Nurses` perspectives on early mobilization of intubated children in the pediatric intensive care unit: a qualitative study of barriers and facilitators

Purpose: To explore factors that promote or inhibit nurses' early mobilization of intubated children, and to identify sources of reassurance for nurses during mobilization. Method: A qualitative study design was employed. Semi-structured interviews with eight specialist nurses working in a Norwegian Pediatric Intensive Care Unit (PICU) were analyzed using Braun and Clarke's reflexive thematic analysis. Results: Nurses described collegial support, clear communication, interdisciplinary collaboration, and shared understanding as key facilitators. Mobilization decisions were also shaped by the child's respiratory and hemodynamic stability and by available resources, physical space, and time. Nurses reported fear of causing harm and emphasized the need for further theoretical and practical training to increase confidence in mobilizing intubated children. Conclusion: Early mobilization was enabled by coordinated teamwork and interdisciplinary collaboration characterized by planning and communication, while barriers included time pressure, staffing constraints, limited space, inadequate equipment, perceived instability, and lack of physician endorsement. Strengthening nurses' knowledge through clear guidelines and training like simulation may support safer and more consistent mobilization practices. Clinical implications: Future research should evaluate clinical outcomes of early mobilization in intubated children and assess how standardized protocols and training interventions influence implementation across diverse PICU settings.