Document Type

Final Project

Graduation Date

Spring 5-2024

Degree Name

Doctor of Nursing Practice

First Advisor

Janet Cuddigan PhD, RN, FAAN

Abstract

Purpose

Early mobilization of Intensive Care Unit (ICU) patients can improve patient outcomes but also includes barriers to implementation. Nebraska Medicine has continued to have ongoing quality improvement initiatives like the ABCDEF liberation bundles and early mobilization that have been attempted but have never fully come to fruition. This project surveys Nebraska Medicines ICUs staff to better understand attitudes, knowledge and behavior regarding early mobilization using a validated tool. The aim was to identify barriers, so the organization could better understand the needs of ICU staff for future implementations of early mobility and related assessment tools.

Materials and Methods

A systematic literature was conducted in MEDLINE, EMBASE, and CINHAL for systematic reviews, meta-analysis, and randomized control trials (RCTs) related to early mobilization of ICU patients. The literature review included data on interventions, improved outcomes, mobility tools used, and surveys to identify existing barriers. A survey created by Johns Hopkins Medicine, Patient Mobilization Attitudes and Beliefs in the ICU (PMABS-ICU) was selected for this project. An invitation to participate in this survey was sent out through email to ICU register nurses (RNs) and patient care technicians (PCTs) in all five ICUs at Nebraska Medicine. Additionally, informational fliers were posted throughout each unit. The survey included 27 questions and an open-ended free text portion for comments. Using SPSS 28.0, the survey results were examined for total score and subscales of knowledge, attitudes, and behaviors. Differences in scores by years of work experience and assigned ICU were examined.

Results

The survey had a response rate of 18.5% (70/378). Of the 70 respondents, 61 were RNs and 9 were PCTs. The survey showed validity and internal consistency with Cronbach α of 0.845 for the total score and subscales being 0.610 for the knowledge subscale, 0.752 for attitudes, and 0.713 for behaviors. One-way ANOVA testing revealed no significant difference in total or any subscale score based on years of experience. There were no significant differences in knowledge subscale scores between units. However, there were significant differences for total score, attitude, and behavioral subscale scores when responses were grouped by unit. The Bonferroni Post Hoc test showed there was no difference between the total scores and subscales in the Cardiovascular Intensive Care Unit (CVICU) and Werner Intensive Care Unit (WICU), whereas Medical Intensive Care Unit (MICU), Neuroscience Intensive Care Unit (NSICU), and Surgical Intensive Care Unit (SICU) had no difference from one another in the total scores nor in the subscales. Both CVICU and WICU were significantly different when each was compared to MICU, NSICU or SICU for attitude subscale scores. The common themes from the qualitative responses include patient safety concerns, staffing constraints, and time and complexity of patients.

Conclusion

The survey results can be summed up into 3 different themes: Concerns about patient safety, staffing, and time needed with the complexity of ICU patients. Each unit has its own identity, expectations, and challenges. The results of the survey indicate that there was no difference between units when it comes to knowledge, but prior to implementing an early mobility protocol, the units need to address potential barriers related to attitudes and behaviors as well as the specific barriers identified in free text comments. Addressing perceived barriers now with evidence-based strategies will facilitate implementation of the early mobilization protocols in ICUs.

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