Factors that Influence Intrinsic Motivation on Program Completion for Rehabilitative Patients: An Integrative Review of Literature Authors: Akif Khan and Zareen Khan Advisor: Dr. Elizabeth Florez, Nursing PhD, RN Background Rehabilitation is defined as a procedural process in which an individual aims to regain, in part or full, their independence that was once impaired by illness or injury. (Newton, 2012). Studies have strongly indicated that rehabilitation is driven by internal factors such as motivation (Russell & Bray, 2010). Motivation is an aspect of many behavioral theories and is understood to be an integral part of rehabilitation (Moody, Hale & Waters, 2012; Russell & Bray, 2010; Tatla, Sauve, Virji-Babul, Holsti, Butler & Van Der Loos, 2013). Intrinsic motivation, as defined by Deci and Ryan (1985), is a learned behavioral trait that is driven by an internal force and produces a rewarding outcome. Deci and Ryan (1985) articulate that intrinsic motivation has greater outcomes for self-serving purposes and can be fostered, if the ideal environment is created. Results A focus on healthcare disciplines and their application of intrinsic motivation to encourage rehabilitation program adherence and completion yielded three common contributing factors: autonomy, competence and relatedness. Discussion Factor 1 – Autonomy Autonomy support refers to the relationship between two individuals in which an expert party aids the client party in self-identification and growth towards an improved behavioral goal (Russell & Bray, 2010). Factor 2 – Competence Competence is defined as the need to be an effective within an environmental setting or the desire to master environmental factors (Deci 1975; Tatla, Sauve, Virji-Babul, Holsti, Butler & Van Der Loos, 2013). Factor 3 – Relatedness Relatedness was formed when participants with similar diagnoses were working closely together during their rehabilitation phase (Blonski, Covert, Gauthier, Monas, Murray, O'Brien & Huijbregts, 2014). Nursing Implication The nursing profession is consider to be advocates and models of autonomous support; through careful application of motivational interviewing, autonomy support can be cultivated and nurtured for the benefit of the client’s intrinsic motivation. Nurses who provided immediate feedback to clients helped them achieve competence by influencing goal perception. Thus, it would be greatly beneficial to include intrinsic motivational factors in the nursing curriculum, ultimately equipping nurses to aid clients in reaching their goals. Conclusion The literature review was successful in determining that specific factors had a greater influence on intrinsic motivation among rehabilitative patients. Clinicians that utilized autonomy support, competence, and relatedness to provide an environment in which intrinsic motivation was positively induced and lead to greater opportunities of self-growth and functional independence. Ultimately, nurses will be able to assess the effects of intrinsic motivation, and eventually provide their patients with proper resources and inspiration for rehabilitation program adherence and completion. References Blonski, D. C., Covert, M., Gauthier, R., Monas, A., Murray, D., O'Brien, K. K., & ... Huijbregts, M. (2014). Barriers to and Facilitators of Access and Participation in Community-Based Exercise Programmes from the Perspective of Adults with Post-stroke Aphasia. Physiotherapy Canada, 66(4), 367-375. doi:10.3138/ptc.2013-70 Deci, E. & Ryan, R. (1985). Intrinsic motivation and self-determination in human behavior. New York: Plenum Press. Moody, J., Hale, L., & Waters, D. (2012). Perceptions of a water-based exercise programme to improve physical function and falls risk in older adults with lower extremity osteoarthritis: barriers, motivators and sustainability. New Zealand Journal Of Physiotherapy, 40(2), 64-70 7p. Newton, C. (2012). Personalising reablement: inserting the missing link. Working With Older People: Community Care Policy & Practice, 16(3), 117-121 5p. doi:10.1108/13663661211260934 Russell, K., & Bray, S. (2010). Promoting self-determined motivation for exercise in cardiac rehabilitation: the role of autonomy support. Rehabilitation Psychology, 55(1), 74-80 7p. doi:10.1037/a0018416 Souza, Marcela Tavares de, Silva, Michelly Dias da, & Carvalho, Rachel de. (2010). Integrative review: what is it? How to do it?. Einstein (São Paulo), 8(1), 102-106. https://dx.doi.org/10.1590/S1679-45082010RW1134 Tatla, S. K., Sauve, K., Virji-Babul, N., Holsti, L., Butler, C., & Van Der Loos, H. M. (2013). Evidence for outcomes of motivational rehabilitation interventions for children and adolescents with cerebral palsy: an American Academy for Cerebral Palsy and Developmental Medicine systematic review. Developmental Medicine & Child Neurology, 55(7), 593-601 9p. doi:10.1111/dmcn.12147 Whittemore, R. and Knafl, K. (2005). The Integrative Review: Updated Methodology. Journal of Advanced Nursing, 52(5), 546-553. Population Autonomy Competence Relatedness 10 post stroke aphasic patients in an outpatient support group X 146 cardiac rehabilitation patients with documented poor motivation. 10 Spinal Cord injury patients; age and diagnosis severity was not specified. Selected sample from a psychiatric clinic in New York City. 15 bipolar disorder patients with medication adherence less than 80%, and demonstration of cognitive understanding. 160 patients with chronic non-specific musculoskeletal pain in an outpatient cognitive behavioral pain rehabilitation program. 17 participants with an average age of 78 years in water aerobics class for improved mobility . Older adult population surveyed for reablement rehabilitation over 15 years in Australia, Canada, northern and southern Europe, New Zealand, United Kingdom and United States of America. Male cardiac patients, median age of 65, in an outpatient rehabilitation clinic. 259 patients requiring specialized brain or spinal injury rehabilitation. Purpose The aim of this integrative literature review was to identify which intrinsic motivational factors influence the completion of rehabilitation programs among rehabilitative patients. Methods Research Design An integrative literature was selected to examine the influencing factors of intrinsic motivation allowing the synthesis of knowledge through a wide-range of studies for greater understanding of a problematic concern (Souza, 2010). Search Methods Articles that were used were in English, and published within the last ten years, with the exception of defining intrinsic motivation and the hallmark study that analyzed the relationship between rehabilitation and overall healthcare cost. The search strategies that were used were yielded from: Cumulative Index of Nursing and Allied Health (CINAHL) Complete and PubMed. Keywords included: “intrinsic motivation”, “motivation”, “rehabilitation” and “quality of life”. Data Synthesis and Analysis Eleven articles were selected after detailed inclusion and exclusion criterion were met. The articles were categorized into a rigor and relevance point scale (Whittemore & Knafl, 2005). Articles were separated into categories of intrinsic motivation, successful rehabilitation program completion and a combination of factors influencing rehabilitative patients. Trends and factors were further analyzed, which allowed specific characteristics of intrinsic motivation to be identified.