Navigating between the familiar and the unfamiliar: A qualitative study exploring critical care nurses' clinical practice during early rehabilitation in the ICU

Background: Critical care nurses provide bedside care around the clock, which offers a unique opportunity to integrate rehabilitative activities into routine care. How nurses perform such activities is underinvestigated. Aim: To explore how competencies related to early rehabilitation emerged in the clinical practice of critical care nurses, and to explore their reflections on this aspect of their clinical practice. Study design and methods: A qualitative study with a phenomenological-hermeneutic approach was conducted in two Norwegian ICUs from January 2022 to January 2023. Observations and video recordings of eight nursepatient dyads were conducted, followed by post-observation nurse interviews. Data were analysed using Heath and Luff's video analysis and Malterud's systematic text condensation, with additional insights drawn from Benner's work on clinical knowledge. Findings: Three categories emerged: 1) range in clinical assessments, displaying adequate assessments and actions related to major organ systems but lacking attention towards the assessment and facilitation of movement; 2) nurses' and physiotherapists' cooperation in terms of roles and responsibilities, revealing established roles within their professions and sparse sharing of situated considerations; and 3) grounding the patient, how the nurses used a verbal and attentive approach that appeared to ground their patients in the present, potentially enhancing participation. Conclusions: Nurses were familiar with essential assessments and interventions connected to major organ systems, both independently and with physiotherapists, as well as in verbal communication. However, they were less familiar with assessing and facilitating movements, sharing professional knowledge, and using bodily communication skills. Implications: This study highlights competencies that can be further explored and developed in CCNs clinical practice and education to improve care for critically ill patients. Future research should further investigate CCNs' roles in early rehabilitation and identify independent nursing interventions, especially where resources and multidisciplinary support are limited.