Barriers and facilitators to including family members in early mobilisation of critically ill adults: An integrative review

BACKGROUND: Family engagement in critical care settings can enhance healthcare outcomes and patient care satisfaction in the intensive care unit. However, there is limited evidence regarding the barriers to and facilitators of engaging families in direct care, notably early mobilisation. OBJECTIVES: To synthesise evidence on barriers and facilitators to including family members in early mobilisation of adult patients in intensive care units. METHODS: Integrative review using Whittemore and Knafl's five-stage framework. A systematic search (January 2015-March 2025) across CINAHL, MEDLINE, ProQuest, ProQuest Dissertations and Theses, and Scopus databases of English-language primary studies examining family participation in early mobilisation of adult patients in intensive care units. Studies were critically appraised using Joanna Briggs Institute tools, and data were extracted and thematically synthesised. RESULTS: Ten studies ranging from moderate to high quality were included in the final review. Thematic synthesis produced four themes affecting family engagement: patient vulnerability and readiness for shared movement (clinical condition); family confidence and relationships (readiness, knowledge, emotional state); clinician gatekeeping and guidance (workload, confidence, communication); and organisational culture and systems (protocols, visitation policies, resources). CONCLUSIONS: Family engagement in early mobilisation is influenced by barriers and facilitators at multiple levels, including patient, family, clinician, and organisational levels. Multi-level approaches combining structured education, clinician training, and supportive policies are essential to enable safe and sustainable participation. IMPLICATIONS FOR CLINICAL PRACTICE: A practical first step in promoting family engagement in early mobilisation is to clarify families' roles within the intensive care team. Providing families with clear information, education, and guidance would reduce uncertainty and support safe participation in mobilisation activities. Organisational policies and structured programs that enable clinician-led invitation, supervision, and communication are also important in facilitating consistent and appropriate family engagement. Attention to patient readiness, family confidence, and contextual constraints is essential when including families in early mobilisation practices.