Barriers and facilitators to implementation of early mobilisation of critically ill patients in Zimbabwean and South African public sector hospitals: a qualitative study

Abstract

Purpose

Implementing early mobilisation in intensive care is challenging, and a detailed knowledge of factors that may hinder or facilitate implementation is essential for success. The study was done to explore the perceived barriers and facilitators to early mobilisation by physiotherapists in Zimbabwean and South African public sector hospital ICUs.

Methods

A qualitative study was done in eight public sector hospitals from South Africa and four hospitals from Zimbabwe. Physiotherapists from the participating hospitals who had at least two years working experience in ICU were invited to participate in semi-structured, in-depth, face-to-face interviews. Purposive sampling was done. Data collected included interpretation of early mobilisation, perceived barriers, and facilitators to early mobilisation. Data analysis was done using the content analysis method.

Findings

A total of 22 physiotherapists were interviewed. In defining the activities regarded as early mobilisation, there was diversity in relation to the specific activities and the nature of the patients in which the defined activities were suitable for. Perceived barriers which emerged included lack of professional autonomy or boundaries, motivation, and clinical skills. Perceived facilitators to early mobilisation included the availability of guidelines, good communication, adequate staff, and mobilisation equipment.

Conclusions

Barriers and facilitators to early mobilisation are multifactorial. There is need for multidisciplinary team collaboration and planning before implementing early mobilisation activities.

Implications to rehabilitation

• Professional roles/identity and or boundaries emerged to be a barrier that hinder implementation of early mobilisation if not clearly defined.

• Non-rotational physiotherapy coverage was highlighted to be important in facilitating good communication and teamwork and sustainability of services in ICU.

• Good communication channels and referrals between different disciplines should be employed in ICU to prevent delay in rendering services to ICU patients.

Keywords:

• Mobilisation
• physiotherapy
• barriers
• facilitators
• critically ill

Acknowledgements

The authors would like to thank the physiotherapists who participated in the study and the other health workers in all the study sites for their support. The authors are so grateful for the assistance in writing this manuscript received from Dr Morna Cornell through a writing retreat workshop arranged by Biomedical Research and Training Institute.

Ethics approval and consent to participate: Ethical clearance for this study was obtained from the Joint Research Ethics Committee for University of Zimbabwe College of Health Sciences and Parirenyatwa Group of Hospitals (JREC REF: 377/15), Medical Research Council of Zimbabwe (MRCZ/A/2040), and the University of the Witwatersrand Human Research Ethics Committee (Medical) (REF: M150927) in SA. Each questionnaire contained information on the study and participation was anonymous and voluntary for unit staff. Informed consent was obtained from each participant.

Authors contributions

CT, HvA and VN participated in the design of the study. CT was responsible for the data collection. CT, HvA and VN participated in the data management, analysis and interpretation. All the authors participated in the write up and final editing of the manuscript. All authors read and approved the final manuscript:

Disclosure statement

The authors declare that they have no competing interests.

Data availability statement

All data and materials are available and are with the first author.

Additional information

Funding

Research reported in this publication was supported by the Fogarty International Center, Grant/Award Numbers (D43 TW009343, D43 TW010137, D43 TW009539); University of California Global Health Institute; National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke; National Institute of Dental & Craniofacial Research; National Institute of Mental Health; National Institute of Nursing Research.