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Volume 17, Issue 3 (2025)
Iran J War Public Health 2025, 17(3): 237-241 |
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Received: 2025/05/23 | Accepted: 2025/07/14 | Published: 2025/07/20
Received: 2025/05/23 | Accepted: 2025/07/14 | Published: 2025/07/20
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Al-Salih S, Faris H, Hindi N. Nurses’ Knowledge about Early Mobilization of Patients in Critical Care Units at Al-Hillah Teaching Hospitals. Iran J War Public Health 2025; 17 (3) :237-241
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1- Department of Adult Nursing, Faculty of Nursing, University of Al-Qadisiyah, AL-Dewaynia, Iraq
2- Department of Laboratory and Clinical Sciences, Faculty of Pharmacy, Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences, Najaf, Iraq
3- Department of Basic and Medical Science, Pharmacy College, Al-Mustaqbal University, Hillah, Iraq
2- Department of Laboratory and Clinical Sciences, Faculty of Pharmacy, Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences, Najaf, Iraq
3- Department of Basic and Medical Science, Pharmacy College, Al-Mustaqbal University, Hillah, Iraq
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Introduction
Medical professionals have been unable to mobilize patients earlier in the intensive care unit (ICU) due to the patients’ conditions and numerous other obstacles, including various invasive lines, tubes, catheters, hemodynamic dysfunction, life-sustaining procedures (i.e., mechanical ventilation), and monitoring machines. Moving complicated and critically ill patients has been considered risky in ICU culture for a long time; however, new evidence indicates that this perspective must shift [1-4]. Moreover, bed rest instructions and inadvertent prolonged immobility have a significant detrimental impact on patient health [1, 5, 6].
Patients with critical illnesses were believed to require restricted movement and extended bed rest to ensure safety and hemodynamic stabilization. However, a systematic review reveals that a lack of motion has resulted in “impaired ability to exercise and ongoing weakness, insufficient quality of life, lasting neuropsychological disabilities, and elevated expenses related to healthcare utilization” for these patients. The detrimental physiological effects of immobilization and postponed rehabilitation in critically ill patients are concerning because they impact almost every body system, including the cardiovascular, endocrine, muscular and skeletal, hematological, respiratory, and metabolic systems [7].
The results of patient care depend on prompt mobilization. Studies have shown that immobilization in ICU patients increases the rates of death, duration of hospitalization, length of stay in the ICU, and the need for ventilatory support and sedatives [6].
It is recommended that ICU patients follow an “early mobilization protocol” to avoid these issues. Since research in this field has only recently started to emerge, there is currently no standard strategy for this level of enhancement project, despite the literature supporting the use of early mobilization or physical rehabilitation in the ICU environment [8]. For critically ill individuals, the European Respiratory Society and the European Society of Intensive Care Medicine recommend that all hospitals establish an early mobilization policy. While there is currently limited ongoing research, multiple organizations are developing procedures for implementation, and new studies have demonstrated their benefits [2, 9]. Since initial movement necessitates intricate clinical processes that require extensive collaboration across professions to ensure speed and efficacy, an interdisciplinary strategy utilizing various movement approaches was chosen [10].
In the publications, nursing staff, intensive care physicians, respiratory clinicians, physiotherapists, and unregistered workers collaborated using various interdisciplinary techniques. Initial mobilization can be carried out by collaborative groups using a variety of methods, such as nurse-led procedures, physiotherapist-led procedures, assigned team techniques, or structured movement procedures with specific movement targets that must be met before progressing to the next movement level. Different levels of motion regimens are described in another investigation. These movement thresholds were implemented as part of the ABCDE method. To ensure patient safety, the procedure was nurse-led and included precautions. Although the collaborative approach was necessary to complete the regular movement program, it was primarily nurse-led [11].
These stages of movement encompass passive range of motion (PROM), active range of motion (AROM), sitting at the edge of the bed, moving up from the bed, and standing. Nevertheless, due to insufficient additional personnel committed to the movement, the number of patients mobilized was limited [11]. This research aimed to assess the knowledge of nurses regarding early patient mobility in critical care facilities and to determine the relationship between their demographics and knowledge level.
Instrument and Methods
This cross-sectional study assessed nurses’ knowledge about early mobilization in ICUs at Al-Hillah Teaching Hospitals during the period from December 1, 2023, to April 1, 2024. The setting of the study was the ICUs in two teaching hospitals in Al-Hillah city (Al-Imam Al-Sadiq Teaching Hospital and Al-Hillah Teaching Hospital). A non-probability convenience sampling method was used to gather data from 93 nurses, representing the entire target population in the ICUs of Al-Hillah city teaching hospitals. Formal permission was issued by the College of Nursing of Al-Mustaqbal University to conduct the study, and a second approval was obtained from the Babylon Health Directorate.
