Intensive care unit nurses' knowledge, attitudes, and perceived barriers regarding early mobilization of patients.

It has been recommended that critically ill patients start mobilization as early as possible. However, the clinical utilization rate of early mobilization remains low in the intensive care unit (ICU), and respiratory therapists and nurses are the primary practitioners of early mobilization in China. The aim of this study is to investigate the knowledge, attitudes, and perceived barriers of ICU nurses regarding the early mobilization of ICU patients. A descriptive and cross-sectional design was used. A cross-sectional design was used, with an e-questionnaire for ICU nurses (n = 227) to assess knowledge and attitudes regarding early mobilization via the "Tencent WeChat" app on their smart phones. As the primary implementers of the early mobilization of ICU patients in China, more than half of ICU nurses passed the knowledge test (scored ≥20/25 points) and had positive attitudes (scored 45/55 points) regarding early mobilization. Nurses had good knowledge (more than 96.5%) of the benefits and stopping indications of early mobilization; however, they had a poor understanding (less than 51.1%) of the population in which early mobilization is applicable and monitoring indicators during early mobilization, and 39.2% of nurses did not support routine implementation of early mobilization for patients in the ICU. The major barriers that they perceived were very heavy workload (76.8%), insufficient equipment and devices (50.2%), lack of written protocols or guidelines (50.2%), inadequate training (47.1%), potential work risks (42.3%), and limited staffing (41.4%). Although over half of ICU nurses exhibited relatively comprehensive knowledge of and positive attitudes to early mobilization, some misunderstandings, negativity, and barriers remain. Training programmes should be conducted continuously, especially focused on common misunderstandings and negative attitudes. Organizational support is required to overcome barriers to the implementation of early mobilization.

Wang J ，Xiao Q ，Zhang C ，Jia Y ，Shi C ... -  《-》

Impact of knowledge, attitudes and self-reported practices of nurses on early mobilization of mechanically ventilated patients in the ICU.

Many ICUs worldwide are striving to integrate early mobilization as part of critical care rehabilitation. However, ICU nurses, who are essential contributors to the early mobilization of critically ill patients, still lack comprehensive surveys assessing their knowledge, beliefs, and practices regarding the early mobilization of mechanically ventilated patients. To analyse the knowledge, attitudes, and practices of intensive care unit (ICU) nurses regarding the early mobilization of mechanically ventilated patients and to explore the effects of these practices. A multicentre cross-sectional study. ICU nurses in five tertiary hospitals in Zhejiang Province, China, were selected by convenience sampling and invited to complete an online questionnaire between 1 June 2021 and 15 June 2021. Sociodemographic data and the knowledge, attitudes, and practices of ICU nurses regarding early mobilization. A total of 296 valid questionnaires were collected, for a response rate of approximately 77.5%. The average scores for knowledge, attitudes, and practices of ICU nurses regarding the early mobilization of mechanically ventilated patients were 42.7 ± 7.4, 34.3 ± 6.5, and 47.1 ± 6.5, respectively, which were good scores. Quantile regressions showed that at the 25% and 50% quartiles, increases in knowledge and attitude scores resulted in increases in practice scores (p < .001); however, at the 75% quartile, increases in knowledge scores did not result in practice score increases (t = 0.000, p = .999); moreover, there was still a 0.5-point increase in practice scores per 1-point increase in attitude scores (t = 0.500, p < .001). The knowledge, attitudes, and self-reported practices of ICU nurses were good, although there is room for improvement. Considering that the influence of attitudes on practice improvement is more important than knowledge, ICU managers should promote knowledge transformation, strengthen attitudes, and adopt comprehensive measures to promote the early mobilization of mechanically ventilated patients in the ICU. To optimize the early mobilization of mechanically ventilated patients in the ICU, introducing multipronged support strategies based on the knowledge and attitudes of ICU nurses is recommended to promote the implementation of such practices.

Sui W ，Gong X ，Zhuang Y 《-》

ICU nurses' practice and intention to implement early mobilization: A multi-centre cross-sectional survey.

