Knowledge, practices, and barriers to early mobilization of critical care nurses in three hospitals in Sabah, Malaysia: A multicentre cross-sectional study

Early mobilization (EM) is increasingly recognized as an important intervention in intensive care units (ICUs) to reduce complications associated with prolonged immobilization, including ICU-acquired weakness, delayed recovery, and longer hospital stay. Despite strong evidence supporting its benefits, EM implementation remains inconsistent in practice and may be influenced by variations in nurses’ knowledge, clinical practices, and perceived barriers, particularly in resource-constrained settings. In Sabah, Malaysia, limited empirical evidence exists to systematically assess these factors across ICU settings. This paper presents a reproducible cross-sectional protocol to evaluate ICU nurses’ knowledge, practices, and perceived barriers toward early mobilization across multiple centres in Sabah. The study uses proportionate stratified sampling and a structured self-administered questionnaire adapted from validated instruments, covering sociodemographic characteristics, knowledge, practice, and perceived barriers. Knowledge will be assessed using a standardized scoring system based on Bloom’s cut-off classification and reported as percentage scores categorized into low, moderate, and high levels. Practice patterns and perceived barriers will be summarized descriptively, including the most frequently reported barriers. This protocol offers a practical and scalable approach to assess EM implementation in ICU settings and may help identify gaps that inform targeted training, protocol refinement, and future implementation strategies.