Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units

OBJECTIVE: To investigate the knowledge of multi-professional staff members about the early mobilization of critically ill adult patients and identify attitudes and perceived barriers to its application. METHODS: A cross-sectional study was conducted during the second semester of 2016 with physicians, nursing professionals and physical therapists from six intensive care units at two teaching hospitals. Questions were answered on a 5-point Likert scale and analyzed as proportions of professionals who agreed or disagreed with statements. The chi-square and Fisher's exact tests were used to investigate differences in the responses according to educational/training level, previous experience with early mobilization and years of experience in intensive care units. RESULTS: The questionnaire was answered by 98 out of 514 professionals (response rate: 19%). The acknowledged benefits of early mobilization were maintenance of muscle strength (53%) and shortened length of mechanical ventilation (83%). Favorable attitudes toward early mobilization included recognition that its benefits for patients under mechanical ventilation exceed the risks for both patients and staff, that early mobilization should be routinely performed via nursing and physical therapy protocols, and readiness to change the parameters of mechanical ventilation and reduce sedation to facilitate the early mobilization of patients. The main barriers mentioned were the unavailability of professionals and time to mobilize patients, excessive sedation, delirium, risk of musculoskeletal self-injury and excessive stress at work. CONCLUSION: The participants were aware of the benefits of early mobilization and manifested attitudes favorable to its application. However, the actual performance of early mobilization was perceived as a challenge, mainly due to the lack of professionals and time, excessive sedation, delirium, risk of musculoskeletal self-injury and excessive stress at work.