The data collection instrument was constructed and adapted based on a review of previous research [12, 13]. The questionnaire consisted of two sections. Section one included six items that constituted demographic variables, while section two assessed the nurses’ knowledge about early mobilization in critical care settings at Al-Hillah Teaching Hospitals and consisted of 17 items. Data collection began with the distribution of the tool to the study samples as a self-report questionnaire after the main items were explained to them. Multiple-choice questions were used, with items rated as correct or incorrect, scored as 1 for incorrect answers and 2 for correct answers. The validity of the questionnaire was established by five experts in nursing education, who evaluated the clarity, relevance, and adequacy of the questionnaire to measure the concept of interest; all their suggestions were taken into consideration. The reliability of the instrument was examined after conducting a pilot study with 10% of the target population, which was excluded from the main study; the reliability coefficient was 0.82.
Data were analyzed using SPSS 26. The Chi-square test was used to assess the relationship between subjects’ demographics and knowledge level, with a significance level set at 0.05.
Findings
Among the participants, 39.8% were aged between 26 and 30 years. In relation to gender, about two-thirds of the sample (61.8%) were female. Additionally, 63.5% held a bachelor’s degree in nursing or above, 68.8% had 1 to 5 years of experience in nursing, 59.1% had 1 to 5 years of experience in ICUs, and finally, 43% had completed a training course on mobilizing patients in intensive care, with 29% having completed one training course (Table 1).
Table 1. Frequency of nurses’ demographic and employment data working in critical care units at Al-Hillah teaching hospitals
Additionally, 48.4% of nurses at Al-Hillah teaching hospitals had sufficient knowledge, 46.2% had moderate knowledge, and 5.4% had a high level of knowledge regarding early patient mobility in ICUs.
There was no significant relationship between nurses’ overall knowledge regarding the early mobilization of patients in ICUs at Al-Hillah Teaching Hospitals and their demographic and employment data (p<0.05; Table 2).
Table 2. Relationship Between overall nurses’ knowledge concerning the patients’ early mobilization in intensive care units at Al-Hillah teaching hospitals and their demographic and employment data
Discussion
This study assessed the knowledge of nurses regarding early patient mobility in critical care facilities and determined the relationship between the sample’s demographics and the nurses’ knowledge. Less than half of the participants were aged between 26 and 30 years. In relation to gender, about two-thirds of the sample were female, and a similar percentage held a bachelor’s degree in nursing or above. Most nurses had 1 to 5 years of experience in nursing, while more than half of the participants had 1 to 5 years of experience in ICUs. Finally, less than half of the participants had completed a training course on mobilizing patients in intensive care, with more than a quarter of them having completed one training course.
The study was supported by another investigation, reporting a mean of 5.25±2.08 years of service in the ICU and a mean age of 30.15±6.22 years, with the majority of nurses in the ICU being female. Most nurses in the ICU were married and older, holding either an undergraduate or junior university certificate. Among those working as nurses, only 36.54% had undergone training [14].
According to the current research, just under half of the nurses at Al-Hillah teaching hospitals had sufficient knowledge about early patient mobility in critical care settings. Another study supports the present research, indicating that many nurses working in ICUs have inadequate knowledge regarding early mobilization. In the mentioned research, the sample’s average rating for knowledge of early mobilization is significantly below the median general average of 8.00, and only 54.9% achieve an acceptable level of 8.00 [15].
Furthermore, the results of additional research conducted in Canada [16, 17], Turkey [18], and Italy [19] support the findings of the current study, leading to the conclusion that nurses lack the knowledge necessary to mobilize patients promptly. However, other studies have found that the level of understanding was high [20, 21].
The disparities in nurses’ educational backgrounds and the quality of their training may be contributing factors. Few nursing training programs include provisions for early mobilization. This finding suggests that training on the application of this approach should be a significant component of ICU nurses’ education, as early mobilization is recommended as standard treatment in the ICU setting.
On the other hand, there was no significant correlation between nurses’ general knowledge of early patient mobility in critical care settings at Al-Hillah teaching hospitals and their demographic and employment data. The present study aligns with certain aspects of research conducted in Addis Ababa [22] but differs in other respects from studies that show that ICU nurses’ knowledge of early mobilization is influenced by factors, such as their age, years of employment in the ICU, professional level, and whether or not they have undergone training on the topic. To enhance ICU nurses’ understanding, specific training and strategies are required [13, 23].
Conclusion
Only half of the nurses at Al-Hillah teaching hospitals have sufficient knowledge about early patient mobility in ICUs, and there is no significant relationship between their knowledge about mobility in ICUs and their demographic and employment data.
Acknowledgments: Grateful thanks and appreciation are extended to all participants.
Ethical Permissions: The Research Ethics Committee of Al-Qadisiya University’s College of Nursing granted ethical permission (23 on September 12, 2023).
