Early Mobilization in Mechanically Ventilated ICU Patients: Advancing Recovery Through Evidence-Based Practice

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When a patient enters the healthcare system, specifically a hospital setting, they undergo a series of assessments to ensure appropriate triaging and placement within a unit that best serves their health needs. For those who require critical and complex care, admission to the Intensive Care Unit (ICU) is often necessary. Patients in the ICU are at an increased risk for prolonged hospitalization, complications, and functional decline due to the intensity of their illness and the nature of critical care interventions. Many critically ill patients become dependent on mechanical ventilation, with approximately one in three requiring ventilatory support during their ICU stay (Jivraj et al., 2023). Prolonged mechanical ventilation, immobility, and sedation are known contributors to the development of ICU-acquired weakness and delirium, both of which can lengthen recovery time and hospital stays.

The importance of studying early mobilization among mechanically ventilated patients supports nurse-led interventions that improve patient outcomes, reduce the incidence of delirium, and shorten the length of stay in the ICU. Understanding the barriers and facilitators to implementing early mobilization strategies can help us as nurses and our interdisciplinary team optimize care for this vulnerable population. This study aims to explore the timing and the implementation of early mobilization interventions in mechanically ventilated patients and how it influences the presence of delirium and ICU length of stay.

Key Concepts and Frameworks

During my review of the literature, several key concepts were identified. These core concepts included early mobilization, mechanically ventilated patients, patient outcomes (specifically the presence of delirium, increased length of stay, and decreased functional recovery), and nurse-led interventions. These concepts are central to understanding how timely and coordinated nursing interventions can influence patient recovery, reduce complications, and improve overall ICU outcomes.

Early mobilization refers to the initiation of physical activity, such as passive or active range of motion, sitting, standing, or ambulation, soon after physiological stabilization in critically ill patients (Lee & Lee., 2025). This practice aims to prevent complications related to prolonged immobility, such as muscle atrophy, weakness, and delirium.

Mechanically ventilated patients are individuals who rely on invasive ventilation via endotracheal or tracheostomy tube to maintain adequate oxygenation, often due to respiratory failure or severe illness (Jivraj et al., 2023). These patients are at an increased risk for
complications related to immobility and sedation.

Patient outcomes, in the context of early mobilization research, focus on the measurable indicators such as the presence of delirium, ICU length of stay, and functional recovery following critical illness. Studies demonstrate that earlier initiation of mobilization activities can reduce delirium incidence, enhance recovery of physical function, and shorten ICU stays (Higgins et al., 2019; Park et al., 2020).

Finally, nurse-led interventions are integral to the success of mobilization activities and programs. Nurses play a central role in assuring for readiness of mobilization, coordinating multidisciplinary efforts, and ensuring patient safety. The Knowledge-to-Action (KTA) framework can be applied to guide the incorporation of evidence-based early mobilization practices into clinical settings. This model emphasizes identifying barriers, tailoring interventions, and monitoring outcomes to ensure sustained practice change (Bhattacherjee, 2012). Collectively, these concepts form the foundation for understanding how early mobilization can influence recovery and they highlight the importance of nurse-led strategies in improving patient outcomes and decreasing complications that may lead to a longer length of stay in the ICU.

Relevant Theories

This study is guided by three interrelated nursing theories; Jean Watson’s Theory of Human Caring, Dorothea Orem’s Self-Care Deficit Nursing Theory, and Sister Callista Roy’s Adaptation Model. These frameworks provide a holistic foundation for understanding the nurse’s role in facilitating early mobilization among mechanically ventilated patients in the ICU. These frameworks collectively address the adaptive, functional, and humanistic dimensions of recovery during critical illness.

Jean Watson’s Theory of Human Caring provides the philosophical grounding for the nurse-patient relationship. Watson’s (2008) early recognition of environmental influences on health care strengthened my belief in the importance of understanding the physical, personal, and social context of illness not only within hospital walls. Watson’s (2008) emphasis on authentic human connection helped me recognize the deep emotional and spiritual dimensions of nursing. Within the context of the study, early mobilization in critically ill patients can foster caring and healing environments that promote patient engagement and human connection that is essential for recovery.

