Psychometric Testing of an Instrument Assessing Family Knowledge, Contemplation, Confidence and Readiness for Engaging in Early Mobilisation of Critically Ill Patients: A Multi-Site Cross-Sectional Design.

BACKGROUND: Early mobilisation is beneficial to support recovery among critically ill patients. The literature highlights the benefits of family engagement in early mobilisation, yet this practice remains underutilised. Effective implementation depends on understanding the key antecedents that influence family engagement in early mobilisation, specifically families' knowledge, contemplation, confidence and readiness. However, no measurement tools currently exist to assess these. Therefore, developing a psychometrically supported instrument is essential to understanding and enhancing families' factors influencing their engagement in early mobilisation. AIM: To develop and evaluate the psychometric properties of an instrument to assess families' knowledge, contemplation, confidence and readiness to engage in early mobilisation. DESIGN: A multi-site cross-sectional survey design. METHODS: Based on established psychological theory (Social Cognitive Theories and Behaviour Change Theories), an item pool was developed to assess families' knowledge, contemplation, confidence and readiness to participate in early mobilisation. To psychometrically evaluate the new tool, a multi-site cross-sectional survey was undertaken from May 2020 to June 2022 across five intensive care units in Australia. Data from 370 families of critically ill patients were used to evaluate the structural, convergent and discriminant validity as well as the reliability of the new instrument. RESULTS: Confirmatory factor analysis indicated good model fit, supporting the proposed structure. All items displayed high standardised factor loadings except one, which improved upon freeing an error covariance. Positive inter-factor correlations were moderate to strong and were substantially lower than the square root of the average variance extracted, supporting both convergent and discriminant validity, respectively. Additionally, all subscales demonstrated well to excellent reliability. CONCLUSION: The findings provide preliminary support for the multiple types of validity evidence and the reliability of the instrument. This new instrument is suitable for use in clinical and research applications to assess families' knowledge, contemplation, confidence and readiness for their engagement in early mobilisation. IMPACT: Family engagement in early mobilisation activities may have multiple benefits but it is not commonly implemented in the ICU. Factors influencing family engagement in early mobilisation are poorly understood. Influential psychological theories highlight the likely importance of knowledge, contemplation, confidence and readiness. A readily available instrument designed to assess these constructs among family members is needed to deepen research understanding and guide clinical practice. The proposed instrument is designed to measure factors influencing family engagement in early mobilisation, which may support healthcare professionals and health services to identify and tailor strategies to support family engagement in early mobilisation. REPORTING METHOD: Recommendations for reporting the results of studies of instrument and scale development and testing was followed to report this study. PATIENT OR PUBLIC CONTRIBUTION: Family members of adult critically ill patients participated in this study, and they provided the data through the survey.

Exploring critically ill patients' functional recovery through family partnerships: A descriptive qualitative study.

BACKGROUND: Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions. OBJECTIVES: The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients. METHODS: A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted. CONCLUSIONS: Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.

Healthcare professionals perspectives on feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients: A descriptive qualitative study.

AIMS: To explore healthcare professionals' perceptions of the feasibility and acceptability of family engagement in early mobilisation for adult critically ill patients. BACKGROUND: Early mobilisation is beneficial to minimise intensive care unit acquired-weakness in critically ill patients and family engagement can help with meeting early mobilisation goals, but it is not widely practiced. Understanding healthcare professionals' perceptions of feasibility and acceptability of family engagement in early mobilisation of adult critically ill patients is required to inform future implementation strategies to promote early mobilisation. DESIGN: A descriptive qualitative study. METHODS: Face-to-face, individual, semi-structured interviews were conducted between August 2021 and March 2022 with healthcare professionals working in two intensive care units in Australia. The interviews were analysed using the inductive content analysis, and descriptive statistics were used to summarise participant characteristics. The COREQ checklist was followed when reporting this study. RESULTS: Eleven ICU nurses, five physiotherapists and four physicians participated in the interviews. Three main categories were identified: (i) healthcare professionals' readiness, (ii) mediators of engagement and (iii) foundations for successful implementation. Most participants demonstrated a positive attitude towards an implementation of family engagement in early mobilisation for adult critically ill patients; however, capability and capacity of healthcare professionals, family members' willingness, availability and readiness and the care context were considered factors that could influence the successful implementation. CONCLUSION: From the perspectives of healthcare professionals, family engagement in early mobilisation is feasible and acceptable to enact but implementation is influenced by contextual factors including, healthcare professionals' capability and capacity and family members' willingness, availability and readiness. Collaborative teamwork and preparing family members and healthcare professionals are needed to support this practice. RELEVANCE TO CLINICAL PRACTICE: The findings provide important information to further identify potential strategies of family engagement in early mobilisation and to help and mitigate factors that impede implementation.

Early mobility and family partnerships in the intensive care unit: A scoping review of reviews.

BACKGROUND: Critical illness significantly impacts the well-being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families. AIM: In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature. STUDY DESIGN: In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA-ScR guidelines were adhered to for reporting. RESULTS: Thirty-three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies. CONCLUSIONS: There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions. RELEVANCE TO CLINICAL PRACTICE: Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation.

An interprofessional team approach to early mobilisation of critically Ill adults: An integrative review.

BACKGROUND: Early mobilisation is beneficial to minimise complications and promote the recovery and physical function of critically ill adult patients. An interprofessional team approach may assist in early mobilisation of these patients; however, adopting this approach may be challenging and optimal strategies to support early mobilisation are unknown. Understanding specific implementation strategies is required to effectively support its implementation in the critically ill adult patient population. OBJECTIVE: To synthesise and critically analyse the literature on interprofessional team approaches to early mobilisation in critically ill adult patients. DESIGN: An integrative review METHODS: The methodology of this integrative review was guided by Whittemore and Knafl's approach. A literature search of online databases including Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica database, Medical Literature Analysis and Retrieval System Online, Physiotherapy Evidence Database, and PubMed was conducted on 13 April 2020 and updated on 2 August 2021. No date limits were applied. Backward citation searching of included articles was used to identify additional articles. Articles were screened by title and abstract following pre-specified inclusion and exclusion criteria, and then by full text using the same criteria. Data describing an interprofessional team approach to early mobilisation were extracted into a specifically designed form. Quality appraisal was undertaken using the Quality Improvement Minimum Quality Criteria Set for quality improvement studies and the Joanna Briggs Institute's critical appraisal tools was used for cohort studies, retrospective studies, and randomised controlled trials. A narrative synthesis was conducted to integrate and summarise the findings. RESULTS: Thirty-seven studies were included. All studies described team compositions, roles, and responsibilities. Multiple strategies were used to support the implementation of a team approach to early mobilisation, most of which included the use of instruction tools, team meetings/team rounds, staff education, and knowledge sharing, and safety criteria. Improving patient's readiness to perform early mobilisation using clinical interventions was also described in 17 studies. Crucial factors that can help or hinder the implementation of an interprofessional team approach to early mobilisation were identified including organisational structure, staff attitudes and staff abilities. CONCLUSIONS: An interprofessional team approach to early mobilisation may be a useful strategy to improve early mobilisation practice; however, team compositions, roles, and responsibilities to support its implementation in individual setting is recommended. Multiple strategies and clinical interventions should be used to overcome barriers for implementing an interprofessional team approach to early mobilisation in critically ill adult patients. REGISTRATION NUMBER: This review was registered into PROSPERO International prospective register of systematic review (CRD42020179943). TWEETABLE ABSTRACT: Use of an interprofessional team approach to improve early mobilisation practice in adult critically ill patients.