{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:59:03Z","timestamp":1780894743236,"version":"3.54.1"},"reference-count":80,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2025,9]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Early mobilisation (EM) in mechanically ventilated (MV) patients is a safe and feasible, evidence\u2010based practice with positive health outcomes. It decreases intensive care unit (ICU)\u2010acquired weakness and delirium, hospital length of stay, duration of mechanical ventilation, readmissions and billings, morbidity and mortality. It improves the physical and mental health of critically ill patients. Healthcare professionals' education and readiness are key in establishing EM for practice. Although it is practised in many high\u2010income countries, it has not yet been introduced as a standard care approach in ICUs of Pakistan, a low\/middle\u2010income country.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n This study aimed to assess the knowledge and attitude of healthcare professionals regarding EM of MV patients at an adult ICU through electronic learning (E\u2010learning).<\/jats:p>\n <\/jats:sec>\n \n Study Design<\/jats:title>\n \n A quasi\u2010experimental pre\/posttest design was employed on a sample of 57 multidisciplinary healthcare professionals. The study was conducted in the medical and surgical adult ICU of a tertiary care hospital in Karachi, Pakistan. A total population sampling strategy was deployed. A questionnaire was administered to assess the knowledge and attitude of healthcare professionals regarding the EM of MV patients. After expert review and pilot testing, the study questionnaire was contextually modified. A self\u2010developed E\u2010learning module inspired by Kirkpatrick's framework was utilised as an intervention. The duration of the intervention was 120\u2009min, with the participants completing the module at their convenience. Paired\n t<\/jats:italic>\n \u2010test and descriptive statistics from the Statistical Package for the Social Sciences version 21 were used to analyse the results. Knowledge and attitude scores were evaluated.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Demographic data revealed that the majority of participants were critical care registered nurses (71.9%), having 3\u20134\u2009years of ICU work experience (38.6%) and working in a surgical ICU (54.4%). Only a few participants received EM training (19.3%). The majority of participants' level of education was Undergraduate Nursing (61.4%), with an average age of 29\u2009years, and female gender (56.1%). A statistically significant change (\n p<\/jats:italic>\n value <\u20090.01) in overall knowledge was identified, specifically for items related to the impact of EM in reducing delirium (\n p<\/jats:italic>\n value\u2009=\u20090.01), improving patients' awareness (\n p<\/jats:italic>\n value\u2009=\u20090.007), requiring less sedation (\n p<\/jats:italic>\n value <\u20090.01), initiating on patients that can respond to verbal commands (\n p<\/jats:italic>\n value\u2009=\u20090.03), promoting feasible (\n p<\/jats:italic>\n value\u2009=\u20090.001) and safe practice (\n p<\/jats:italic>\n value\u2009=\u20090.004), and requiring a multidisciplinary team approach (\n p<\/jats:italic>\n value\u2009=\u20090.03). However, overall attitude (\n p<\/jats:italic>\n value\u2009=\u20090.096) was unchanged with E\u2010learning.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The study reflected an increase in knowledge among healthcare professionals. E\u2010learning was seen to be a useful strategy for knowledge improvement. EM in MV patients was a new concept for the participants. Participants became aware of the benefits of the EM process and acknowledged the role of multidisciplinary collaboration. There is evidence to upscale the study to test the intervention and expand to other tertiary care hospitals in Pakistan to attain generalisability of results.