Conflicts of Interests: No conflicts of interests were disclosed by the author.
Authors' Contribution: Al-Salih SSH (First Author), Introduction Writer/Methodologist/Main Researcher/Discussion Writer/Statistical Analyst (70%); Faris HI (Second Author), Methodologist/Assistant Researcher/Statistical Analyst (15%); Hindi NKK (Third Author), Introduction Writer/Assistant Researcher/Discussion Writer (15%)
Funding/Support: The researcher declared that they had not received funding from any organization, either directly or indirectly.
Medical professionals have been unable to mobilize patients earlier in the intensive care unit (ICU) due to the patients’ conditions and numerous other obstacles, including various invasive lines, tubes, catheters, hemodynamic dysfunction, life-sustaining procedures (i.e., mechanical ventilation), and monitoring machines. Moving complicated and critically ill patients has been considered risky in ICU culture for a long time; however, new evidence indicates that this perspective must shift [1-4]. Moreover, bed rest instructions and inadvertent prolonged immobility have a significant detrimental impact on patient health [1, 5, 6].
Patients with critical illnesses were believed to require restricted movement and extended bed rest to ensure safety and hemodynamic stabilization. However, a systematic review reveals that a lack of motion has resulted in “impaired ability to exercise and ongoing weakness, insufficient quality of life, lasting neuropsychological disabilities, and elevated expenses related to healthcare utilization” for these patients. The detrimental physiological effects of immobilization and postponed rehabilitation in critically ill patients are concerning because they impact almost every body system, including the cardiovascular, endocrine, muscular and skeletal, hematological, respiratory, and metabolic systems [7].
The results of patient care depend on prompt mobilization. Studies have shown that immobilization in ICU patients increases the rates of death, duration of hospitalization, length of stay in the ICU, and the need for ventilatory support and sedatives [6].
It is recommended that ICU patients follow an “early mobilization protocol” to avoid these issues. Since research in this field has only recently started to emerge, there is currently no standard strategy for this level of enhancement project, despite the literature supporting the use of early mobilization or physical rehabilitation in the ICU environment [8]. For critically ill individuals, the European Respiratory Society and the European Society of Intensive Care Medicine recommend that all hospitals establish an early mobilization policy. While there is currently limited ongoing research, multiple organizations are developing procedures for implementation, and new studies have demonstrated their benefits [2, 9]. Since initial movement necessitates intricate clinical processes that require extensive collaboration across professions to ensure speed and efficacy, an interdisciplinary strategy utilizing various movement approaches was chosen [10].
In the publications, nursing staff, intensive care physicians, respiratory clinicians, physiotherapists, and unregistered workers collaborated using various interdisciplinary techniques. Initial mobilization can be carried out by collaborative groups using a variety of methods, such as nurse-led procedures, physiotherapist-led procedures, assigned team techniques, or structured movement procedures with specific movement targets that must be met before progressing to the next movement level. Different levels of motion regimens are described in another investigation. These movement thresholds were implemented as part of the ABCDE method. To ensure patient safety, the procedure was nurse-led and included precautions. Although the collaborative approach was necessary to complete the regular movement program, it was primarily nurse-led [11].
These stages of movement encompass passive range of motion (PROM), active range of motion (AROM), sitting at the edge of the bed, moving up from the bed, and standing. Nevertheless, due to insufficient additional personnel committed to the movement, the number of patients mobilized was limited [11]. This research aimed to assess the knowledge of nurses regarding early patient mobility in critical care facilities and to determine the relationship between their demographics and knowledge level.
Instrument and Methods
This cross-sectional study assessed nurses’ knowledge about early mobilization in ICUs at Al-Hillah Teaching Hospitals during the period from December 1, 2023, to April 1, 2024. The setting of the study was the ICUs in two teaching hospitals in Al-Hillah city (Al-Imam Al-Sadiq Teaching Hospital and Al-Hillah Teaching Hospital). A non-probability convenience sampling method was used to gather data from 93 nurses, representing the entire target population in the ICUs of Al-Hillah city teaching hospitals. Formal permission was issued by the College of Nursing of Al-Mustaqbal University to conduct the study, and a second approval was obtained from the Babylon Health Directorate.
The data collection instrument was constructed and adapted based on a review of previous research [12, 13]. The questionnaire consisted of two sections. Section one included six items that constituted demographic variables, while section two assessed the nurses’ knowledge about early mobilization in critical care settings at Al-Hillah Teaching Hospitals and consisted of 17 items. Data collection began with the distribution of the tool to the study samples as a self-report questionnaire after the main items were explained to them. Multiple-choice questions were used, with items rated as correct or incorrect, scored as 1 for incorrect answers and 2 for correct answers. The validity of the questionnaire was established by five experts in nursing education, who evaluated the clarity, relevance, and adequacy of the questionnaire to measure the concept of interest; all their suggestions were taken into consideration. The reliability of the instrument was examined after conducting a pilot study with 10% of the target population, which was excluded from the main study; the reliability coefficient was 0.82.
