Factors Predicting Nurses’ Intention to Practice Patient and Family-Centered Care in Medical and Surgical Wards

Abstract

The healthcare system has established clear operational standards to ensure patients receive safe and high-quality care. The Healthcare Accreditation Institute has defined standards that emphasize patient and family participation to enhance healthcare quality and safety. This approach aligns with the concept of patient and family-centered care,a care model that promotes collaboration among patients,families,and healthcare teams under the principle of mutually beneficial partnerships.Patient and family-centered care has been developed from the concepts of patient-centered care and family-centered care. The patient and family-centered care concept consists of four core principles:1)dignity and respect, 2)information sharing, 3)participation,and 4)collaboration. The literature review reveals that patient and family-centered care leads to positive service outcomes by increasing patients’self-management skills, shortening hospital stays,reducing readmission rates,and improving quality of life. Furthermore,  families experience diminished anxiety and improved relationships with the healthcare team, while the healthcare team reports increased satisfaction and confidence in their work. Thus,patient and family-centered care promotes family participation and effective coordination between the healthcare team, patients, and families. However, implementing patient and family-centered care in healthcare services is not easy.Professional nurses, who are the primary healthcare team working closely with patients 24 hours a day, often face multiple barriers. These include organizational factors, such as overly strict visiting policies and limited space for families. More importantly,human resource issues such as nursing shortages,high workloads,and operating under time constraints cause nurses to focus primarily on medical orders to address patients’ physical problems.Consequently ,prioritizing and meeting psychosocial needs and communicating with patients and families are assigned to be a lower priority.

When considering nursing care behaviors through the Theory of Planned Behavior(TPB), whether patient and family-centered care behaviors occur depends not only on time and nursing skills but also,significantly on the nurse’sintention.According to the TPB,a nurse’sintention to provide patient and family-centered care depends on three factors: 1)attitude toward the behavior,arising from the evaluation of whether patient and family-centered care will result in good outcomes for the patient; 2) subjective norm, which are social pressure from influential people affecting the nurse’smotivation for patient and family-centered care,such as physicians,ward heads,the healthcare team, patients,and families;and 3)perceived behavioral control, which is the assessment of nurses’ own ability to provide patient and family-centered care and manage problems and obstacles arising in patient and family-centered care.From the current situation, it is found that most patients admitted to medical and surgical wards have severe illnesses and constantly changing symptoms. Nurses must monitor and manage patients’conditions when they deteriorate ,which is a heavy and urgent workload that may compromise patient and family-centered care. Therefore, studying the factors influencing nurses’ intentions to practice patient and family-centered care in general medical and surgical wards based on the TPB will identify the determinants of these intentions. This will lead to the establishment of guidelines for promoting patient and family-centered care practices that are appropriate for the specific context of the clinical units.

This study examined the predictive power of variables related to patient- and family-centered care (i.e.,attitude,subjective norm,and perceived behavioral control)on registered nurses’intention to practice patient and family-centered care in medical and surgical wards. A predictive,descriptive research design was used, guided by the patient and family-centered care concept and the TPB. The study sample included 185 registered nurses in 14 medical and surgical inpatient units at Ramathibodi Hospital.Participants were selected through purposive sampling based on the criterion of being professional-level nurses with at least one year of experience in their respective units. Data were collected using a five-section questionnaire comprising 1) demographic data, 2) attitudes toward patient and family-centered care practice, 3)subjective norm in patient and family-centered care practice, 4) perceived behavioral control in patient and family-centered care practice, and 5)intention to practice patient and family-centered care.Descriptive statistics and hierarchical multiple regression analysis were employed for data analysis.

The results revealed that attitudes toward patient and family-centered care practice,subjective norm in patient and family-centered care practice, and perceived behavioral control in patient and family-centered care practice collectively predicted the intention to practice patient and family-centered care at a statistically significant level, explaining 70% of the variance (R² = .70,p < .001). Among the predictors, subjective norm (b = .45, p < .001) and perceived behavioral control (b = .78, p < .001) were statistically significant, while attitudes were not (b = –.02, p = .759). Perceived behavioral control strongly influenced intention to practice patient and family-centered care(β = .69,p<.001), followed by subjective norm(β = .25,p<.001). These findings suggest that nursing administrators can use this evidence as a foundation to promote patient and family-centered care practices by enhancing nurses’ perceived behavioral control and reinforcing supportive subjective norm. Doing so may increase patient and family engagement, improve care quality, and lead to better health outcomes.

Keywords: Intention to practice, Medical and surgical wards,Patient and family-centered care,Perceived behavioral control,Subjective norm

Author Contributions:
SR: Conceptualization,Method and design, Tool development, Tool validation,Data collection,Data analysis, Wrote manuscript, Revised manuscript
SD: Conceptualization, Method and design, Supervision, Analysis and interpretation of data,Manuscript editing and revising, Corresponding with editor-in-chief
NP: Conceptualization, Method and design, Analysis and interpretation of data, Manuscript revising