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AIMS: To map the concepts of the caring life-course theory that are used in life-course approaches from different disciplines; establish whether there is a common recognition of, or language used, to describe care in those life-course approaches; and identify the role and contribution of care to the life-course literature. DESIGN: This discursive paper uses a narrative review process to explore points of convergence and divergence between life-course approaches and the caring life-course theory. METHODS: Categories for analysis were developed deductively and inductively, focusing on the constructs of fundamental care, capacity and capability, care network, care transition, care trajectory and care biography. RESULTS: We identified four disciplinary perspectives: (1) life-course sociology; (2) life-course epidemiology; (3) lifespan developmental psychology; and (4) life-course health development. While six core constructs of the caring life-course theory were described, either explicitly or implicitly, in existing life-course approaches, no single approach fully describes the role and contribution of care across the lifespan. CONCLUSION: Life-course approaches have largely neglected the contribution and role of care in informing the life-course discourse. This review highlights the significance of care beyond traditional healthcare settings and recognizes it as a fundamental human need for well-being and development, which can contribute to existing life-course literature. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE: There is a need to understand care as a complex system and embrace a whole-system, life-course approach to enable nurses and other healthcare professionals to provide high-quality, patient-centred care. IMPACT: Incorporating care within a life-course approach provides opportunities to integrate and deliver care centred around the person, their life transitions, trajectories and care networks, including informal carers and healthcare professionals. NO PATIENT OR PUBLIC CONTRIBUTION: Patients or members of the public were not involved in this study as it is a discursive paper based on the relevant literature.
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Cuidadores, Ocupações, Humanos, Cuidados Paliativos, Pessoal de SaúdeRESUMO
AIMS: To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments. DESIGN: A descriptive and comparative study, with a consecutive selection. METHODS: A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement. RESULTS: Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did. CONCLUSION: There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts. IMPACT: There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care. PATIENT CONTRIBUTION: Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment. REPORTING METHOD: This study was carried out according to the STROBE checklist.
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INTRODUCTION: Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. METHODS: We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0-100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. RESULTS: At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. CONCLUSION: Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.
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AIM(S): The aim of this research study is to collaboratively generate insights in the current institutional long-term care environment for activity and mobility of older adults, and of solutions that could be used to increase the activity and improve the mobility of the older adults. DESIGN: This research constitutes a qualitative study with a critical approach. METHODS: Data were collected using photo-elicitation in four long-term care units in Finland during the spring of 2022. Older adults participated in individual data collection sessions which combined photographing and discussion. Staff members individually took photographs and later participated in a group discussion based on the photographs. Reflexive thematic analysis was used to analyse all data together. RESULTS: Ten older adults and 12 staff members participated in the research study. Four themes were identified: (1) facilities should be designed and equipped for their users, (2) moving in the institutional environment, (3) passivity as a norm, and (4) nurses should act differently and have the resources to do so. CONCLUSION: To increase the activity and improve the mobility of older adults, improvements are needed in terms of the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Increased attention to the support of activity and mobility could benefit older adults in institutional long-term care. Physical activity promotion should be incorporated as an integral part of nursing practice. PATIENT OR PUBLIC CONTRIBUTION: Directors of units were consulted when planning the study. Older adults and nurses contributed to the data collection and interpretation of data. IMPACT: (ADDRESSING): What problem did the study address? âOlder adults have recurrently been reported as living inactive lives in institutional long-term care. âThere is evidence of the relationship between the environment and the activity and mobility of older adults, but there seems to be a research-practice gap in terms of implementing activity- and mobility-promoting environments. âOlder adults and staff members are important in developing practice and change-oriented knowledge that can be used to increase the activity and improve the mobility of older adults in institutional long-term care. What were the main findings? âVarious environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. âImprovements for the design of facilities, opportunities for freedom of movement, outdoor activity, daily life activities, exercise, nurses' role in activating older adults and resources for activity support would benefit older adults' activity and mobility. Where and on whom will the research have an impact? âIncreasing the activity of older adults requires better activity promotion and mobility support by nurses in institutional care. Sufficient education and resources should be organized for activity promotion, in addition to a care and organizational culture that values activity. âEnvironmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. âPolicymakers and care organizers should consider evidence of the harms and benefits of different institutional living environments when making decisions on organizing care. REPORTING METHOD: The study is reported using the Consolidated Criteria for Reporting Qualitative Research (COREQ).
