Fundamental nursing care: A systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene

Abstract

Aims and objectivesTo determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs.BackgroundPatient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene.DesignSystematic review.MethodsWe searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants' nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots.ResultsWe included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene and three addressing two or more areas simultaneously (67 randomised controlled trials, 32 non‐randomised controlled trials and 50 uncontrolled trials). Studies into interventions on participant self‐management of nutrition (n = 25), oral health (n = 26), catheter care (n = 23) and self‐management of elimination (n = 21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient‐reported outcomes, such as quality of life, experience or self‐reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses and did not conform to standard reporting quality criteria.ConclusionsThe current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence‐based guidance to practising nurses.Relevance to clinical practiceResearchers in nursing internationally should now undertake a programme of work to produce evidence for clinical practice in the fundamentals of care that is reliable, replicable and robust.

The development of Nursing Quality Care Process Metrics and Indicators for use in Older Persons Care Settings: A Delphi‐Consensus Study

“…The grey and non‐grey literature successfully identified practice evidence, but there was little higher‐level research evidence supporting the identified metrics. As they were closely linked to the fundamentals of care around which there is a lack of high‐quality research evidence (Muntlin Athlin, ; Richards et al, ), this is unsurprising. Similarly, there was little patient and public evidence to further support which areas of practice might be considered relevant.…”

“…Nursing care processes in the care of older people are also thought to influence outcomes but again empirical evidence to support this is scarce (Richards, Hilli, Pentecost, Goodwin, & Frost, 2018). As there is considerable variation in the quality of nursing care processes in services for older people, stronger regulatory frameworks have been implemented (Australian Government Department of Conclusion: Developing this suite of nursing quality care process metrics and indicators for use in older persons care settings provided consensus on what nursing processes should be measured to improve the quality and safety of care delivery.…”

“…Nursing care processes in the care of older people are also thought to influence outcomes but again empirical evidence to support this is scarce (Richards, Hilli, Pentecost, Goodwin, & Frost, ). As there is considerable variation in the quality of nursing care processes in services for older people, stronger regulatory frameworks have been implemented (Australian Government Department of Health, ; Care Quality Commission, ; Health Information & Quality Authority, ).…”

Design and psychometric testing of the attitude towards the prevention of incontinence‐associated dermatitis instrument (APrIAD)

“…Skin care is part of fundamental nursing care or care meeting the basic needs of humans, such as nutrition, hydration, sleep, and dignity . However, during the last decade, several studies have determined that skin care is often the subject of missed nursing care .…”

Fundamental nursing, complex problems and the lure of the simple solution

“…Oral hydration and the complications of immobility have long been topics of interest for nursing research (e.g., Hamilton‐Smith, ; Norton, McLaren, & Exton‐Smith, ), yet their evidence base is still poor (Richards, Hilli, Pentecost, Goodwin, & Frost, ). Over four decades later, the potential for initiatives such as Team Hydr8 and EndPJParalysis to contribute to the evidence base for nursing, in the absence of systematic evaluation, critique or monitoring of their efficacy and safety, is limited, despite the evident enthusiasm, enterprise and good intentions which have driven them.…”