The Development of Islamic Based Caring Model for Critically Ill Patients in the Intensive Care Unit Suhartini Ismail A Thesis Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing (International Program) Prince of Songkla University 2016 Copyright of Prince of Songkla University i The Development of Islamic Based Caring Model for Critically Ill Patients in the Intensive Care Unit Suhartini Ismail A Thesis Submitted in Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing (International Program) Prince of Songkla University 2016 Copyright of Prince of Songkla University ii Thesis Title The Development of Islamic Based Caring Model for Critically Ill Patients in the Intensive Care Unit Author Mrs. Suhartini Ismail Major Program Nursing (International Program) Major Advisor Examining Committee .................................................... ..............................................Chairperson (Assoc. Prof. Dr. Urai Hatthakit) (Assoc. Prof. Dr. Aranya Chaowalit) ...............................................Committee (Assoc. Prof. Dr. Praneed Songwathana) ...............................................Committee (Assoc. Prof. Dr. Kittikorn Nilmanat) ...............................................Committee (Assoc. Prof. Dr. Urai Hatthakit) ...............................................Committee (Asst. Prof. Dr. Jom Suwanno) The Graduate School, Prince of Songkla University, has approved this thesis as fulfillment of the requirements for the Doctor of Philosophy Degree in Nursing (International Program). ................................................................. (Assoc. Prof. Dr. Teerapol Srichana) Dean of Graduate School iii This is to certify that the work here submitted is the result of the candidate’s own investigations. Due acknowledgement has been made of any assistance received. .....................................Signature (Assoc. Prof. Dr. Urai Hatthakit) Major Advisor ......................................Signature (Mrs. Suhartini Ismail) Candidate iv I hereby certify that this work has not been accepted in substance for any degree, and is not being currently submitted in candidature for any degree. ....................................................Signature (Mrs. Suhartini Ismail) Candidate v Thesis Title The Development of Islamic Based Caring Model for Critically Ill Patients in the Intensive Care Unit Author Mrs. Suhartini Ismail Major Program Nursing (International Program) Academic Year 2015 ABSTRACT It is common for the nurses in ICU to deal with critical health problems and with patients at risk of dying by providing them with immediate skillful nursing care and critical care technology. There is a growing concern that holistic caring is not adequately emphasized and practiced in ICU. This study aimed to develop Islamic based caring model for critically ill patients in the Intensive Care Unit (IBC-ICU) in order to promote harmony of life. The action research approach was used to develop the model. The Islamic caring theory according to Barolia and Karmaliani’s theory was used to guide this study. There were 24 nurses as the key participants, 14 patients and their family caregivers as associate participants recruited to the study. Data were gathered using focus group discussions, interviews, field notes, observations, and questionnaires. The data were analyzed by using inductive content analysis. There were two cycles of the model development; the capability building to increase awareness, knowledge and improving the caring practice; and the strengthening caring practice for sustaining the Islamic based caring model. The IBC- ICU composed of four core values: healing presence, caring relationship, caring environment, and faith in God. These core values and the five dimensions of Islamic concepts were integrated into the caring healing process using action research approach in assisting the critically ill patients to achieve harmony of life. In enhancing harmony of critically ill patients based on IBC-ICU, the nurses were required to promptly help respond to the patients’ health care problems and needs, and maintain connectedness in four main aspects: the connection with self; others (nurses, families, and significant others); God, and environment. The findings revealed that the expected outcomes of the IBC-ICU were achieved through nurses’ caring actions incorporating power of faith in God into their practice. The IBC-ICU was beneficial not only to the patients and their families in obtaining better nursing care but also to the nurses in uplifting them as well as nursing profession as a result of satisfactory nursing practice. Implications of the study can be made to other Muslim critically ill patients in similar sociocultural context. Key