Dorothea Orem’s Self-Care Deficit Nursing Theory (Orem, 1991) supports the study’s focus on promoting autonomy, both in the patient’s recovery and in the professional role of the nurse. Mechanically ventilated patients experience prolonged periods of immobility, resulting in muscle weakness and diminished ability to perform activities of daily living (ADLs) such as brushing their teeth, grooming, dressing, and walking. Within the context of the study, the nurse plays a critical role in assessing self-care limitations, providing support through means of early mobilization, and implementing interventions that can gradually restore independence once the patient has become liberated from mechanical ventilation.

Sister Callista Roy’s Adaptation Model (Roy, 2009) further informs the study by viewing the critically ill patient as an adaptive system that continuously responds to internal and external stimuli. During mechanical ventilation, patients face significant physiological and psychological stressors that challenge their adaptive capacities. The nurse can initiate early mobilization and monitor the patient’s responsiveness and tolerance as recovery progresses.

Together the theories of Watson, Orem, and Roy provide a holistic foundation to discuss the fundamentals of nursing and how they can influence patient recovery. Each theory offers a unique perspective that explains how nursing actions, such as early mobilization, are not only physical interventions but a holistic, patient-centered nursing practice that promotes healing, autonomy, and adaptive recovery.

Literature Review

Despite the growing evidence and existing unit protocols that support the use of early mobilization practices in mechanically ventilated patients, implementation of this intervention remains inconsistent across critical care settings. Lee and Lee (2025) conducted a systematic review to compare large collections of data on early mobilization practices in mechanically ventilated patients. Their findings indicated that early mobilization is an effective intervention for decreasing complications related to mechanical ventilation, such as delirium, and length of stay in the ICU. However, they also recognized several staff-reported barriers, such as insufficient manpower and time restraints that limited the number of patients who were able to participate in early mobilization. A key strength of this study was focusing on nurse-led initiatives that promoted early mobilization, as nurses play a crucial role in implementing interventions that directly influence a patient’s recovery trajectory. The authors acknowledge that one limitation of this study was only including English-language articles, which could create bias and demonstrate a lack of multicultural practices.

In comparison, Wang et al. (2020) conducted a cross-sectional study to identify nurses’ knowledge and attitudes regarding early mobilization in mechanically ventilated patients. The authors distributed an electronic questionnaire to evaluate nurses’ understanding of the benefits, challenges, and implementation of early mobilization practices. Based on their results, 96.5% of nurses were able to identify the benefits of early mobilization. However, a staggering 32.9% of nurses did not agree with consistently implementing early mobilization practices based on perceived barriers. The most frequently cited barriers included heavy workload, insufficient equipment, lack of written protocols, potential safety risks, and limited staffing. These findings support the ongoing gap between awareness of best-practice and ability to implement interventions in a busy critical care environment. One strength of this study is that it allows for a large sample size for the authors to capture a wide range of nursing experiences and perspectives. A key limitation to this study is that with the use of self-reporting questionnaires, they may introduce response bias if a nurse lacks experience with a certain concept. For instance, some participants may have selected answers based on what they believed to be the most desirable, rather than those that accurately reflect individual knowledge or practice.

Wshah et al. (2025) also conducted a cross-sectional study using a structured online questionnaire that collected data on participants’ demographics, patient selection criteria for early mobilization, and early mobilization practices. The findings of this study revealed that implementing early mobilization practices was patient- and provider-dependent. One key difference in this study was the inclusion of Physiotherapists (PT) perspectives in ICU care and practices. The results of this study indicated that many PTs lack ICU-specific experience, which may affect their confidence and consistency when mobilizing critically ill patients. A strength of this study was incorporating the perspectives of other interdisciplinary team members and their role with early mobilization practices. One limitation identified by the authors of this study was that the sample may have been a convenience sample, as participants were healthcare professionals who were actively utilizing and supporting early mobilization practices, potentially introducing selection bias.

