Promoting a Multidisciplinary Team for Early Mobilisation in Mechanically Ventilated Patients: An Innovation in Health Professional Education-A Quasi-Experimental Pre-Post Study

Abstract

Background: Early mobilisation (EM) in mechanically ventilated (MV) patients is a safe and feasible, evidence-based practice with positive health outcomes. It decreases intensive care unit (ICU)-acquired weakness and delirium, hospital length of stay, duration of mechanical ventilation, readmissions and billings, morbidity and mortality. It improves the physical and mental health of critically ill patients. Healthcare professionals' education and readiness are key in establishing EM for practice. Although it is practised in many high-income countries, it has not yet been introduced as a standard care approach in ICUs of Pakistan, a low/middle-income country.

Aim: This study aimed to assess the knowledge and attitude of healthcare professionals regarding EM of MV patients at an adult ICU through electronic learning (E-learning).

Study design: A quasi-experimental pre/posttest design was employed on a sample of 57 multidisciplinary healthcare professionals. The study was conducted in the medical and surgical adult ICU of a tertiary care hospital in Karachi, Pakistan. A total population sampling strategy was deployed. A questionnaire was administered to assess the knowledge and attitude of healthcare professionals regarding the EM of MV patients. After expert review and pilot testing, the study questionnaire was contextually modified. A self-developed E-learning module inspired by Kirkpatrick's framework was utilised as an intervention. The duration of the intervention was 120 min, with the participants completing the module at their convenience. Paired t-test and descriptive statistics from the Statistical Package for the Social Sciences version 21 were used to analyse the results. Knowledge and attitude scores were evaluated.

Results: Demographic data revealed that the majority of participants were critical care registered nurses (71.9%), having 3-4 years of ICU work experience (38.6%) and working in a surgical ICU (54.4%). Only a few participants received EM training (19.3%). The majority of participants' level of education was Undergraduate Nursing (61.4%), with an average age of 29 years, and female gender (56.1%). A statistically significant change (p value < 0.01) in overall knowledge was identified, specifically for items related to the impact of EM in reducing delirium (p value = 0.01), improving patients' awareness (p value = 0.007), requiring less sedation (p value < 0.01), initiating on patients that can respond to verbal commands (p value = 0.03), promoting feasible (p value = 0.001) and safe practice (p value = 0.004), and requiring a multidisciplinary team approach (p value = 0.03). However, overall attitude (p value = 0.096) was unchanged with E-learning.

Conclusion: The study reflected an increase in knowledge among healthcare professionals. E-learning was seen to be a useful strategy for knowledge improvement. EM in MV patients was a new concept for the participants. Participants became aware of the benefits of the EM process and acknowledged the role of multidisciplinary collaboration. There is evidence to upscale the study to test the intervention and expand to other tertiary care hospitals in Pakistan to attain generalisability of results.

Relevance to clinical practice: The study has assessed and generated knowledge among healthcare professionals, predominantly critical care nurses, and has baseline data for devising institutional policies and protocols, educational interventions and research avenues for EM implementation. It also gave an optimistic approach to using a combination of E-learning and high-fidelity simulation for capacity building. Implementing EM in MV patients is crucial for critical care nurses, promoting proactive and preventive nursing care that improves patient outcomes and reduces immobility-related complications. It would also increase multidisciplinary collaboration while enhancing nursing empowerment and professional satisfaction.

Keywords: E‐learning; early mobilisation; intensive care unit; knowledge and attitude; mechanical ventilation.