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Table 2 Important beliefs according to the domain of the TDF

From: Barriers and facilitators to early rehabilitation in mechanically ventilated patients—a theory-driven interview study

Belief (number of participants endorsing belief) Excerpt from the interview
Skills domain
 Skills for early rehabilitation are developed by working with experienced colleagues. (12) “I’d say what’s helped me a lot is mentorship, working with a more skilled ICU therapist that’s been doing things for a little bit longer...” (PT)
Social and professional role/identity domain
 Leadership has an important role in early rehabilitation. (22) “… I work so closely with the nurses that if the nurses weren’t on board it would be very difficult to do early mobility.” (PT)
 Physicians have an important role in identifying appropriate patients for early rehabilitation. (16) “…we all try to be there and try to suggest or support rehabilitation, but in the end, again it ends up being a physician call when the physios get involved.” (RT)
 Physicians have an overall leadership role in early rehabilitation. (7) “And I like to talk to the doctors and have it spelled out to me what’s okay, what’s not okay with that patient, if it’s not clear from looking at the chart.” (PT)
Beliefs about capabilities domain
 Early rehabilitation is challenging. (22) “I would describe it as very important but also very challenging, to get the people up at such a … critical time as their care.” (PT)
Beliefs about consequences domain
 Early rehabilitation decreases muscle atrophy or reduces weakness. (31) “It limits or even reverses weakness and muscle wasting.” (PT)
 Early rehabilitation affects long-term physical function. (22) “I would say the most important goal… is to improve patient outcomes …also functional outcomes in the long term.” (MD)
 Early rehabilitation affects the mental health of the patient. (27) “…it gives them a huge sense of psychological and psychiatric benefits, because I think laying in that bed, day after day, it can put a tremendous strain on these patients, and this allows them to … get out of the four walls of the Critical Care.” (RT)
 Early rehabilitation affects duration of mechanical ventilation. (25) “For me, ventilator days. If we’re seeing a … significant decrease in ventilator days in our patient population I think that would … go a long way.” (RT)
Environmental context and resources domain
 We have adequate staff to perform early rehabilitation. (35) “Staffing is our main thing; that is a huge thing which interferes with… what we want to do.” (PT)
 ICU specialized equipment is required for early rehabilitation. (30) “We really just need walkers. We don’t use anything special. I know people have fancy stuff; we don’t.” (PT)
 Early rehabilitation requires coordination and scheduling between staff and team members. (22) “The problem is that it’s a multidisciplinary process so it does involve … all the RTs, all the nurses, all the physios, the dieticians, so it involves everybody. To get everybody to organize to do anything is always a challenge.” (RT)
 Early rehabilitation requires therapy staff specifically assigned to the ICU. (16) “I would definitely say that even amongst the physio personnel it would be better to either maintain a smaller, more experienced group continually coming to the ICU.” (RT)
Social influences domain
 Local champions influence early rehabilitation practice. (12) “Our lead physical therapist recently left and she was a huge advocate of mobilizing patients and it quickly became apparent how person-specific our mobility culture was, that she was driving a lot of it.” (MD)
 ICU leadership facilitates early rehabilitation practice. (14) “It wouldn’t happen without the leaders of the ICU, the lead nurses and the nurse educators.” (PT)
 Discord between team members affects delivery of early rehabilitation. (30) “…we go in there and they [say], don’t touch them, they are finally settled. Don’t touch them … they’re sleeping. Don’t touch them; they have a line in them. And I’m like, yeah so what? So, it can definitely influence things.” (PT)
 Family members affect delivery of early rehabilitation. (33) “I think for the most part we’re probably undershooting the goals, so we’re actually doing less in order to not … freak out the family.” (RT)
Behavioral regulation domain
 Feedback affects early rehabilitation practice. (33) “I think talking about the successes and failures and how we could make it better would be more important. I don’t think we get as much feedback on that as I think would be beneficial to say, hey, this is working and this is where we fell short and we need to step up to do a better job.” (RT)
 Having a unit protocol facilitates early rehabilitation.(27) “It would be nice to have a standard of care with regard to at least a consideration of mobilization and maybe realize that everybody will need to make their own decisions, but we’re asking a question; has the patient mobilized and if not, what sort of barriers or what sort of thought processes getting in the way of that happening should be undertaken?” (PT)
  1. RN nurse, MD physician, RT respiratory therapist, PT physiotherapist, OT occupational therapist