Barriers and facilitators to early mobilisation programmes in the paediatric intensive care unit: A scoping literature review

Abstract

AbstractBackgroundEarly mobilisation (EM) in paediatric intensive care units (PICU) is safe and feasible. Nurses, patients and family caregivers are integral to EM. Understanding their perspectives is necessary to implement and sustain EM for children in the PICU.AimTo identify and critique research literature on the perspectives of nurses, patients and families regarding EM in the PICU.Study designFor this scoping review, PubMed and EMBASE databases were searched. Included studies reported experiences of PICU nurses, caregivers and patients. Outcomes included feasibility, acceptability, satisfaction, benefits, facilitators, barriers, concerns, comfort with participation, and experiences and knowledge of EM. Exclusion criteria were: studies with preterm infants, other paediatric settings, review articles and editorials, studies of non‐mobility interventions or chest physiotherapy alone. Quality assessment tools for qualitative and quantitative designs were used.ResultsNine studies met the inclusion criteria: six quantitative and three qualitative studies. Six themes were identified: nurses' responses, concerns about patient risk factors and adverse events, equipment and staffing resources, family/caregivers' responses, patients' perspectives and overall impact.ConclusionsFindings demonstrate the importance of an interdisciplinary approach to address cultural, psychological and practical issues with EM. Unvalidated surveys conducted at single time points were used to measure nurses' perspectives. EM presents opportunities and challenges for family caregivers. Patients' experiences of EM are underrepresented in published research.Relevance to clinical practiceNurses and family caregivers are instrumental in EM in the PICU. Positive attitudes and competence are essential to PICU EM programme's success. Barriers may be minimized when programme benefits are understood.