<\/jats:p>\n <\/jats:sec>\n \n Relevance to Clinical Practice<\/jats:title>\n The study has assessed and generated knowledge among healthcare professionals, predominantly critical care nurses, and has baseline data for devising institutional policies and protocols, educational interventions and research avenues for EM implementation. It also gave an optimistic approach to using a combination of E\u2010learning and high\u2010fidelity simulation for capacity building. Implementing EM in MV patients is crucial for critical care nurses, promoting proactive and preventive nursing care that improves patient outcomes and reduces immobility\u2010related complications. It would also increase multidisciplinary collaboration while enhancing nursing empowerment and professional satisfaction.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/nicc.70132","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T10:29:26Z","timestamp":1754908166000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Promoting a Multidisciplinary Team for Early Mobilisation in Mechanically Ventilated Patients: An Innovation in Health Professional Education\u2014A Quasi\u2010Experimental Pre\u2013Post Study"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-2779-4488","authenticated-orcid":false,"given":"Zahira Amir","family":"Ali","sequence":"first","affiliation":[{"name":"School of Nursing and Midwifery Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khairulnissa","family":"Ajani","sequence":"additional","affiliation":[{"name":"Network of Quality of Teaching and Learning Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Sohaib","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Anesthesiology and Critical Care, Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fauzia Basaria","family":"Hasnani","sequence":"additional","affiliation":[{"name":"Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laila","family":"Ladak","sequence":"additional","affiliation":[{"name":"School of Nursing and Midwifery Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1441-2772(23)01424-2"},{"key":"e_1_2_18_3_1","doi-asserted-by":"publisher","DOI":"10.4046\/trd.2023.0144"},{"key":"e_1_2_18_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2023.01.003"},{"key":"e_1_2_18_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/DCC.0000000000000575"},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-016-4513-2"},{"key":"e_1_2_18_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnc.2019.07.005"},{"key":"e_1_2_18_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e3283427243"},{"key":"e_1_2_18_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/nicc.12507"},{"key":"e_1_2_18_10_1","first-page":"193","article-title":"Early Mobilization on Patients With Mechanical Ventilation in the ICU","author":"Wang T. H.","year":"2020","journal-title":"Physical Therapy Effectiveness"},{"key":"e_1_2_18_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2017.09.019"},{"key":"e_1_2_18_12_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0223151"},{"key":"e_1_2_18_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2253-14-84"},{"key":"e_1_2_18_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2015.05.004"},{"key":"e_1_2_18_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cnc.2016.07.002"},{"key":"e_1_2_18_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0993-7"},{"key":"e_1_2_18_17_1","doi-asserted-by":"publisher","DOI":"10.21037\/jeccm.2018.01.04"},{"key":"e_1_2_18_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/jbcr\/irac008"},{"key":"e_1_2_18_19_1","first-page":"10","article-title":"The Effects of Early Mobilization in Mechanically Ventilated Adult ICU Patients: Systematic Review and Meta\u2010Analysis","volume":"10","author":"Wang L.","year":"2023","journal-title":"Frontiers in Medicine"},{"key":"e_1_2_18_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/CNQ.0000000000000390"},{"issue":"1","key":"e_1_2_18_21_1","first-page":"100","article-title":"Early Mobilization on Mortality of Patients With Mechanical Ventilation in Intensive Care Unit After Discharge: A Meta\u2010Analysis","volume":"33","author":"Yang L.","year":"2021","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"key":"e_1_2_18_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTN.0000000000000479"},{"key":"e_1_2_18_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60658-9"},{"key":"e_1_2_18_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.medine.2022.03.005"},{"key":"e_1_2_18_25_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04741"},{"key":"e_1_2_18_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000000149"},{"key":"e_1_2_18_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0765-4"},{"key":"e_1_2_18_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2022.07.010"},{"key":"e_1_2_18_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/jep.13378"},{"key":"e_1_2_18_30_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.175939"},{"key":"e_1_2_18_31_1","doi-asserted-by":"publisher","DOI":"10.4103\/0972-5229.152782"},{"issue":"3","key":"e_1_2_18_32_1","first-page":"29","article-title":"Patient