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Assistência de Longa Duração, Instituições de Cuidados Especializados de Enfermagem, Humanos, Idoso, Exercício Físico, FinlândiaRESUMO
AIMS AND OBJECTIVES: To conduct an in-depth exploration of oral hydration care provided to people living with dementia in acute hospital wards, using a person-centred care framework. BACKGROUND: Oral hydration care is an important, yet rarely explored aspect of fundamental care for people with dementia admitted to acute hospitals. Using person-centred care as a conceptual framework we investigated how oral hydration care is delivered for people living with dementia in acute hospital wards. DESIGN: A qualitative, multiple-case study. The cases were three acute wards in one hospital. METHODS: Direct observation of care for 13 people with dementia (132 h), semistructured interviews with ward staff (n = 28), ward leaders (n = 4), organisational leaders (n = 5), people with dementia (n = 6), their relatives (n = 5), documentary analysis of clinical inpatient records (n = 26) and relevant hospital policies. Data were analysed using framework analysis. RESULTS: Four themes were identified: (1) The acute hospital: oral hydration is obscured and not prioritised (2) Overshadowing of oral hydration at ward level (3) Siloed nature of hydration roles (4) Strategies for, and barriers to, delivering person-centred oral hydration care. CONCLUSIONS: This study combines the concept of person-centred care and oral hydration care for people living with dementia admitted to acute hospital wards, demonstrating that person-centred hydration care was complex and not prioritised. RELEVANCE TO CLINICAL PRACTICE: Nurses should consider means of improving prioritisation and cohesive delivery of person-centred hydration care in acute hospital wards.
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Demência, Humanos, Idoso, Pesquisa Qualitativa, Hospitais, Hospitalização, Assistência Centrada no PacienteRESUMO
BACKGROUND: Nurse engagement, perceived need and usefulness affect healthcare technology use, acceptance and improvements in quality, safety and accessibility of healthcare. Nurses' opinions regarding continuous monitoring appear to be positive. However, facilitators and barriers were little studied. This study explored nurses' post-implementation experiences of the facilitators and barriers to continuously monitoring patients' vital signs using a wireless device on general hospital wards. METHODS: This study employed a cross-sectional survey. Vocational and registered nurses from three general wards in a Dutch tertiary university hospital participated in a survey comprising open and closed questions. The data were analysed using thematic analysis and descriptive statistics. RESULTS: Fifty-eight nurses (51.3%) completed the survey. Barriers and facilitators were identified under four key themes: (1) timely signalling and early action, (2) time savings and time consumption, (3) patient comfort and satisfaction and (4) preconditions. CONCLUSIONS: According to nurses, early detection and intervention for deteriorating patients facilitate the use and acceptance of continuously monitoring vital signs. Barriers primarily concern difficulties connecting patients correctly to the devices and system.
