Perspectives of early mobility in the cardiac surgery intensive care unit: an interpretive description study

Abstract

Objective: Early mobility after cardiac surgery in the intensive care unit improves patient outcomes, yet implementation by clinicians remains inconsistent. To inform interventions to increase adoption, this study sought to explore clinicians’ perspectives on the definition of early mobility in the cardiac surgery intensive care unit and describe perceived barriers and facilitators to implementation. Design: This qualitative study was guided by interpretive description. Setting: A tertiary hospital that performs 1000 cardiac surgeries annually. Participants: A total of 26 clinicians, including nurses, physicians, healthcare aides, respiratory therapists, and physiotherapists, participated. Main Measures: The nine focus groups and four individual interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Three themes and 13 categories were created from the data: (1) Incongruent operationalization and conceptualization (across micro, meso, and macro levels), (2) uncertainty, and (3) inconsistency in mobilization practices. Themes were rooted in ambiguous definitions of “early” and “mobility,” discrepancy between conceptualization and implementation of timing, varied interpretations of success, and perceived safety concerns. In addition, 4 barriers and 4 facilitators were identified and categorized into patient-care and clinician-related. Conclusion: Developing early mobility protocols and education informed by clinicians may enhance its implementation in the cardiac surgery intensive care unit. Incorporating the perspectives of clinicians into early mobility protocol development is essential to support behaviour change and provide this beneficial care.