Early mobilization (EM) is acknowledged for its safety and benefits in the recovery of critically ill patients, yet its implementation in intensive care units (ICU) remains inconsistently aligned with established guidelines. This discrepancy highlights a gap between theoretical endorsement and practical application. While barriers to EM have been extensively studied, the intentions and perceived practices of ICU nurses towards EM, especially in certain geographical regions, have not been adequately understood. The objective of this study is to assess the perceptions, actual practices and intentions of ICU nurses regarding the implementation of EM for patients in the ICU setting. A cross-sectional, multi-centre, survey-based study. The study collected data through an electronic questionnaire from 227 ICU nurses across eight hospitals in Beijing, China, concerning their experiences, practices and intentions related to EM. The survey response rate was 50% (114 of 227), indicating a moderate level of engagement by the target population. Among the surveyed participants, 68.7% (n = 156) reported having experience with EM for critically ill patients. Of these experienced nurses, 49.3% (n = 77) indicated they carried out EM less frequently than once per week, while only 29.5% (n = 46) reported dedicating more than 20 min to EM activities per patient. Only 24.2% (n = 55) of participants confirmed the presence of specific EM guidelines in their workplace. Notably, guideline adherence could be influenced by the patient's condition severity, which may affect how these protocols are applied. Notably, the approach and frequency of EM practices showed significant variation across different ICUs. A substantial majority (75%, n = 170) of participants expressed a strong intention towards implementing EM, correlating significantly with factors such as having a higher education level (bachelor's degree or higher), receiving departmental support, encountering fewer perceived barriers, and belonging to specific departments like respiratory (SICU) and surgery (RICU). The EM guidelines mentioned by participants were primarily focused on specific protocols and guidance, highlighting the emphasis on structured approaches to EM in their clinical settings. Despite the recognized experience with EM among ICU nurses, there is a notable divergence between their practices and the recommendations outlined in EM guidelines. This study underscores the need for the establishment of clear, actionable guidelines, alongside the provision of targeted educational programmes and robust support systems, to foster the consistent and effective implementation of EM in ICU settings. This study underscores the clinical relevance of EM in ICU settings, advocating for the development of precise EM guidelines to improve patient outcomes.

Wang J ，Shi C ，Xiao Q ，Jia Y ... -  《-》

Knowledge, attitudes, and perceived barriers regarding pain assessment and management among Thai critical care nurses: A cross-sectional study.

Pain is a distressing problem which commonly occurs among critically ill patients. Nurses' knowledge of, attitudes, and perceived barriers to pain assessment and management can influence the effectiveness of nursing care. To explore the current knowledge of, attitudes, and perceived barriers to pain assessment and management among Thai critical care unit nurses. A cross-sectional survey conducted between November 2022 and January 2023 among 158 Thai nurses working in one of eight adult critical care units in a tertiary hospital, evaluated their knowledge of, attitudes, and perceived barriers to pain assessment and management. Nurses possessed inadequate knowledge and negative attitudes regarding pain assessment and management. The most important barrier to pain assessment and management was "patients are unable to communicate their pain". The results showed a significantly weak positive correlation between nurses' attitudes toward pain assessment and management age (r = 0.26, p = 0.001), year of ICU experience (r = 0.29, p < 0.001), and obtaining a certificate in intensive care nursing (r = 0.37, P < 0.001). Thai critical care unit nurses possessed inadequate knowledge and negative attitudes. Further training and education regarding pain assessment and management could include case studies or simulation and immersive virtual reality to improve critical care unit nurses' knowledge and attitudes as well as identifying potential barriers to pain assessment and management in the critical care settings. The implications for clinical practice recommend that continued quality assurance procedures should be implemented and maintained to evaluate the effectiveness of current pain assessment practices. Additionally, the perceived barriers to effective pain assessment and management should be considered and managed not only through continued education and training but could include using nursing case review, morbidity and mortality data identifying those patients that experience chronic pain post-ICU discharge.

Chaleewong N ，Chaiviboontham S ，Christensen M 《-》

Nurses' perceived barriers and educational needs for early mobilisation of critical ill patients.

Early mobilisation (EM) of critically ill patients is an evidence-based intervention designed to improve treatment outcomes and enhance the quality of life after intensive care. However, several barriers exist to its establishment in clinical practice. Thus, the objective of the present study was to identify barriers perceived by critical care nurses, corresponding educational needs, and provide useful information for program implementation in Korea. A cross-sectional study was conducted from April to June 2017 using a structured, self-administered questionnaire that was completed by 151 critical care nurses from three tertiary hospitals and four secondary hospitals located in Seoul. The survey was designed to rate experiences with EM, identify educational experiences, and measure perceived barriers regarding attitudes, knowledge, behaviours, and educational needs. Data were analysed using descriptive statistics, t-tests, and analyses of variance. The mean number of perceived barriers was 3.13 ± 0.38 out of 5 on a Likert scale. Attitude-related barriers (3.25 ± 0.49) were higher than behaviour-related (3.21 ± 0.44) and knowledge-related (2.94 ± 0.59) barriers. The top five barrier items were high workload, patients' inability to exercise, lack of time, inappropriate nurse/patient ratio, and absence of relevant education. Educational needs for early mobilisation were rated 3.74 ± 0.78 out of 5. Educational items were prioritised as identifying potential problems in EM and possible solutions, related protocols and guidelines, and procedures for special conditions. The present study revealed that critical care nurses in Korea perceive various barriers to successfully implementing evidence-based EM interventions for critically ill patients, as well as the educational needs necessary to overcome such challenges. Accordingly, an educational program should be developed based on the educational needs revealed in the present study. In parallel, organisational efforts should also be made to meet environmental conditions.

Kim C ，Kim S ，Yang J ，Choi M ... -  《-》