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Enfermeiras e Enfermeiros, Quartos de Pacientes, Humanos, Estudos Transversais, Hospitais Universitários, Sinais Vitais, Monitorização FisiológicaRESUMO
AIMS: To test a model for person-centred pain management using qualitative evidence in the literature and refine it based on the results. DESIGN: A qualitative systematic review with thematic synthesis using the Fundamentals of Care framework. METHODS AND DATA SOURCES: A literature search in February 2021 in six scientific databases: CINAHL, PsycInfo, Pubmed, Scopus, Social Science Premium Collection and Web of Science, reported using ENTREQ and PRISMA. Quality assessment was performed for the individual studies. Thematic analysis and the GRADE-CERQual approach were used in the synthesis including the assessment of confidence in the evidence. RESULTS: The model was tested against the evidence in 15 studies appraised with moderate or high quality and found represented in the literature but needed to be expanded. A refined model with a moderate/high confidence level of evidence presents elements to be used in a holistic care process; The nurse is guided to establish a trusting relationship with the patient and enable communication to identify and meet pain management needs using pharmacological and non-pharmacological management. Nurse leaders are guided to support this process by providing the right contextual conditions. CONCLUSIONS: The strengths of the confidence level in the refined model, and that it is represented from the nurse and patient perspectives in nursing research across countries and cultures, support our recommendation for empirical evaluation. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The model links the knowledge of pain management elements from individual studies together into actions to be performed in clinical practice. It also outlines the organizational support needed to make this happen. Nurses and nursing leaders are suggested to test the model to implement person-centred pain management in clinical practice. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPACT: What Problem Did the Study Address? There is a need to transfer available evidence of person-centred pain management into practice to relieve the patient from pain. What Were the Main Findings? Person-centred pain management is of high priority for patients and nurses around the world and can be performed in a holistic care process including patient-nurse trust and communication, supported by contextual conditions to deliver timely pharmacological and non-pharmacological pain management addressing the patient's physical, psychosocial and relational care needs. Where and on Whom will the Research Have an Impact? The model is to be tested and evaluated in clinical practice to guide the providers to relieve the patient from pain. REPORTING METHOD: Relevant EQUATOR guidelines were used to report the study: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
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Manejo da Dor, Cuidados Paliativos, Humanos, Relações Enfermeiro-Paciente, DorRESUMO
AIMS: To explore in-depth nurses' use and further development of assessment skills in different nursing contexts in the first 2 years after graduation, and factors that influenced their use and development of assessment skills. DESIGN: The study had explorative qualitative design. METHODS: Eight nurses who previously had been interviewed about their learning of physical assessment skills in clinical rotation as students participated in this follow-up study. Individual in-depth interviews were conducted, where the nurses spoke freely about their experiences after graduation. RESULTS: Four prominent features influencing the nurses' use and development of assessment skills were identified: (a) assessment approaches and readiness for practice, (b) the primacy of communication, (c) recognition related to performing assessments, and (d) the influence of organizational factors on their assessment applications. CONCLUSION: Newly graduated nurses' use of assessment skills is an important part of providing holistic care. This study suggest that assessment skills is not only an assessment task but is central in relationship building and in supporting the professional development of nursing competence. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution, due to study design.
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Aprendizagem, Enfermeiras e Enfermeiros, Humanos, Seguimentos, Pesquisa Qualitativa, Estudantes, Competência ClínicaRESUMO
AIMS: To evaluate the effect of video interaction guidance on improving the nurse-child relationship during the wound care procedures. Additionally, determine whether the interactional behavior of nurses is related to pain and distress experienced by children. METHODS: The interactional skills of seven nurses receiving video interaction guidance were compared with those of ten other nurses. The nurse-child interactions were video-taped during wound care procedures. Of the nurses receiving video interaction guidance, three wound dressing changes were videotaped before they received video interaction guidance and three after. The interaction between nurse and child was scored with the Nurse-child interaction taxonomy by two experienced raters. The COMFORT-B behavior scale was used to assess pain, and distress. All raters were blinded regarding video interaction guidance allocation and the sequence of tapes RESULTS: Five nurses in the intervention group (71 %) showed clinically relevant progress on the taxonomy while only four nurses (40 %) showed similar progress in the control group [p = .10]. A weak association was found between the nurses' interactions and the children's pain and distress [r = -.30, p = .002]. CONCLUSIONS: This is the first study to show that video interaction guidance can be used as a tool to train nurses to become more effective during patient encounters. Furthermore, nurses' interactional skills are positively associated with a child's pain and distress level.
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Queimaduras, Humanos, Queimaduras/terapia, Dor, Estresse PsicológicoRESUMO
BACKGROUND: International evidence suggests that clinical nurses and nursing students perceive fundamental care as not being important, not complicated and even not a nurse's responsibility, thus resulting in negative patient outcomes. AIM: To explore nurse preceptors' perceptions about the factors that influence nursing students' gaining of knowledge about fundamental care during their clinical practice at nursing home. METHODS: A qualitative descriptive study using individual interviews was conducted from September 2020 to April 2021. Nine nurse preceptors employed at five nursing homes participated. The data were analysed by employing an inductive qualitative content analysis. FINDINGS: The analysis generated one main category-'Fostering students' knowledge and understanding of fundamental care'-supported by two categories: (i) 'Nurse preceptors - enablers of nursing students' learning fundamental care' and (ii) 'Nursing home - a learning environment that facilitates students' learning about the delivery of fundamental care', which can be interpreted as the preconditions that may contribute to fostering students' knowledge and understanding of fundamental care. CONCLUSION: The study reveals that nurse preceptors' attributes, an effective preceptorship and a social learning environment can create opportunities for nursing students learning the provision of fundamental care in nursing homes. Furthermore, Vygotsky's theory of sociocultural learning may be applied when teaching in clinical nursing education.