Early Mobilization: A Malaysia's Study of Nursing Practices","volume":"3","author":"Chong M.","year":"2017","journal-title":"Journal of Intensive and Critical Care"},{"key":"e_1_2_18_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40560-016-0179-7"},{"issue":"2","key":"e_1_2_18_34_1","first-page":"63","article-title":"The Role of Early Mobilization in the Prevention of Post Operative Wound Infection After Lower Extremity Orthopedic Surgeries","volume":"7","author":"Shakil\u2010ur\u2010Rehman S.","year":"2015","journal-title":"Journal of Islamic International Medical College"},{"key":"e_1_2_18_35_1","doi-asserted-by":"publisher","DOI":"10.15621\/ijphy\/2017\/v4i4\/154721"},{"issue":"1","key":"e_1_2_18_36_1","first-page":"99","article-title":"Effect of Chest Physical Therapy With Early Mobilization on Post\u2010Operative Pulmonary Complications in Upper Abdominal Surgeries","volume":"44","author":"Bashir S.","year":"2019","journal-title":"Rawal Medical Journal"},{"key":"e_1_2_18_37_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/250536"},{"issue":"1","key":"e_1_2_18_38_1","first-page":"64","article-title":"Staff Perceived Barriers to Early Mobility in Medical vs. Surgical ICU at Hospital","volume":"10","author":"Niaz M.","year":"2021","journal-title":"Health Sciences"},{"issue":"2","key":"e_1_2_18_39_1","article-title":"Knowledge, Attitudes and Practices of Cardiopulmonary Rehabilitation Among Physiotherapists in ICU","volume":"6","author":"Akmal S.","year":"2023","journal-title":"Pakistan Journal of Physical Therapy (PJPT)"},{"issue":"2","key":"e_1_2_18_40_1","first-page":"5","article-title":"The Application of Physical Therapy in Intensive Care. Units; A Practice Survey","volume":"1","author":"Naveed S.","year":"2021","journal-title":"Journal of Health and Rehabilitation Research"},{"issue":"2","key":"e_1_2_18_41_1","first-page":"12","article-title":"Knowledge of Physical Therapy Students Regarding Acute Care Physical Therapy","volume":"2","author":"Mehmood N.","year":"2023","journal-title":"International Journal of Natural Medicine and Health Sciences"},{"key":"e_1_2_18_42_1","article-title":"Improving Nurses Knowledge and Attitude Regarding Early Mobilization of Post\u2010Operative Patients","volume":"51","author":"Mary Z.","year":"2018","journal-title":"Journal of Health, Medicine and Nursing"},{"key":"e_1_2_18_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2016.01.011"},{"key":"e_1_2_18_44_1","article-title":"E\u2010Learning for Health Professionals","volume":"1","author":"Vaona A.","year":"2018","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_18_45_1","first-page":"58","volume-title":"Acts, Ordinances, President's Orders and Regulations","author":"The Gazette of Pakistan","year":"2023"},{"key":"e_1_2_18_46_1","doi-asserted-by":"publisher","DOI":"10.2991\/j.jegh.2018.06.100"},{"key":"e_1_2_18_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13187-017-1308-2"},{"key":"e_1_2_18_48_1","unstructured":"Kloudlearn \u201cOverview of the Kirkpatrick Model and Foundational Principles \u201d(n.d.) https:\/\/kloudlearn.medium.com\/overview\u2010of\u2010the\u2010kirkpatrick\u2010model\u2010and\u2010foundational\u2010principles\u20101d9a349a9ae3."},{"issue":"17","key":"e_1_2_18_49_1","article-title":"Nurse Driven Early Mobility Protocols","volume":"16","author":"Agency for Health Care Research and Quality","year":"2017","journal-title":"Agency for Health Care Research and Quality"},{"key":"e_1_2_18_50_1","unstructured":"Lippincott Procedures \u201cProgressive Mobilization for a Patient Receiving Mechanical Ventilation \u201d(2019) https:\/\/procedures.lww.com\/lnp\/view.do?pId=4099547&hits=progressive mobility&a=false&ad=false."