Effects of social influence and implementation climate and leadership on nurse-led early mobility behaviours in critical care

BMJ Open Qual. 2022 Jun;11(2):e001885. doi: 10.1136/bmjoq-2022-001885.


Introduction: Early mobility (EM), initiating and advancing physical activity in the earliest days of critical illness, has been described as the most difficult component of the ABCDEF bundle to implement and coordinate. Successful implementation of EM in clinical practice requires multiple targeted implementation strategies.

Objective: Describe the associations of nurses' EM attitudes, subjective norms, perceived behavioural control, intention, and implementation climate and leadership with self-reported and documented EM behaviour in the intensive care unit (ICU).

Design: This was a two-site, descriptive, cross-sectional study to explore nurses' perception of the factors influencing EM adherence.

Setting: Three ICUs (medical, surgical and cardiovascular) in an academic medical centre and two ICUs (medical/surgical and cardiovascular) in a regional medical centre in middle Tennessee.

Patients: Critically ill adults.

Interventions: None.

Main outcome measures: A 34-item investigator-developed survey, Implementation Leadership Scale, and Implementation Climate Scale were administered to ICU nurses. Survey development was informed by a Theory of Planned Behavior based elicitation study and implementation science frameworks.

Results: The academic medical centre had markedly lower EM documentation. We found no difference in nurses' EM attitudinal beliefs, social influence, facilitators, and barriers at both sites. Nurses perceived moderate social influence to perform EM similarly across sites and considerable control over their ability to perform EM. We did note site differences for implementation climate and leadership and objective EM adherence with the regional community medical centre demonstrating statistically significant relationships of implementation climate and leadership with self-report and documented EM behaviours.

Conclusions: We identified contextual differences in implementation climate and leadership influence when comparing nurse EM behaviours. Streamlined documentation, leadership advocacy for interprofessional coordination and manpower support, and multicomponent context-based implementation strategies could contribute to better EM adherence.

Keywords: Critical care; Exercise; Nurses; Patient Care Bundles.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Critical Care
  • Critical Illness
  • Cross-Sectional Studies
  • Humans
  • Intensive Care Units
  • Leadership*
  • Nurse's Role*