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Bacharelado em Enfermagem, Estudantes de Enfermagem, Humanos, Bacharelado em Enfermagem/métodos, Pesquisa Qualitativa, Aprendizagem, Preceptoria, Casas de Saúde, Competência ClínicaRESUMO
AIM: To report an analysis of the concept of fundamental care in the literature. DESIGN: An evolutionary concept analysis. DATA SOURCES: PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included. METHODS: Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care. RESULTS: A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care. CONCLUSION: This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care. IMPACT: What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings.
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Enfermeiras e Enfermeiros, Cuidados de Enfermagem, Humanos, Relações Enfermeiro-Paciente, Comunicação, Qualidade da Assistência à Saúde, Formação de ConceitoRESUMO
AIM: This study aimed to analyse the study focus, thematic trends and evolution of studies on the leadership and care in nursing by using a bibliometric analysis. DESIGN: Descriptive and bibliometric analyses were employed. METHODS: The study universe included 3558 articles on the leadership and care in the Web of Science (WoS) database. The data analysis and graphical presentation were conducted using Bibliometrix Package in R software. RESULTS: Within the scope of the study, articles published by 10,255 authors in 184 different sources between 1982-2021 were reached. Five thousand eight hundred and twenty-eight author keywords were found in these studies. The most frequent author keywords included "leadership," "nursing," "nurse," "evidence-based practice," "management," "nursing leadership" and "patient safety." It was further suggested that the most frequently used trend topics in early years were "new roles," "faculty practice," "research implementation" while trend topics such as "systematic review," "older adults" and "COVID-19' have become popular in recent years. CONCLUSION: The number of studies on the leadership and care in nursing has gradually increased over the years, and this subject has already become an active field of study in nursing research. In addition, nurse-related themes such as job satisfaction, teamwork and retention have been reviewed more intensively while patient-based and fundamental care-based themes have been less studied. IMPACT: This study was the first bibliometric analysis to focus on the research focus, thematic trends and evolution of research on the leadership and care in nursing. Only a limited amount of data are available on the current knowledge structure, research focus, thematic trends and evolution of research on leadership and care in nursing. The results of this study may establish a solid ground to design further studies and provide guidance.
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COVID-19, Pesquisa em Enfermagem, Humanos, Liderança, Bibliometria, PublicaçõesRESUMO
AIMS: To explore and describe hospital nurses' perceptions of leadership behaviours in facilitating patient participation in fundamental care. DESIGN: An ethnographic interview study. METHODS: Individual semi-structured interviews with 12 nurses with a bachelor's or master's degree working at a university medical centre were conducted between February and April 2021. The interview data were analysed using thematic analysis. RESULTS: Six themes were derived from the data: (1) nursing leadership; (2) patient participation; (3) using patients' preferences; (4) building relationships; (5) task-focused nursing; (6) need for role modelling. CONCLUSION: Nurses indicated leadership behaviour to facilitate patient participation in fundamental care as inviting patients to participate and eliciting and supporting patients' preferences. Although nurses also regarded leadership as motivating colleagues to act and enhancing evidence-based practice, they appeared not to practise this themselves about patient participation. Role modelling was indicated as a need for improvement. IMPACT: The findings established that not all leadership behaviours mentioned were used in practice about patient participation in fundamental care. Role modelling and the use of evidence-based practice are needed to increase patient participation. Further research will be necessary to develop and test leadership interventions to improve patient participation in fundamental care.
