重症成年与老年患者早期活动的伦理关切与实施障碍：重症监护护士视角

BACKGROUND: 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.

AIMS: 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.

DESIGN: A single-centre analytical cross sectional study.

METHODS: A convenience sample of ICU nurses completed a self-administered questionnaire comprising demographic and professional data and the researcher-developed Ethical Issues in Early Mobilisation-Critical Care Scale and Early Mobilisation Barriers Scale. Data were analysed using descriptive statistics, independent-samples t-tests, one-way analysis of variance, Pearson's correlation and multiple linear regression.

RESULTS: A total of 100 ICU nurses participated in the study. The mean ethical-concern 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-being had the highest ethical-domain score. Patient-related barriers had the highest descriptive domain score, although all four barrier domains were closely distributed (76.6%-79.2%). Ethical-concern and barrier scores were modestly correlated (r = 0.292, 95% CI 0.103-0.461; p = 0.003), indicating limited shared variance. In mutually adjusted models, education level, ICU experience and previous early-mobilisation training were associated with both outcomes. The coded ICU-type term was associated with ethical-concern scores only, whereas professional nursing classification was associated with neither outcome. Age and gender were not associated with either score.

CONCLUSIONS: 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-sensitive approaches combining graded safety assessment, ethical decision-making, role clarity and organisational support warrant prospective evaluation.

RELEVANCE TO CLINICAL PRACTICE: The findings support the development of evidence-based protocols, targeted educational initiatives and organisational strategies that strengthen nurses' clinical decision-making and facilitate the safe and consistent implementation of early mobilisation in critical care settings.