Doctoral Candidate WRHA/ UM Winnipeg, Manitoba, Canada
Background: Early mobility after cardiac surgery (CS) in the intensive care unit (ICU) improves patient outcomes, yet implementation remains inconsistent. To inform interventions to increase adoption, this study sought to explore clinicians’ perspectives on the definition of early mobility in the CS ICU and describe perceived barriers and facilitators to implementation.
METHODS AND RESULTS: This qualitative study was guided by interpretive description. A total of 26 clinicians, including nurses, physicians, healthcare aides, respiratory therapists, and physiotherapists, participated. 19 of the participants identified as female. The median age of the participants was 39.5 years. The median years of experience in the CS ICU was 7.5 years. The nine focus groups and four individual interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Three themes and 13 categories were created from the data: (1) Incongruent Operationalization and Conceptualization across micro (clinician), meso (unit), and macro (hospital) levels, (2) Uncertainty, and (3) Inconsistency in Mobilization Practices. Themes were rooted in ambiguous definitions of "early" and "mobility," discrepancies between conceptualization and implementation of timing, varied interpretations of success, and perceived safety concerns. The themes and categories can be seen in the Figure. In addition, 15 barriers and 16 facilitators were identified. These were categorized into incongruent operationalization and conceptualization, patient-, clinician-, and unit-specific factors. See the Table for details on the barriers and facilitators.
Conclusion: Refining clinician-informed protocols with input from those who provide care can strengthen early mobility implementation. Addressing perceived barriers and increasing facilitators in both conceptualization and operationalization can reduce clinician uncertainty and promote more consistent, effective early mobility practices.