},{"key":"e_1_2_18_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2011.12.001"},{"key":"e_1_2_18_52_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10071-23835"},{"key":"e_1_2_18_53_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318206b5b5"},{"key":"e_1_2_18_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2018.09.001"},{"key":"e_1_2_18_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2022.105679"},{"key":"e_1_2_18_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.1343"},{"key":"e_1_2_18_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sempedsurg.2020.150910"},{"key":"e_1_2_18_58_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.802524"},{"key":"e_1_2_18_59_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066618807120"},{"key":"e_1_2_18_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.iccn.2017.06.005"},{"key":"e_1_2_18_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jphys.2020.03.001"},{"issue":"3","key":"e_1_2_18_62_1","first-page":"E448","article-title":"Early Mobilization of Critically Ill Adults: A Survey of Knowledge, Perceptions and Practices of Canadian Physicians and Physiotherapists","volume":"4","author":"Koo K. K.","year":"2016","journal-title":"Canadian Medical Association Open Access Journal"},{"issue":"4","key":"e_1_2_18_63_1","first-page":"21","article-title":"Early Mobilization of Mechanically Ventilated Patients: Nursing Practice in Quebec Intensive Care Units","volume":"29","author":"Bilodeau C.","year":"2018","journal-title":"Canadian Journal of Critical Care Nursing"},{"key":"e_1_2_18_64_1","first-page":"A2276","article-title":"Knowledge, Attitude and Practices of Care\u2010Providers About Early Mobilization in the Icu\u2010Report From A Nigerian Hospital","volume":"191","author":"Sanusi A. A.","year":"2015","journal-title":"American Journal of Respiratory and Critical Care Medicine"},{"key":"e_1_2_18_65_1","doi-asserted-by":"publisher","DOI":"10.3928\/01484834-20220412-01"},{"key":"e_1_2_18_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2020.09.021"},{"key":"e_1_2_18_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apnr.2017.11.006"},{"issue":"2","key":"e_1_2_18_68_1","first-page":"141","article-title":"Impact of a Mobility Team on Intensive Care Unit Patient Outcomes","volume":"31","author":"Ratcliffe J.","year":"2019","journal-title":"Critical Care Nursing Clinics"},{"key":"e_1_2_18_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003067"},{"key":"e_1_2_18_70_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10122607"},{"key":"e_1_2_18_71_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxaa247"},{"key":"e_1_2_18_72_1","doi-asserted-by":"publisher","DOI":"10.1891\/1078-4535.26.1.5"},{"issue":"4","key":"e_1_2_18_73_1","first-page":"541","article-title":"ICU Burden in a Tertiary Care Hospital in Pakistan; a Descriptive Analysis","volume":"22","author":"Aziz P. A.","year":"2018","journal-title":"Anaesthesia, Pain & Intensive Care"},{"issue":"1","key":"e_1_2_18_74_1","first-page":"541","article-title":"Cost of Workplace Bullying for Employees: An Anti\u2010Bullying Policy Through Introduction of Workplace Spirituality in Higher Education Sector of Lahore, Pakistan","volume":"28","author":"Khan S.","year":"2016","journal-title":"Science International"},{"key":"e_1_2_18_75_1","doi-asserted-by":"publisher","DOI":"10.1177\/0886260517719903"},{"key":"e_1_2_18_76_1","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/7840743"},{"key":"e_1_2_18_77_1","doi-asserted-by":"publisher","DOI":"10.5334\/aogh.2413"},{"key":"e_1_2_18_78_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3156.2008.02202.x"},{"key":"e_1_2_18_79_1","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2022385"},{"key":"e_1_2_18_80_1","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2019654"},{"key":"e_1_2_18_81_1","doi-asserted-by":"publisher","DOI":"10.1080\/08998280.2014.11929108"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70132","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nicc.70132","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.70132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:25:24Z","timestamp":1780892724000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.70132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":80,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1111\/nicc.70132"],"URL":"https:\/\/doi.org\/10.1111\/nicc.70132","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]},"assertion":[{"value":"2024-05-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70132"}}