Introduction

Insufficient physical activity in ICU patients leads to muscle weakness, delirium, and prolonged mechanical ventilation, and these complications persist years after ICU discharge [1]. Multidisciplinary early activities [2–3]within 72 hours of ICU admission [4–5], the early mobility team, composed of doctors, ICU nurses, and rehabilitation therapists, worked together to formulate a systematic and personalized early mobility plan for patients and implement it. At the same time, the plan was discussed and adjusted by multidisciplinary teams. Studies have confirmed that the effect of multidisciplinary early mobilization is superior to that of routine early mobilization groups [6], and the success of multidisciplinary early mobilization depends on effective teamwork [7]. However, affected by many factors, early ambulation teams often face the problem of poor collaboration, which directly affects the development of early ambulation of patients [8]. Effective implementation of early ambulation in ICU patients should increase the dose of rehabilitation therapy and consider the necessary teamwork and cultural intervention [9].

According to Mukpradab [10], structured teams for early activity in ICU patients most often included nurses (97.3%), physiotherapists (86.5%), doctors (75.7%), respiratory therapists (48.6%), occupational therapists (35.1%), pharmacists (21.6%), technicians (8.3%), nursing assistants (8.3%), and senior practice staff (8.3%). However, staffing structures do not facilitate early activity work, and collaborative staffing programs may be more helpful. Team strategies facilitate the implementation of early mobilization, such as defining team composition and disciplinary roles [11], providing education, reminders, audits, feedback strategies [12], adequate calming assessments and delirium management [13], etc. In practice, the implementation of multidisciplinary early activities was also challenged by the absence of clear team responsibilities and leaders, low levels of staff knowledge and practical skills, negative staff attitudes, high staff workloads, and poor communication [14–16]. Specifically, the optimal team composition, disciplinary roles, and responsibilities included in this approach are unclear and require extensive experimental research to explore and validate [17].

In the previous study [18], our research team used a multi-center cross-sectional survey to understand the implementation situation of multidisciplinary early activities in ICUs across China and analyze the influencing factors. It is found that most of the multidisciplinary teams cooperation in ICU early mobility in China faces the problems of lack of standardized programs, unclear division of responsibilities, and unclear multi-professional and multidisciplinary team. However, the specific processes undertaken remain unclear, including the perspectives of multidisciplinary team members and the challenges encountered during implementation. Quantitative research has limitations in understanding the deep motivations of healthcare workers, decision-making processes, and the complex ethical and sociocultural barriers that may be encountered in team collaboration. Therefore, it is necessary to conduct qualitative research to explore the experiences, perspectives, and challenges of multidisciplinary team members in early mobility practice through in-depth interviews, so as to more fully understand the complex factors affecting early mobility implementation and provide more targeted recommendations for future interventions.

Methods

Results

22 medical and technical personnel participated in the interview, including nine doctors, ten nurses, and three rehabilitation therapists(N1-N22). The mean age was 37.41(SD = 6.50), and the mean work experience was 13.18(SD = 7.27). (Table 1)

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Table 1. General Information Of Interviewees (N = 22).

https://doi.org/10.1371/journal.pone.0330516.t001

Three themes and six subthemes emerged from the analysis (Table 2). The themes and subthemes are presented below with illustrative quotes.

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Table 2. Themes And Subthemes.

https://doi.org/10.1371/journal.pone.0330516.t002

Discussion

At present, the early activities of multidisciplinary collaboration in China are still in the exploratory stage, and there are still many obstacles in the promotion and practice of early activities, including the relative shortage of human resources, lack of team cooperation experience, and other problems [8]. If we blindly build an early activities team without knowing how to collaborate, it will increase team members’ workload and hinder early activities implementation [21]. Therefore, early activities can be genuinely promoted only by clarifying the actual feelings of team members in the early activity collaboration, strengthening team building from multiple dimensions, and constructing and improving the collaboration plan.

1. (1) Improve the teamwork concept of team members

The safety of early mobilization has been demonstrated in different stages of the disease in ICU patients [22–24]. Due to the complexity of the disease and the fact that early mobilization involves interdisciplinary fields such as critical care medicine, nursing, and rehabilitation medicine, there are many problems in the intervention process. Multidisciplinary team cooperation can enable patients to obtain comprehensive, timely, and effective treatment, care, and rehabilitation and ensure the implementation of early mobilization [25]. The study found that without multidisciplinary collaboration, nurses would be able to provide in-bed or bedside activities to only 21% of ICU patients [26]. Therefore, from the individual level, medical staff at all levels should realize that multidisciplinary collaboration to carry out early activities is necessary to promote the rehabilitation of ICU patients.

From the management level, an important method to improve the concept of early activities of medical staff is to carry out ICU culture construction. Many studies have shown that culture and concept are important factors affecting the development of early activities in ICU patients. However, the construction of culture and concept is often difficult to implement and evaluate the effect [26]. At present, there are many scientific models for the cultural construction of medical personnel [27] and assessment tools for team collaboration [28], and the effectiveness of enhancing cultural awareness, knowledge, and skills of medical staff and promoting positive behavior change has been confirmed [29]. Only by improving internal ideas, carrying out cultural construction from a scientific perspective, and changing from “passive” to “active” can we truly benefit the development of early activities.

1. (2) Strengthen the team building of early activities

1. 1) Poor team structure

A clear team structure and a clear division of responsibilities are prerequisites for good teamwork. Doherty [30] found that the unclear division of labor and poor communication among multidisciplinary team members were essential factors that made it challenging to implement the early activities of patients. The responsibilities of multidisciplinary team members in patients’ early activities included pre-activity assessment, activity preparation, activity process implementation and monitoring, team members’ discussion of activity obstacles, activity plan and goal formulation, and activity level and adverse events recording.

