Service Quality as a Mediator Between ICU Care, Shared Decision-Making and Family Loyalty: Implications for ICU Nursing Practice
DOI:
https://doi.org/10.37231/jmtp.2025.6.2.474Keywords:
ICU care, Decision-Making, Service Quality, family loyalty, SEMAbstract
Families of patients in the ICU develop high stress and many are required to make decisions regarding treatment on?behalf of incapacitated patients. The quality of ICU care and communication strongly shapes family satisfaction, which can influence loyalty to the healthcare organisations. There is little information on families' views in middle-income Asian countries; most previous studies have been conducted on either patients or in Western settings. These dynamics might have implications for ICU nurses, related to the loyalty of family members, which could influence the organisations reputation, retention capacity, and overall sustainability. Objective: This study aims to explore whether service quality mediates the relations among ICU care, shared decision-making, and family loyalty, offering guiding principles for hospital administrators to establish other effective strategies regarding intensive care unit (ICU) nurses and quality. This is a cross-sectional study of family members of ICU patients at a tertiary hospital. The instruments were scored on validated scales: the ICU Care Scale, the ICU Decision Making Scale, the SERVQUAL and family loyalty. Mediation was tested?using Structural Equation Modelling (SEM) with bootstrapping for direct and indirect effects. The quality of ICU care (? = 0.297) and decision-making (? = 0.424) have a positive impact on service quality via family loyalty (? = 0.099). ICU care (? = 0.227) and decision-making (? = 0.372) directly influence loyalty, with service quality as a partial mediator of these relationships. This research extends the evidence base for family-centred nursing by showing how ICU nursing practice translates into family loyalty in terms of perceived service quality, providing context-specific implications for ICU care in middle-income Asian healthcare.
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