledge towards early mobilization in intensive care unit among clinicians were 16.8%, 57.9% and 25.3%, respectively; while that of negative, fair and positive attitude were 16.4%, 60.2% and 23.4%, respectively. Factors associated with better knowledge were being a physiotherapist (adjusted odds ratio = 2.9, confidence interval = 1.2-6.7), having a total work experience >5 years (adjusted odds ratio = 4.6, confidence interval = 1.7-12.1), having an intensive care unit work experience >5 years (adjusted odds ratio = 2.8, confidence interval = 1.1-6.8), previous in-service training (adjusted odds ratio = 1.8, confidence interval = 1.1-3.0) and reading guidelines (adjusted odds ratio = 1.9, confidence interval = 1.1-3.2). Better attitude was associated with in-service training (adjusted odds ratio = 1.9, confidence interval = 1.2-3.1), attending early mobilization courses (adjusted odds ratio = 1.8, confidence interval = 1.1-3.0), presence of mobilization advocators (adjusted odds ratio = 1.7, confidence interval = 1.0-2.8), good knowledge (adjusted odds ratio = 2.6, confidence interval = 1.2-5.8) and fair knowledge (adjusted odds ratio = 2.5, confidence interval = 1.3-4.8).

Conclusion

Most of the clinicians had demonstrated fair knowledge and attitude towards early mobilization in intensive care unit. However, there were significant proportion of clinicians who had poor knowledge and negative attitude. We recommended active engagement of physiotherapists and experienced clinicians in intensive care units. Clinicians need to have self-learning habits and attend regular training/courses related to early mobilization in intensive care unit.

ICU quasi-speciality nurses' knowledge, attitudes and practices regarding early mobilization: A cross-sectional survey

AIM

Early mobilization (EM) improves critical illness survivors' clinical outcomes. This study examines ICU quasi-specialty nurses' EM-related knowledge, attitudes and practices (KAP).

DESIGN

This cross-sectional study was conducted at a provincial ICU specialty nurse training site from 2019 to 2021. KAP data were collected using a self-report questionnaire.

METHODS

Participants were registered nurses enrolled in the training programme; 485 nurses from 188 hospitals completed the questionnaire.

RESULTS

Of the participants, 37.7% had EM training, and 30.7% reported their wards performed EM. Median (IQR) scores for knowledge, attitudes and practices were 14.0 (4.0), 47.0 (9.0) and 37.0 (8.0), belonging to medium, high and medium levels. Scores were lowest for EM scope, implementation indicators and out-of-bed mobilization. There were significant deviations in KAP scores amongst nurses at different levels of hospitals with EM training and whose departments performed EM. Significant positive correlations between knowledge and practice, and attitude and practice were identified.