title: Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior.
abstract: OBJECTIVE
  Early mobilization in intensive care unit (ICU) is safe, feasible, and beneficial. However, mobilization frequently does not occur in practice. The study objective was to elicit attitudinal, normative, and control beliefs (barriers and enablers) toward the mobilization of ventilated patients, to inform development of targeted implementation interventions.
  
  
  METHODS
  A 9-item elicitation questionnaire was administered electronically to a convenience sample of multidisciplinary staff in a tertiary ICU. A snowball recruitment approach was used to target a sample size of 20 to 25. Two investigators performed word count and thematic analyses independently. Themes were cross-checked by a third investigator.
  
  
  RESULTS
  Twenty-two questionnaires were completed. Respondents wrote the most text about disadvantages. Positive attitudinal beliefs included better respiratory function, reduced functional decline, and reduced muscle wasting/weakness. The main negative attitudinal beliefs were that mobilization is perceived as time consuming and poses a risk of line dislodgement/disconnection. Positive control beliefs (enablers) included increased staff availability, positive staff attitudes, engagement, and teamwork. Negative control beliefs (barriers) included unstable patient physiology and negative workplace culture.
  
  
  CONCLUSIONS
  Intensive care unit staff expressed positive and negative attitudinal, normative, and control beliefs across the spectrum, and disadvantages were most frequently reported. Identified beliefs can be used to inform development of future interventions.
authors.affiliation: Department of Physiotherapy, Western Health, Footscray 3011, VIC, Australia. Electronic address: clare.holdsworth@wh.org.au.
authors.forename: Clare
authors.initials: C
authors.lastname: Holdsworth
authors.affiliation: Clinical Education Unit, Austin Health, Heidelberg 3081, VIC, Australia. Electronic address: kimberley.haines@austin.org.au.
authors.forename: Kimberley J
authors.initials: KJ
authors.lastname: Haines
authors.affiliation: School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, United Kingdom. Electronic address: Jill.Francis.1@city.ac.uk.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
authors.affiliation: NHMRC Centre of Research Excellence in Nursing, Menzies Health Institute QLD, Griffith University and Gold Coast Health, Gold Coast 4222, Australia. Electronic address: a.marshall@griffith.edu.au.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marshall
authors.affiliation: School of Public Health and Preventative Medicine, Monash University, Prahran 3004, VIC, Australia. Electronic address: denise.oconnor@monash.edu.
authors.forename: Denise
authors.initials: D
authors.lastname: O'Connor
authors.affiliation: Department of Physiotherapy, Western Health, Footscray 3011, VIC, Australia; Allied Health Research Unit, Monash Health, Cheltenham 3192, VIC, Australia; Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston 3199, VIC, Australia; School of Physiotherapy, Faculty of Medicine Nursing and Health Sciences, The University of Melbourne, Melbourne 3000, VIC, Australia. Electronic address: elizabeth.skinner@wh.org.au.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Skinner
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D016638:Critical Illness; D003430:Cross-Sectional Studies; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness; D026741:Physical Therapy Modalities; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires
keywords: Mobilization; critical illness; implementation science; mechanical ventilation; rehabilitation; translation