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Liderança, Participação do Paciente, Humanos, Pesquisa Qualitativa, Antropologia Cultural, Preferência do PacienteRESUMO
AIMS: To explore nurse preceptors' experiences in promoting and teaching the delivery of fundamental care to nursing students during their clinical period at nursing homes. DESIGN: The study used a qualitative descriptive approach. METHODS: Nine in-depth, semistructured interviews were conducted with clinical nurses employed at five different nursing homes. Data collection lasted from September 2020 to April 2021. The interviews were recorded and transcribed verbatim. Inductive, qualitative content analysis was employed to analyse the data. RESULTS: Qualitative content analysis yielded one main category-'Fostering nursing students' knowledge and understanding of fundamental care'-supported by two subcategories: (i) 'Raising awareness of the importance of fundamental care' and 'Providing for learning through exchange and cooperation', which are interpreted as the ways nurse preceptors enable students to learn how to provide fundamental care during their clinical period at nursing homes. CONCLUSION: By taking the role of nurse preceptors, clinical nurses act as enablers for students' learning of the provision of fundamental care within nursing homes as the learning context. Nurse preceptors possess the pedagogical skills to initiate and conduct nursing students' learning processes. The study reveals that nurse preceptors stress the importance of providing fundamental care to patients; hence, teaching students to provide fundamental care was also found to be important. IMPACT: Within a nursing home context, nurses are responsible for providing fundamental care; therefore, they play an essential role in both providing and teaching about caregiving. The study shows that because of their preceptorship, nurse preceptors can enhance students' awareness of the importance of learning to provide fundamental care to patients. In addition, the study reveals that nurse preceptors work to enhance student's reflection and critical thinking by targeting the student's zone of proximal development, which represents a preliminary phase in students' learning.
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Bacharelado em Enfermagem, Estudantes de Enfermagem, Humanos, Competência Clínica, Pesquisa Qualitativa, Aprendizagem, PreceptoriaRESUMO
AIMS: This manuscript aims to describe one acute care hospital's ICU journey during the COVID-19 pandemic and how fundamental care was central to the implementation of team-based models of care. BACKGROUND: Over the course of the COVID-19 pandemic, team-based and alternative models of care are being employed to manage and address global shortages and surge capacity. Employing these alternate models of care required attention to ensure fundamental care needs of patients were being met. DESIGN/METHOD: The following paper describes an ICU's journey of focusing on the delivery of the fundamentals of care through the implementation of team-based models of care to address the surge in patient care demands experienced in response to our global pandemic. CONCLUSIONS: The implementation of an evidence-informed approach to optimizing models of care and staffing in the ICU amid the evolving COVID-19 waves in one acute-care hospital is provided. This local approach focused on meeting patients' fundamental care needs throughout the necessary introduction of team-based care models and staffing changes and drew from evolving evidence, the ILC Fundamentals of Care Framework, and regulatory guidance.
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COVID-19, Cuidados de Enfermagem, Humanos, Pandemias, COVID-19/epidemiologia, Unidades de Terapia Intensiva, Cuidados CríticosRESUMO
AIMS: This manuscript aims to provide a description of an evidence-informed Science of Care practice-based research and innovation framework that may serve as a guiding framework to generate new discoveries and knowledge around fundamental care in a more integrated manner. BACKGROUND: New ways of thinking about models of care and implementation strategies in transdisciplinary teams are required to accelerate inquiry and embed new knowledge and innovation into practice settings. A new way of thinking starts with an explicit articulation and commitment to the core business of the healthcare industry which is to provide quality fundamental care. DESIGN: This discursive paper delineates an iteratively derived Science of Care research and innovation framework (Science of Care Framework) that draws from a targeted literature review. METHOD: The Science of Care Framework integrates caring science with safety and symptom sciences with implementation, improvement, innovation and team sciences. Each science dimension is described in terms of seminal and evolving evidence and theoretical explanations, focusing on how these disciplines can support fundamental care. CONCLUSIONS: The Science of Care Framework can serve as a catalyst to guide future efforts to propel new knowledge and discoveries around fundamental care and how best to implement it into clinical practice through a transdisciplinary lens. IMPACT ON NURSING SCIENCE, PRACTICE, OR DISCIPLINARY KNOWLEDGE: The Science of Care Framework can accelerate nursing discipline-specific knowledge generation alongside inter and transdisciplinary insights. The novel articulation of the Science of Care Framework can be used to guide further inquiries that are co-designed, and led, by nurses into integrated models of care and innovations in clinical practice.
