• Daniel L Young, Jason Seltzer, Mary Glover, Caroline Outten, Annette Lavezza, Earl Mantheiy, Ann M Parker, and Dale M Needham.
• Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University.
• Am. J. Crit. Care. 2018 May 1; 27 (3): 186-193.

BackgroundNurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care.ObjectivesTo report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit.MethodsAn interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis.ResultsDuring three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%).ConclusionsNurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.© 2018 American Association of Critical-Care Nurses.

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