{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:00:39Z","timestamp":1790316039502,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:00:00Z","timestamp":1790208000000},"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":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Early mobilisation is central to contemporary critical care, yet implementation remains inconsistent and ethically complex, particularly when patient safety, autonomy and resource constraints must be balanced.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To examine ICU nurses' perceptions of ethical concerns and implementation barriers related to early mobilisation in critically ill adults, including older adults, and their associations with professional characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A single\u2010centre analytical cross sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A convenience sample of ICU nurses completed a self\u2010administered questionnaire comprising demographic and professional data and the researcher\u2010developed Ethical Issues in Early Mobilisation\u2013Critical Care Scale and Early Mobilisation Barriers Scale. Data were analysed using descriptive statistics, independent\u2010samples\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests, one\u2010way analysis of variance, Pearson's correlation and multiple linear regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 100 ICU nurses participated in the study. The mean ethical\u2010concern score was 113.41\/150 (75.6% of the maximum possible score), and the mean barrier score was 69.94\/90 (77.7%). Beneficence and Patient Well\u2010being had the highest ethical\u2010domain score. Patient\u2010related barriers had the highest descriptive domain score, although all four barrier domains were closely distributed (76.6%\u201379.2%). Ethical\u2010concern and barrier scores were modestly correlated (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.292, 95% CI 0.103\u20130.461;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), indicating limited shared variance. In mutually adjusted models, education level, ICU experience and previous early\u2010mobilisation training were associated with both outcomes. The coded ICU\u2010type term was associated with ethical\u2010concern scores only, whereas professional nursing classification was associated with neither outcome. Age and gender were not associated with either score.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Early mobilisation emerged as an ethical and organisational challenge, not merely a technical task. Ethical concerns and implementation barriers were related but largely distinct. Associations with education, ICU experience and training should be interpreted as correlational rather than causal. Integrated, context\u2010sensitive approaches combining graded safety assessment, ethical decision\u2010making, role clarity and organisational support warrant prospective evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>The findings support the development of evidence\u2010based protocols, targeted educational initiatives and organisational strategies that strengthen nurses' clinical decision\u2010making and facilitate the safe and consistent implementation of early mobilisation in critical care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.70704","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:52:47Z","timestamp":1790315567000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethical Concerns and Implementation Barriers to Early Mobilisation in Critically Ill Adult and Older Adult Patients: Perspectives of\n                    <scp>ICU<\/scp>\n                    Nurses"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9047-386X","authenticated-orcid":false,"given":"Zahra Ahmed","family":"Sayed","sequence":"first","affiliation":[{"name":"Department of Critical Care Nursing, Faculty of Nursing Aswan University  Aswan Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Ali","family":"Abdraboh","sequence":"additional","affiliation":[{"name":"Department of Gerontological Nursing, Faculty of Nursing Damietta University  Damietta Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman Mohamed Ebrahim","family":"Abdelrazek","sequence":"additional","affiliation":[{"name":"Department of Geriatric Nursing, College of Nursing and Health Sciences Jazan University  Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"issue":"9","key":"e_1_2_17_2_1","doi-asserted-by":"crossref","first-page":"e744","DOI":"10.1097\/CCM.0000000000003850","article-title":"A Progressive Early Mobilization Program Is Significantly Associated With Clinical and Economic Improvement: A Single\u2010Center Quality Comparison Study","volume":"47","author":"Liu K.","year":"2019","journal-title":"Critical Care Medicine"},{"issue":"6","key":"e_1_2_17_3_1","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1111\/nicc.12455","article-title":"The Effect of Early Mobilization in Critically Ill Patients: A Meta\u2010Analysis","volume":"25","author":"Zang K.","year":"2020","journal-title":"Nursing in Critical Care"},{"issue":"1","key":"e_1_2_17_4_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s40560-018-0355-z","article-title":"Early Mobilisation in Mechanically Ventilated Patients: A Systematic Integrative Review of Definitions and Activities","volume":"7","author":"Clarissa C.","year":"2019","journal-title":"Journal of Intensive Care"},{"issue":"1","key":"e_1_2_17_5_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4266\/acc.2022.00094","article-title":"2021 KSCCM Clinical Practice Guidelines for Pain, Agitation, Delirium, Immobility, and Sleep Disturbance in the Intensive Care Unit","volume":"37","author":"Seo Y.","year":"2022","journal-title":"Acute and Critical Care"},{"key":"e_1_2_17_6_1","doi-asserted-by":"crossref","first-page":"4893","DOI":"10.2147\/JMDH.S469489","article-title":"Latent Trajectories of Activities of Daily Living Disability and Associated Factors Among Adults With Post\u2010Intensive Care Syndrome One Week After ICU Discharge","volume":"17","author":"Zhang X.","year":"2024","journal-title":"Journal of Multidisciplinary Healthcare"},{"issue":"1","key":"e_1_2_17_7_1","article-title":"Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit","volume":"2020","author":"Alaparthi G. 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