Patient mobilization in the intensive care unit: Assessing practice behavior - A multi-center point prevalence study

Abstract

Objectives: To describe intensive care unit mobility clinical practice behaviors and the factors associated with these behaviors that could explain the theory-practice gap.

Methodology: A multi-center, descriptive, retrospective, one-day point prevalence study.

Setting: intensive care patients hospitalized for a minimum of 24 hours, in 20 Israeli Adult Intensive Care Units, from six medical centers.

Main outcome measures: Maximum patient mobility level during the 24 hours prior to the prevalence study collection day and 48 hours from patient admission; mobility clinical practice behaviors and their inhibiting factors.

Results: The study included 210 patients from a relatively even distribution of admission diagnoses. About half (46%) were intubated and 31% were hemodynamically unstable. Position change was most frequently reported as the maximum mobility level. The use of intubation, ventilation, tracheostomy, and inotropes was positively correlated with the level of mobility. Charlson Comorbidity Index and body mass index were not related to the level of mobility. A multiple regression model including these variables found that only intubation was a significant predictor of mobility level (R² = 0.52, p < 0.001).

Conclusion: There is a gap between clinical practice guidelines and actual intensive care mobility practice behaviors. The association between mobility level and common therapies suggests subjective norms or common practices that could serve as a barrier to guideline implementation and partially explain the gap between clinical practice guidelines and clinical practice behavior.

Implications for clinical practice: Behaviors and their subjective norms can be barriers to the implementation of clinical practice guidelines. Promoting increased provider awareness and policies of proactive mobilization could potentially improve patient outcomes.

Keywords: Critical Care (N02.421.585.190); Early Mobilization (No.02.831.335); Nursing Care (N02.421.533); Patient Care (N02.421.585); Practice Guidelines (No.2.515.500).