Data were analyzed using SPSS 26. The Chi-square test was used to assess the relationship between subjects’ demographics and knowledge level, with a significance level set at 0.05.
Findings
Among the participants, 39.8% were aged between 26 and 30 years. In relation to gender, about two-thirds of the sample (61.8%) were female. Additionally, 63.5% held a bachelor’s degree in nursing or above, 68.8% had 1 to 5 years of experience in nursing, 59.1% had 1 to 5 years of experience in ICUs, and finally, 43% had completed a training course on mobilizing patients in intensive care, with 29% having completed one training course (Table 1).
Table 1. Frequency of nurses’ demographic and employment data working in critical care units at Al-Hillah teaching hospitals
Additionally, 48.4% of nurses at Al-Hillah teaching hospitals had sufficient knowledge, 46.2% had moderate knowledge, and 5.4% had a high level of knowledge regarding early patient mobility in ICUs.
There was no significant relationship between nurses’ overall knowledge regarding the early mobilization of patients in ICUs at Al-Hillah Teaching Hospitals and their demographic and employment data (p<0.05; Table 2).
Table 2. Relationship Between overall nurses’ knowledge concerning the patients’ early mobilization in intensive care units at Al-Hillah teaching hospitals and their demographic and employment data
Discussion
This study assessed the knowledge of nurses regarding early patient mobility in critical care facilities and determined the relationship between the sample’s demographics and the nurses’ knowledge. Less than half of the participants were aged between 26 and 30 years. In relation to gender, about two-thirds of the sample were female, and a similar percentage held a bachelor’s degree in nursing or above. Most nurses had 1 to 5 years of experience in nursing, while more than half of the participants had 1 to 5 years of experience in ICUs. Finally, less than half of the participants had completed a training course on mobilizing patients in intensive care, with more than a quarter of them having completed one training course.
The study was supported by another investigation, reporting a mean of 5.25±2.08 years of service in the ICU and a mean age of 30.15±6.22 years, with the majority of nurses in the ICU being female. Most nurses in the ICU were married and older, holding either an undergraduate or junior university certificate. Among those working as nurses, only 36.54% had undergone training [14].
According to the current research, just under half of the nurses at Al-Hillah teaching hospitals had sufficient knowledge about early patient mobility in critical care settings. Another study supports the present research, indicating that many nurses working in ICUs have inadequate knowledge regarding early mobilization. In the mentioned research, the sample’s average rating for knowledge of early mobilization is significantly below the median general average of 8.00, and only 54.9% achieve an acceptable level of 8.00 [15].
Furthermore, the results of additional research conducted in Canada [16, 17], Turkey [18], and Italy [19] support the findings of the current study, leading to the conclusion that nurses lack the knowledge necessary to mobilize patients promptly. However, other studies have found that the level of understanding was high [20, 21].
The disparities in nurses’ educational backgrounds and the quality of their training may be contributing factors. Few nursing training programs include provisions for early mobilization. This finding suggests that training on the application of this approach should be a significant component of ICU nurses’ education, as early mobilization is recommended as standard treatment in the ICU setting.
On the other hand, there was no significant correlation between nurses’ general knowledge of early patient mobility in critical care settings at Al-Hillah teaching hospitals and their demographic and employment data. The present study aligns with certain aspects of research conducted in Addis Ababa [22] but differs in other respects from studies that show that ICU nurses’ knowledge of early mobilization is influenced by factors, such as their age, years of employment in the ICU, professional level, and whether or not they have undergone training on the topic. To enhance ICU nurses’ understanding, specific training and strategies are required [13, 23].
Conclusion
Only half of the nurses at Al-Hillah teaching hospitals have sufficient knowledge about early patient mobility in ICUs, and there is no significant relationship between their knowledge about mobility in ICUs and their demographic and employment data.
Acknowledgments: Grateful thanks and appreciation are extended to all participants.
Ethical Permissions: The Research Ethics Committee of Al-Qadisiya University’s College of Nursing granted ethical permission (23 on September 12, 2023).
Conflicts of Interests: No conflicts of interests were disclosed by the author.
Authors' Contribution: Al-Salih SSH (First Author), Introduction Writer/Methodologist/Main Researcher/Discussion Writer/Statistical Analyst (70%); Faris HI (Second Author), Methodologist/Assistant Researcher/Statistical Analyst (15%); Hindi NKK (Third Author), Introduction Writer/Assistant Researcher/Discussion Writer (15%)
Funding/Support: The researcher declared that they had not received funding from any organization, either directly or indirectly.
Keywords:
References
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