Nurses carried out the whole early ambulation assessment, planning, and implementation process [31,32]. Doctors assisted with the assessment process, and rehabilitation therapists were responsible for nurse training and guidance on key points of activities. For the multidisciplinary early mobility team, the division of labor was as follows: the ICU director was responsible for supervising the study implementation; The ICU head nurse was responsible for contacting team members and coordinating teamwork. ICU doctors were responsible for patient evaluation and rehabilitation doctor's advice. The respiratory therapists were responsible for artificial airway management, mechanical ventilation parameter adjustment, and weaning. Rehabilitation therapists and early activity full-time nurses were responsible for evaluating the rehabilitation effect on patients and completing rehabilitation training [33]. This study found that most of the respondents’ multidisciplinary early mobility teams had no clear division of labor. The reasons were as follows: ① Activities were not planned: There was no systematic activity plan, so the activities of patients were limited. Most of them stayed in bed or bedside for primary activities, and the requirements for human resources and professional members of the activity team were not high; ② Insufficient number of rehabilitation therapists: In order to save the time of patients’ lagging activities caused by waiting for the intervention of rehabilitation therapists, the work of rehabilitation therapists was partially replaced, and the professional boundaries of early mobility were gradually blurred. However, its implementation effect needs to be further investigated. ③Empiricism: The implementation process of early activities tended to be random, not based on standardized procedures, without scientific evaluation tools and implementation plans, unwilling to take risks and responsibilities, and seeking stability, which made high-level activities impossible or unfamiliar with the indications. The early activity of ICU patients is a continuous and teamwork process, and a clear division of labor guarantees safe and efficient implementation. It is impossible to carry out early activities in a standardized and continuous manner if the team members’ responsibilities, risks, and powers are unclear.

1. 2) Adopt practical training and practice modes

A survey of 528 ICU medical staff found no significant difference in the cognition of ICU doctors, nurses, and respiratory therapists on the theory of early mobility in the ICU. However, only 55.9% of the medical staff participated in implementing early mobility [34]. This result reflects that they received the training of relevant theoretical knowledge and did not really “get moving.” Compared with the traditional training mode of “theory teaching + assessment,” the scientific team situational awareness education program was applied [35] or used multimedia and carried out workshops [36]. Learning and practicing in scenario simulation can better stimulate team members’ interest. In addition, multi-mode education that promotes information sharing among team members by holding meetings, lectures, or internal team discussions is a critical way to improve their knowledge reserve and practice. Practical training focuses on changing inefficient teaching methods rather than the task itself.

1. 3) Set up an appropriate incentive mechanism

After the knowledge and concept of medical staff carrying out early activities for ICU patients have been improved, there is still a problem of insufficient action [37], partly due to the lack of a long-term incentive mechanism. Studies have shown that appropriate reward mechanisms (e.g., including the number of early activities performed in individual evaluation/performance evaluation indicators, giving appropriate team rewards, etc.) are as important as receiving relevant knowledge and skills training and reasonable allocation of human resources [35]. In addition, the lack of self-value in the team is also the internal cause of adverse actions [38]. At present, the role of essential members is weakened in implementing early mobilization in ICUs in China. Hence, the professionalism and effectiveness of early mobilization still need to be further verified [32]. Cultivating early activity specialized MDT teams with a clear division of labor can not only solve the problem of human resources shortages but also reflect the professional level of the team in the implementation process. Members can give professional opinions on the early activities and find their value while ensuring the implementation of the early activities.

1. (3) Build a team collaboration model

In the patient safety goals of the Chinese Hospital Association released in 2019, strengthening effective communication between medical staff was included as one of the top ten patient safety goals. In clinical practice, the team members’ unclear responsibilities and division of labor, the imperfect team operation mode, and the management mechanism led to a lack of communication among multidisciplinary members. Inevitable conflicts in rehabilitation, treatment, and nursing work processes become important factors affecting the effective implementation of early mobilization [17].

This study identifies critical gaps in ICU multidisciplinary collaboration—including unclear division of labor, poor communication, and ad hoc workflows—that directly hinder early mobilization efforts. These systemic flaws mirror catastrophic failures observed in surgical settings, where teamwork breakdowns result in preventable harm [39]. The parallels underscore a universal truth: patient safety across specialties depends on structured roles, verifiable accountability, and standardized protocols. To mitigate risks and optimize outcomes, ICU teams must adopt rigorous collaboration models, integrating surgical-style checklists, continuous training, and non-punitive reporting mechanisms. Only by institutionalizing these practices can we bridge the gap between theory and action, ensuring that early mobilization—like surgical safety—becomes an uncompromising standard of care.

Conclusion

In this research, 22 members of the ICU multidisciplinary early mobility team were interviewed to learn about their feelings regarding cooperation and the challenges they faced when carrying out early mobility. It was found that there were problems such as a weak sense of teamwork, incomplete team building, and an imperfect team management mechanism. In the future, we can adjust the management concept (regarding resources, performance support, etc.), enhance the role of the multidisciplinary team, establish a team structure based on the cooperation requirements of medical staff, formulate continuous incentives or improvement measures, and optimize the team cooperation mode of ICU patients’ early activities so as to improve the efficiency of team cooperation and facilitate the implementation of early activities.

Supporting information

Acknowledgments

Thank you to all the interviewees and authors who participated in this study.