Factors Influencing Intention to Perform Patient and Family- Centered Care among Critical Care Nurses during COVID-19 Pandemic

Abstract

Patient- and family-centered care (PFCC) is a care concept that emphasizes collaboration among patients, families, and healthcare teams to maximize the benefits of care. It consists of four main concepts: 1) dignity and respect, 2) information sharing, 3)participation, and 4) collaboration. PFCC has been widely used in various patient groups, yielding favorable clinical outcomes for patients, their families, and healthcare teams. However, implementing PFCC in critically ill patients is challenging because the critical care system is designed to use various technologies as tools for treatment and monitoring. In addition, barriers to PFCC implementation in critically ill patients may come from the patients and their families, the environment in the critical care unit, and the healthcare team. Therefore, critical care nurses who provide continuous care to patients 24 hours a day play an essential role in PFCC. However, during the COVID-19 pandemic, there have been limitations in interactions and communication between patients, families,and critical care nurses, and critical care nurses have not been prepared for this situation. COVID-19 infection prevention guidelines, increased workload, fatigue, stress, and anxiety of COVID-19 infection may affect critical care nurses' intention to provide PFCC care. Understanding the factors affecting critical care nurses' intention to provide PFCC is significant. The Theory of Planned Behavior (TPB) is a widely used theory that investigate factors affecting individual behavior.According to the TPB, an individual's intention to perform a behavior is predicted by three key factors: 1) attitude toward the behavior, 2) subjective norm, and 3) perceived behavioral control.Therefore, using the TPB as a conceptual framework to study the factors affecting critical care nurses' intention to provide PFCC care during the COVID-19 pandemic will promote the understanding of critical care nurses' patient care behavior and improve the quality of care and patient safety.

This study aimed to examine the predictive factors for the intention to perform PFCC among critical care nurses during the COVID-19 pandemic, including education level, work experience in the critical care unit, attitude toward PFCC, subjective norms in PFCC, and perceived behavioral control in PFCC. This study employed a predictive correlational research design based on the conceptual frameworks of PFCC, TPB, and nurses' characteristics. The sample group consisted of 124 critical care nurses working in eight critical care units at Chulalongkorn Hospital,a facility affiliated with the Thai Red Cross Society. The sample was purposively selected to include only professional nurses with at least six months of experience working in a critical care unit. The instruments consisted of five questionnaires: 1) the Personal Data Questionnaire, 2) the Attitude toward PFCC Questionnaire, 3) the Subjective Norm in PFCC Questionnaire, 4) the Perceived Behavioral Control in PFCC Questionnaire, and 5) the Intention to Perform PFCC Questionnaire.The data were analyzed using descriptive statistics and multiple regression with the Enter method.

The results revealed that education level, work experience in the critical care unit,attitude toward PFCC, subjective norms in PFCC, and perceived behavioral control in PFCC could predict critical care nurses' intention to perform PFCC by 25% with statistical significance (F =7.849, p < .01). Perceived behavioral control in PFCC (β = .314, p = .002), subjective norms in PFCC (β = .223, p = .015), and education level (β = .175, p = .038) were significant predictors of critical care nurses' intention to perform PFCC. From the results of this study, nursing administrators should set up a PFCC training program to promote understanding and positive attitudes for critical care nurses, as well as establish a system to support communication and cooperation among patients, families, and the healthcare team, such as meeting rooms and a consultation team for patients and families.

Keywords: COVID–19 pandemic, Critical care nurses, Intention, Patient and family-centered care