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Cuidados de Enfermagem, Humanos, Cuidados de Enfermagem/métodos, Cuidados de Enfermagem/normas, Assistência Centrada no Paciente, Enfermagem Baseada em EvidênciasRESUMO
AIMS: To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery. DESIGN: A qualitative, exploratory study using a critical realist approach. METHOD: One-to-one semi-structured interviews with 14 nursing and allied health professionals conducted between May and September 2019. RESULTS: Several tensions and contradictions were identified in the data, which demonstrated clinicians' perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians' perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians' perception that preventing readmissions is everyone's responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery. CONCLUSION: Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top-down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator-led change through relational leadership strategies. IMPACT: Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians' perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change.
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Atenção à Saúde, Readmissão do Paciente, Humanos, Hospitais, Pessoal Técnico de Saúde, Pesquisa QualitativaRESUMO
AIMS: To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care. DESIGN: A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ). METHODS: Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants. RESULTS: Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs. CONCLUSION: This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas. IMPACT: Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes.
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Enfermeiros Administradores, Humanos, Nova Zelândia, Qualidade da Assistência à Saúde, Hospitais, Dinamarca, LiderançaRESUMO
AIMS: To investigate and describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps. DESIGN: A scoping review. DATA SOURCES: CINAHL, Medline, PsycINFO and EMBASE databases were searched in April 2021 for eligible literature, published from January 2010, onwards. REVIEW METHODS: This scoping review was built around the recommendations of Peters et al. (2020 version). Two researchers conducted the literature search, and three researchers independently screened the titles and abstracts of the retrieved studies' data, using the eligibility criteria and the review questions as a guide. RESULTS: The search yielded 763 records, of which 107 were included. Results are presented under seven subheadings: (a) Countries and Continents, (b) Context, (c) Research Design, (d) Publishing/Journal, (e) Participants and Population, (f) Keywords and (g) Fundamental of Care Framework and Practice Process. All the retrieved articles describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps. CONCLUSION: This scoping review highlighted the elevated number of articles that have been published since the beginning of the work on Fundamental Care, 10 years ago. The included articles are related to different dimensions of research, practice and teaching and to the Fundamentals of Nursing Care, but also to nursing theory. Finally, most of the articles had a nursing focus. IMPACT: The results of this scoping review allow us to highlight the work from the past 10 years. This may be of interest to learn more about the research surrounding Fundamental Care. This scoping review allows us to better target the theoretical and empirical developments to focus on in the coming years.
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Cuidados de Enfermagem, Humanos, Aprendizagem, Teoria de EnfermagemRESUMO
AIM: To identify and describe nursing-sensitive indicators in Danish clinical quality databases and to examine the association between nurse representation on database steering committees and the presence of indicators related to aspects of fundamental care. DESIGN: This was a cross-sectional study. The STROBE checklist was employed to ensure reporting quality. METHODS: We reviewed data from the latest annual report of 71 clinical quality databases in April 2021. Aspects of fundamental care were defined as the 12 nursing domains defined in the Danish Minimum Nursing Data framework. For each database, we recorded the number and type of indicators and identified indicators measuring fundamental care aspects. We used the prevalence ratio to estimate the likelihood of indicators related to aspects of fundamental care in databases with nurse representation on the steering committee. RESULTS: One-third of the databases included indicators related to aspects of fundamental care. The most common aspects were Respiration and circulation, Nutrition and Psychosocial conditions, whereas Skin and mucous membranes, Elimination and Pain were rarely measured. Nurse representation on the steering committee of a quality database increased the likelihood of having indicators related to aspects of fundamental care three-fold (prevalence ratio 3.25). CONCLUSION: Fundamental care was rarely monitored in Danish clinical quality databases, but databases with nurse representation on the steering committee had a higher likelihood of monitoring fundamental care. IMPACT: This study addressed the knowledge gap of how fundamental nursing care is measured in clinical quality databases. It introduces nurses to the measurement of fundamental care as a first step toward performing nursing intervention studies and investigating associations with patient outcomes. The increased likelihood of fundamental care monitoring in clinical databases with nurse representation on the steering committee indicates a feasible way for decision makers and nurse leaders to ensure a stronger focus on fundamental care to the patients' benefit.
