UCSF

Background: Early Mobilization (EM) in Pediatric Intensive Care Units (PICU) is safe and feasible. However, there are many issues preventing the adoption of EM into clinical practice.

Aim: The first aim is to use in-depth interviews, including open-ended and semi-structured questions, explore nurses’ concerns for patient safety while performing EM and how nurses overcome those safety concerns and still choose to participate in EM. The focus of the interviews is on describing the dimensions of patient safety concerns and how nurses develop strategies to safely deliver EM to their patients. The second aim is to use in-depth interviews, to explore, describe and analyze nurses’ perceptions of barriers and facilitators to performing EM, and to identify strategies nurses perceive would assist them to overcome barriers and increase adoption of EM within the PICU.

Methods: This focused ethnographic study included 15 in-depth interviews with 10 PICU nurses. Data were analyzed using thematic analysis.

Results: This is a three article-based dissertation. The first article is a scoping review of the literature examining nurses’ and family caregivers’ perceptions of early mobility programs in the PICU. This article was instrumental in identifying the scope of the dissertation study after the gaps in the literature were identified. In the second article, nurses discussed their perceptions of barriers to EM care in the PICU, beyond patient safety. In the third article, nurses perceived three categories of barriers: nurse engagement and nursing and unit factors, resources and equipment issues, and interdisciplinary issues. Facilitators to EM include improved condition with mobility, rehabilitation team, and impact on unit culture. The overarching theme that integrated these categories was nurses’ commitment to EM because they recognize the benefit and see the positive outcomes. These barriers presented challenges and nurses felt frustrated by having to navigate through these barriers, but these frustrations created opportunities for nurses to brainstorm and strategize ideas to overcome these barriers.

Conclusions: This study demonstrates the importance of thoughtfully considering the burden evidence-based programs have on the nurses who carry out EM. EM activities fall primarily on nursing staff, and organizational structures and resources must be allocated to reliably deliver this essential care. By better understanding the barriers, leaders can analyze and develop strategies to better integrate EM into practice.