A multisite study of multidisciplinary ICU team member beliefs toward early mobility
Section snippets
Background
Innovations in critical care have led to 70% of mechanically ventilated (MV) patients surviving critical illness.1 However, intensive care unit (ICU) treatment modalities often result in immobility that leads to ICU-acquired weakness (ICU-AW).2 ICU-AW is a predictor of post-ICU physical impairment affecting functional status, return to work, and quality of life of ICU survivors.3,4 ICU-AW and post-ICU physical impairment are serious public health problems that compel the study of methods to
Theoretical framework
The TPB is an accepted theory for describing, explaining, and predicting overt choice behaviors.15 The TPB can be applied to theorize the effects of behavioral attitudes (i.e., disposition toward a behavior), subjective norms (i.e., social influence), and perceived control (i.e., ability to perform) on intention to perform or not perform EM. Fig. 1 displays the three beliefs that contribute to TPB constructs and influence intention on actual behavior.
Design
We applied a qualitative descriptive design
Results
The Early Mobility Salient Belief Survey instrument was completed by 95 team members across all units. Table 1 provides a detailed description of respondents by site, unit, and discipline. The majority (66%) of respondents were nurses. Respiratory therapists (18%) were the second highest number of respondents. Data were complete for all respondents.
Discussion
This multisite, multidisciplinary study applied the TPB to elicit attitudes, normative referents, and control beliefs influencing implementation of early ICU mobility. The utilization of open-ended questions allowed for richer understanding of the reported salient beliefs. Nurses were identified as primarily responsible for EM coordination and process. Immediate risk vs. long-term patient benefit (e.g., risk aversion) and situational factors (e.g., workload, collaboration challenges) were
Conclusions
Our data validate previous elicitation behavioral outcomes and control beliefs that early mobility is protective, but team members are risk averse to mobilizing. Likewise, nurses were overwhelmingly identified as both positive and negative examples to consider and are most likely to be performing EM on their unit. Reports of the nurse as primary initiator, and other situational factors, added to our current understanding of behavioral intentions. Findings from the study are influenced by the
Declaration of Competing Interest
None.
Acknowledgements
None.
Financial disclosure
This project was supported by the Vanderbilt Institute for Clinical and Translational Research (UL1 TR000445 from NCATS/NIH). Dr. Boehm has received grant-funding from the American Association of Critical-Care Nurses and the National Heart, Lung, and Blood Institute (K12HL137943). The authors’ funding sources did not participate in the planning, collection, analysis or interpretation of data or in the decision to submit for publication. The content is solely the responsibility of the authors
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