Early Mobility Practice in Selected Ministry of Health Intensive Care Units in Sarawak: Perceived Barriers and Facilitators of Early Mobility Protocol Adherence among Nurses

Yong, Siew Yieng (2020) Early Mobility Practice in Selected Ministry of Health Intensive Care Units in Sarawak: Perceived Barriers and Facilitators of Early Mobility Protocol Adherence among Nurses. Masters thesis, Universiti Malaysia Sarawak (UNIMAS).

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Abstract

Early Mobility (EM) of patient during ICU stay is essential to enhance short-term functional outcomes, shorten duration on mechanical ventilation and hospital length of stay. Mobilising ICU patients remains a challenge evidenced by poor adoption of EM practice in ICU. Therefore, this study aimed to determine the prevalence of EM practice, adherence rate of EM protocol, perceived barriers to and facilitators of EM protocol adherence at the five government hospitals in Sarawak. A quantitative, cross-sectional study was conducted at Sarawak General Hospital, Sarikei, Sibu, Bintulu and Miri Hospital. A four-week audit was carried out to determine the prevalence and adherence rate of EM protocol in ICUs. The perceived barriers and facilitators of EM protocol adherence among the ICU staff nurses were determined by using self-administered questionnaire consisting of socio-demographic characteristics, perceived barriers and facilitators of EM protocol adherence. The prevalence of EM practice and adherence rate of EM protocol were calculated based on defined formulas. Descriptive statistics were used to characterise the samples and analyse the perceived barriers and facilitators of EM protocol adherence. Multiple linear regression (MLR) analysis was performed to identify the determinants of perceived barriers and facilitators of EM protocol adherence. During the four-week audit, a total of 1344 patient-days was audited for EM practice in the MOH ICUs Sarawak after excluding seven missing data. The prevalence of EM practice in the MOH ICUs Sarawak was 65.6% (n=882 patient-days). An average adherence rate of EM protocol was 52.5% among the five government ICUs in Sarawak. The greatest barrier to EM protocol adherence was behaviour-related barriers, which included inadequate staff (72.3%), and unavailability of necessarily equipment (70.3%); followed by attitude-related barriers, which comprised concern of health care provider’s safety (50.9%), and patient’s safety (50.3%). The top five perceived facilitators identified were presence of a dedicated physiotherapist (96.8%), acquiring more equipment for EM and interdisciplinary teamwork (96.4%), skill training on EM (96.8%), education on EM and role clarity of each discipline (92.3%). The determinants of perceived barriers to EM protocol adherence were years of professional service and experience in ambulating patients with ETT in-situ. Those with one-year seniority in professional service had 0.02%, 0.01% and 0.14% lesser knowledge, attitude, and behaviour-related barriers scores, respectively. Those with experience in ambulating patients with ETT in-situ had 0.2 and 1.9% lesser knowledge and behaviour-related barriers score, respectively. Experience in ambulating patient with ETT in-situ (b = 0.1, 95% CI: 0.01, 0.25%) was the significant determinant of perceived facilitators of EM protocol adherence. This study provided preliminary data on the EM practice in the five government hospitals in Sarawak. The findings of this study indicated that the adoption of EM protocol remains a challenge in the Sarawak ICUs. The implementation of EM had to take in consideration of perceived barriers, facilitators and determinants identified in the local context. Reinventing ICU culture with multidisciplinary teamwork and collaboration to promote EM is key to address the barriers in EM implementation. Keywords:Early mobility, barriers, facilitators, adherence

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