Lastly, Zhang et al. (2023) used a systematic review to explore ICU patients’ perspectives when it comes to early mobilization. Eight studies were reviewed and key concepts emerged that influenced a patient's recovery when early mobilization practices were implemented. These concepts included self-determination, relationship with nursing staff, the need for competency and self-control, perceived benefits of physical function, increased self-confidence, as well as negative emotions, unpleasant experiences, and suffering. This study found that the primary factors influencing patients’ acceptance of early mobilization in the ICU were negative emotions and a lack of motivation. A strength of this study was the focus on the patient-centered experience, which was hard to find amongst other literature. However, a limitation to this study was the small sample size that was collected that could interfere with the generalizability of the findings.

Overall, the review of literature highlights that while early mobilization is widely recognized as beneficial for mechanically ventilated patients, the implementation of this practice continues to face significant barriers at the organizational, provider, and patient levels.
Systematic reviews have demonstrated the positive impact on recovery, a decreased incidence of delirium and ICU length of stay, yet cross-sectional studies reveal persistent gaps in staff confidence and available resources. These findings further emphasize the need for further exploration of the factors that influence the consistent application of early mobilization protocols and how nurses, as primary care providers, can play a leading role in overcoming these barriers to improve patient outcomes.

Conclusion

After conducting a review of the literature, it is evident that early mobilization is a vital intervention for improving recovery outcomes in mechanically ventilated patients, yet implementation of this intervention is inconsistent across various critical care settings.
Systematic and cross-sectional studies reveal a clear disconnect between evidence-based

interventions and implementation at the bedside. Integrating this evidence with basic nursing theories highlights the deeper implications. Through Watson, Orem, and Roy len’s early mobilization is a multifactorial nursing practice that combines caring, adaptive support, and restoration of independence. Bridging these gaps requires empowering nurses to apply theory-informed, patient-centered, evidence-based care to improve recovery and outcomes in critically ill patients.

References

Bhattacherjee, A. (2012). Social science research: Principles, methods, and practices (2nd ed.). Textbooks Collection. Book 3. University of South Florida. http://scholarcommons.usf.edu/oa_textbooks/3
Jivraj, N. K., Hill, A. D., Shieh, M., et al. (2023). Use of mechanical ventilation across 3 countries. JAMA Internal Medicine, 183(8), 824–831. https://doi.org/10.1001/jamainternmed.2023.2371
Lee, J., Kim, Y., & Lee, H. J. (2025). Nurse-involved early mobilization in the intensive care unit: A systematic review and meta-analysis. Nursing in Critical Care, 30(2). https://doi.org/10.1111/nicc.13278
Orem, D. E. (1991). Nursing: Concepts of practice (4th ed.).
Mosby Page, V. (2021). Sedation in mechanically ventilated patients with COVID-19. The Lancet Respiratory Medicine, 9(3), 218–219. https://doi.org/10.1016/S2213-2600(20)30570-1.
Roy, C. (2009). The Roy adaptation model (3rd ed.). Pearson.
Wang, J., Xiao, Q., Zhang, C., Jia, Y., & Shi, C. (2020). Intensive care unit nurses' knowledge, attitudes, and perceived barriers regarding early mobilization of patients. Nursing in Critical Care, 25(6), 339-345. https://doi.org/10.1111/nicc.12507
Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). University Press of Colorado.
Wshah, A., Obaidat, S., AI, S., Muhsen, A., Bin, S. B., Alkasassbeh, A., Wshah, S., Al Hadidi, A. R. B., Altaim, T. A., Sawafta, B., & Alqallab, S. (2025). Exploring Early Mobilization Practices in Adult Intensive Care Units in Jordan: A Cross-Sectional Survey. Journal of Multidisciplinary Healthcare, 18, 3749-3761. https://doi.org/10.2147/JMDH.S524236
Zhang, H., Yu, S., Yu, C., & Cheng, Q. (2024). Understanding the needs and perceptions of early mobilization for critically ill patients: A systematic review of qualitative studies. Intensive & Critical Care Nursing, 81. https://doi.org/10.1016/j.iccn.2023.103584