(1383) Identifying Barriers to Early Mobilization by Nursing Staff in the ICU

Introduction: Early mobilization (EM) is a key component of the ICU liberation bundle and may be perceived as a more difficult component. Physical activity is sufficient to elicit physiologic change to enhance ventilation, perfusion, muscle metabolism, alertness and counteract venous stasis. If early ambulation occurs, most patients will be ambulatory on discharge. EM can be accomplished by physical therapy or nursing staff. This study aims to identify barriers to EM by nursing staff in the ICU.

Methods: This study occurred at a Level I trauma center and comprehensive stroke center in Youngstown, OH. A 20-question survey was distributed to nurses in surgical (SICU), neurosurgical (NSICU), medical (MICU), and cardiovascular (CVICU) ICUs. The surveys were anonymous and voluntary. Identified barriers were analyzed using X2 and ANOVA in SPSS (version 25) with a p-value < 0.05. Surveys collected demographic information (gender, employment type, education level, and length of experience) and perceptions about EM.

Results: Months in practice ( < 120 months vs >120 months), education (Associates vs. Bachelors degree), gender, employment (full-time vs. part-time), and type of ICU were all compared to see if perceptions of EM differed. Increased workload and confidence were concerns among nurses who have practiced longer (> 120 months). More nurses felt confident mobilizing patients if they had worked < 120 months (61.8% vs. 36.7%). Female nurses (90.6%), compared to male nurses (66.7%), believed insufficient staff for EM existed. Education is also an issue regarding EM—nearly half of the NSICU and MICU stated they received education on EM, and 11% of SICU and none of the CVIC stated they received education. The NSICU staff felt the most confident mobilizing their patients. Most nurses agreed that EM improves patient outcomes and ROM is part of progressive mobility. There were disagreements about patients being too sick to mobilize, whether only PT/OT should mobilize ICU patients, and whether sufficient equipment exists. However, none of these reached statistical significance.

Conclusions: Misperceptions about EM exist among nurses. However, this study suggests that these perceptions can be changed with education. This finding underscores the importance of ongoing education and training in the healthcare field.