Factors influencing the delivery of the fundamentals of care: Perceptions of nurses, nursing leaders and healthcare consumers

Self Cite

Objective:To explore how nurses in hospitals enact person-centred fundamental care delivery.Background: Effective person-centred care is at the heart of fundamental nursing care, but it is deemed to be challenging in acute health care as there is a strong biomedical focus and most nurses are not trained in person-centred fundamental care delivery. We therefore need to know if and how nurses currently incorporate a person-centred approach during fundamental care.Design: Focused ethnography approach.Methods: Observations of 30 nurses on three different wards in two Dutch hospitals during their morning shift. Data were collected through passive observations and analysed using framework analysis based on the fundamentals of care framework.The COREQ guideline was used for reporting.Results: Some nurses successfully integrate physical, psychosocial and relational elements of care in patient interactions. However, most nurses were observed to be mainly focused on physical care and did not take the time at their patients' bedside to care for their psychosocial and relational needs. Many had a task-focused way of working and communicating, seldom incorporating patients' needs and experiences or discussing care planning, and often disturbing each other. Conclusions:This study demonstrates that although some nurses manage to do so, person-centred fundamental care delivery remains a challenge in hospitals, as most nurses have a task-focused approach and therefore do not manage to integrate the physical, relational and physical elements of care. For further improvement, attention needs to be paid to integrated fundamental care and clinical reasoning skills.Relevance to clinical practice: Although most nurses have a compassionate approach, this study shows that nurses do not incorporate psychosocial care or encourage patient participation when helping patients with their physical fundamental care needs, even though there seems to be sufficient opportunity for them to do so.

Section: Discussionmentioning

confidence: 99%

Exploring person‐centred fundamental nursing care in hospital wards: A multi‐site ethnography

Belle¹,

Giesen²,

Conroy

et al. 2019

Self Cite

“…Culture has many manifestations. According to Conroy (2018), nurse leaders recognise how hospital culture carries implied relationships of trust of the healthcare professional. They warn how hospital patients are reticent to speak out because of the unquestioned trust in the nurse–patient relationship.…”

Section: Building Trusting Relationshipsmentioning

confidence: 99%

“…How fundamental care is “done” is being measured (Parr, Bell, & Koziol‐McLain, 2018) in two district health boards (DHBs), and there is a growing emphasis on patient stories and experience measures to help organisations “own” the care that is delivered. Researchers across Australia and New Zealand are actively researching the fundamentals of care and have published their findings (Conroy, 2018; Feo, Frensham, Conroy, & Kitson, 2019; Kitson, 2018; Minton, Batten, & Huntington, 2018). However, questions remain about why the fundamentals of care are still not delivered in a safe, consistent manner.…”

Section: Introductionmentioning

confidence: 99%

The culture conversation: Report from the 2nd Australasian ILC meeting—Auckland 2019

Aspinall

Parr

Slark

et al. 2020

Aim and objective: This paper reports on the proceedings of the second AustralasianInternational Learning Collaborative conference and summit.Background: In December 2019, over a hundred people attended the second Australasian International Learning Collaborative Conference and Summit. This was the first to be held in Aotearoa New Zealand, the land where cultural safety was developed, its origins being in nursing education. Perhaps not surprisingly, culture, cultural safety and the context of care featured highly in the presentations and workshops.Design and methods: Discussion paper. Results:A key outcome of the conference proceedings and workshops was the call for nurses and the International Learning Collaborative to work in partnership with indigenous groups to iterate the importance of the Fundamentals of Care framework and evaluate the impact of that on health equity. Other essential messages were to value establishing relationships, to continue to talk about the fundamentals of care, to research and to own them. Nurses were reminded to use their humanity to create a climate and culture in which patients and staff feel valued, safe and trusted. Conclusions: Future iterations of the Fundamentals of Care framework must incorporate indigenous worldviews, which emphasise the importance of relationships, family and spirituality on wellbeing. Such additions will provide an opportunity for the International Learning Collaborative to optimally respond and direct nursing practice. Relevance to clinical practice: International Learning Collaborative members and conference attendees learned, listened and worked on meeting the challenges of consistently implementing and applying the fundamentals of care in practice and its importance to education, research and policy. The takeaway message is, when this does not happen, nurses must speak up. K E Y W O R D S cultural issues, fundamental care, holistic care, indigenous health, inequalities in health, models of care, nurse-patient relationship, spirituality

“…This discursive paper is based on the FOC framework literature (Feo, Conroy, et al, ; Kitson, ; Kitson, Conroy, et al, ) and on the proposed FOC‐PP (Feo, Conroy, Alderman, et al, ). Several articles on the FOC framework have used clinical scenarios to illustrate the framework (Conroy, ; Feo, Conroy, Alderman, et al, ; Feo, Rasmussen, et al, ; Kitson, ). This article presents a clinical scenario that develops through the five stages of the FOC‐PP.…”

Section: Designmentioning

confidence: 99%

Finding the fundamental needs behind resistance to care: Using the Fundamentals of Care Practice Process

Rey

Voyer

Bouchard

et al. 2019

A person living with Alzheimer's disease (PA) can experience difficulty during bodily care and therefore may show resistance to care behaviours (RTCBs). Nurses must take a clinical approach to planning care that meets the person's needs. Therefore, it is necessary to identify training strategies for bedside nurses and nursing students. Aims and objectives: To describe and discuss how the FOC practice process (FOC-PP) can help nurses understand PAs who show RTCBs during bodily care. Background: Resistance to care behaviour phenomenon and the importance of bodily care as fundamental care are described. The FOC-PP enables nurses to apply the FOC framework in their practice. Design: This discursive paper is based on the literature of the FOC framework and PP. Method: A clinical scenario that develops through the five stages of the FOC-PP. Results: The scenario centres on Mrs. Emily Morgan, 81, who lives in a nursing home and is not receiving the bodily care that she needs. Camille, a nursing student, and her supervisor Florence collaborate with Mrs. Morgan's family to improve the quality of her care. Three particular aspects of nursing practice based on the FOC-PP are described: the critical thinking process, relational process and pedagogical process. Conclusion: The FOC-PP promotes holistic care centred on the person and his or her needs and encourages the nurse to use his or her skills and knowledge. All these dimensions are fundamental for high-quality nursing care. Relevance to clinical practice: Mrs. Morgan's scenario enables us to perceive that the FOC-PP is very useful for nursing students and bedside nurses. However, given the amount of specific and diverse knowledge required by the FOC-PP, it is necessary to identify avenues for teaching them. Using clinical scenarios could facilitate the integration of the FOC-PP, with taking into account the specific characteristics of individual clients. K E Y W O R D S Fundamentals of Care Practice Process, needs, nursing, resistance to care | 1775 REY Et al.