words: action research; Islamic based caring model; critically ill patients; Muslim. vii CONTENTS Page ABSTRACT v ACKNOWLEDGEMENTS vi CONTENTS vii LIST OF TABLES xi LIST OF FIGURES xii CHAPTER 1 INTRODUCTION 1 Background and Significance of the Problem 1 Research Objective 7 Research Questions 7 Theoretical Framework of the Study 7 Theory of caring from an Islamic perspective 8 Methodological Framework for the Research 10 Definition of Terms 12 Significance of the Study 12 CHAPTER 2 LITERATURE REVIEW 14 Caring in Nursing Practice 15 Theories of caring 15 Comparison of caring theories 25 Integration of Islam into caring practice 29 Caring Outcomes 32 Caring outcomes; the nurses, patients, and families 32 Harmony as a caring outcome 33 Harmony in Islamic perspectives for Muslim nurses and patients in the ICU 40 Measurement of Caring Outcomes 41 Critical Care Nursing in the Intensive Care Unit (ICU) 42 viii CONTENTS (continued) Page Patient, setting, and technology in the ICU 42 Nursing standards on caring for critically ill patients in ICU 45 Critical care nurse caring behaviour for critically ill patients 47 in the ICU Family participation on caring for critically ill patients in the 48 ICU Factors influencing caring for critically ill patients 52 Critical Social Theory and Action Research 55 Critical Social Theory 55 Action research 56 Types of action research 57 The cycle of action research 60 Summary 63 CHAPTER 3 RESEARCH METHODOLOGY 64 Research Design 64 Researcher Roles 65 Research Setting 66 Participants of the Study 67 Research Instruments 67 Demographic Data Form 67 Interview guides 68 Observation guides 69 Research Process 69 Preparation phase 69 Literatures review 70 Pilot study 70 Building rapport 75 Testing data collection process 75 ix CONTENTS (continued) Page Development and implementation of the tentative caring model 75 Lesson learned from preparation phase 76 Action research phase 77 Data Collection Method 80 Data Analysis 81 Trustworthiness of the Data 83 Translation Issue 87 Ethical Consideration 88 Summary 89 CHAPTER 4 FINDINGS AND DISCUSSION 90 Demographic Characteristics of the Participants 91 The Development Process of Islamic Based Caring Model for Critically Ill Patients 93 Reconnaissance phase 93 Understanding caring situation in the ICU 94 Nursing practice for critical care in the ICU 99 Islamic based caring practice in the ICU 101 The spiral action research process for developing Islamic based caring 103 Cycle 1 capability building; increasing awareness, knowledge, and improving the caring practice 103 Cycle 2 strengthening caring practice for sustaining the Islamic based caring model 130 The final caring outcome: Harmony of critically ill patients 148 The Islamic Based Caring Model for Critically Ill Patients 152 Discussion 162 x CONTENTS (continued) CHAPTER 5 CONCLUSION AND RECOMMENDATIONS Page Conclusions 188 Implication for Nursing Profession 188 Recommendation for Further Research 190 Limitation of the Study 192 REFERENCES 194 APPENDICES A-1 Demographic data questionnaire for nurse participants 209 A-2 Demographic data questionnaire for family participants 210 A-3 Demographic data questionnaire for patient participants 211 B Interview Guide for Focus Group discussion (FGD) and In-depth Interview with Nurses 212 C Interview Guide for Focus Group discussion (FGD) and In-depth Interview with Families 213 D Interview Guide Family’s Satisfaction with Islamic Based Caring in the ICU 214 E Interview Guide Nurse’s Satisfaction with Islamic Based Caring in the ICU 215 F Observation Guide Nurse caring Behaviour 216 G Informed Consent Form 217 H Proposal Workshop on Islamic Based Caring for Critically Ill Patients 219 I Application of Islamic Caring Theory in Nursing with a 222 Patient in ICU J Learning and Translating Theory into Islamic Based Caring 225 K Letter of Research Permission 233 L Ethical Clearance Letter 234 VITAE 235 xi LIST OF TABLES Tables Page Table 2.1 The Comparison of Caring Theories 28 Table 2.2 The Empirical Outcomes of Caring and Non-Caring for Patients and Nurses 32 Table 2.3 Examples of Measurement of Caring Outcomes 42 Table 2.4 The Nurses Caring for Critically Ill Patients Based on AACN Standards of Care 46 Table 2.5 Eight Critical Care Nursing Competencies 47 Table 2.6 The 10 Most Important Nurse Caring Behaviours as Perceived By Nurses and Relatives in Critical Care Unit 48 Table 2.7 The Characteristics of Three Modes of Participatory Action Research 59 Table 4.8 Demographic Characteristics of Nurses 92 Table 4.9 Demographic Characteristics of Patients 93 Table 4.10 Caring Protocol for Critically Ill Patients 129 xii LIST OF FIGURES Figures Page Figure 1.1 Theoretical and Methodological Framework of the Study 13 Figure 2.2 Theory