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Edfeldt K, Jangland E, Larsson Ingwall L, Wistedt SM, Gunnarsson AK, Fröjd C. Oral health and oral care in patients in a surgical context: A quantitative study comparing patients' and nurses' assessments. J Clin Nurs 2024; 33:2201-2208. [PMID: 38093514 DOI: 10.1111/jocn.16961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024]
Abstract
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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Affiliation(s)
- Katarina Edfeldt
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Linn Larsson Ingwall
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Sandra-Marie Wistedt
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
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Giesen J, Timmerman I, Bakker-Jacobs A, Berings M, Huisman-de Waal G, Van Vught A, Vermeulen H. What can nurses learn from patient's needs and wishes when developing an evidence-based quality improvement learning culture? A qualitative study. Scand J Caring Sci 2024. [PMID: 38525853 DOI: 10.1111/scs.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/02/2024] [Accepted: 02/24/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Patient participation is fundamental in nursing care and has yielded benefits for patient outcomes. However, despite their compassionate care approach, nurses do not always incorporate patients' needs and wish into evidence-based practice, quality improvement or learning activities. Therefore, a shift to continuous quality improvement based on evidence-based practice is necessary to enhance the quality of care. The patient's opinion is an essential part of this process. To establish a more sustainable learning culture for evidence-based quality improvement, it is crucial that nurses learn alongside their patients. However, to promote this, nurses require a deeper understanding of patients' care preferences. OBJECTIVE To explore patients' needs and wishes towards being involved in care processes that nurses can use in developing an evidence-based quality improvement learning culture. METHODS A qualitative study was conducted in two hospital departments and one community care team. In total, 18 patients were purposefully selected for individual semi-structured interviews with an average of 15 min. A framework analysis based on the fundamental of care framework was utilised to analyse the data deductively. In addition, inductive codes were added to patients' experiences beyond the framework. For reporting this study, the SRQR guideline was used. RESULTS Participants needed a compassionate nurse who established and sustained a trusting relationship. They wanted nurses to be present and actively involved during the care delivery. Shared decision-making improved when nurses offered fair, clear and tailored information. Mistrust or a disrupted nurse-patient relationship was found to be time-consuming and challenging to restore. CONCLUSIONS Results confirmed the importance of a durable nurse-patient relationship and showed the consequences of nurses' communication on shared decision-making. Insights into patients' care preferences are essential to stimulate the development of an evidence-based quality improvement learning culture within nursing teams and for successful implementation processes.
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Affiliation(s)
- Jeltje Giesen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse Timmerman
- Psychiatry Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annick Bakker-Jacobs
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjolein Berings
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Surgical Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anneke Van Vught
- Department on Health and Vitality, HAN University of Applied Sciences, School of Allied Health, Nijmegen, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Department on Health and Vitality, HAN University of Applied Sciences, School of Allied Health, Nijmegen, The Netherlands
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Lawless MT, Tieu M, Golley R, Kitson A. How and where does "care" fit within seminal life-course approaches? A narrative review and critical analysis. J Adv Nurs 2024; 80:871-883. [PMID: 37684708 DOI: 10.1111/jan.15852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
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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Affiliation(s)
- Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
- College of Humanities, Arts and Social Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Rebecca Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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Kitson A, Carr D, Feo R, Conroy T, Jeffs L. The ILC Maine statement: Time for the fundamental care [r]evolution. J Adv Nurs 2024. [PMID: 38379317 DOI: 10.1111/jan.16108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
AIM The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice. DESIGN Position paper. METHODS This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice. RESULTS The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership. CONCLUSION The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems. IMPACT Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally. PATIENT OR PUBLIC CONTRIBUTION Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.
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Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Devin Carr
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Maine Medical Center, Portland, Maine, USA
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- The International Learning Collaborative, Adelaide, South Australia, Australia
| | - Lianne Jeffs
- The International Learning Collaborative, Adelaide, South Australia, Australia
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
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Narsakka N, Suhonen R, Groot B, Stolt M. Promoting activity and mobility in long-term care environments: A photo-elicitation study with older adults and nurses. J Clin Nurs 2023; 32:8078-8094. [PMID: 37698144 DOI: 10.1111/jocn.16866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
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? ○Older adults have recurrently been reported as living inactive lives in institutional long-term care. ○There 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. ○Older 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? ○Various environmental improvements are recommended to increase the activity and improve the mobility of older adults in institutional long-term care settings. ○Improvements 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? ○Increasing 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. ○Environmental aspects to promote activity and mobility need to be considered already at the planning, building and renovating phases of facilities. ○Policymakers 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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Affiliation(s)
- Noora Narsakka
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Riitta Suhonen
- Department of Nursing Science, University of Turku, Turku, Finland
- Wellbeing Services County of Southwest Finland, Turku University Hospital, Turku, Finland
| | - Barbara Groot
- Department of Health Sciences, Vrije Universiteit and Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Higgins S, Baillie L, Moorley C, Nolan F. Person-centred oral hydration care for older people with dementia admitted to acute hospital wards: Empirical research qualitative. J Clin Nurs 2023; 32:7467-7482. [PMID: 37353949 DOI: 10.1111/jocn.16807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 05/12/2023] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
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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Affiliation(s)
- Shanlee Higgins
- Institute of Health and Social Care, School of Nursing and Midwifery, London South Bank University, London, UK
| | - Lesley Baillie
- Institute of Health and Social Care, School of Nursing and Midwifery, London South Bank University, London, UK
| | - Calvin Moorley
- Institute of Health and Social Care, School of Nursing and Midwifery, London South Bank University, London, UK
| | - Fiona Nolan
- Faculty of Health, Education, Medicine & Social Care, School of Nursing and Midwifery, Anglia Ruskin University, Chelmsford, UK
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Schafthuizen L, Spruit-Bentvelzen L, van Dijk M, van Rosmalen J, Ista E. Implementation of a nursing oral health care protocol in a university teaching hospital: A cluster-randomized stepped-wedge design. Int J Dent Hyg 2023. [PMID: 37722075 DOI: 10.1111/idh.12748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/24/2023] [Accepted: 07/30/2023] [Indexed: 09/20/2023]
Abstract
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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Affiliation(s)
- Laura Schafthuizen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Lotte Spruit-Bentvelzen
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus University Medical Centre, Rotterdam, the Netherlands
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Byermoen KR, Brembo EA, Egilsdottir HÖ, Eide T, Heyn LG, Moen A, Eide H. Newly graduated nurses use and further development of assessment skills-An in-depth qualitative study. J Adv Nurs 2023; 79:3286-3298. [PMID: 36876732 DOI: 10.1111/jan.15631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/29/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
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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Affiliation(s)
- Kirsten Røland Byermoen
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Espen Andreas Brembo
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - H Ösp Egilsdottir
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Tom Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lena Günterberg Heyn
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Anne Moen
- Faculty of Medicine, Department of Public Health Sciences, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Becking-Verhaar FL, Verweij RPH, de Vries M, Vermeulen H, van Goor H, Huisman-de Waal GJ. Continuous Vital Signs Monitoring with a Wireless Device on a General Ward: A Survey to Explore Nurses' Experiences in a Post-Implementation Period. Int J Environ Res Public Health 2023; 20:ijerph20105794. [PMID: 37239523 DOI: 10.3390/ijerph20105794] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/10/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023]
Abstract
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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Affiliation(s)
- Femke L Becking-Verhaar
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Robin P H Verweij
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Marjan de Vries
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Hester Vermeulen
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Huispost 160, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Getty J Huisman-de Waal
- Department of Surgery, Radboud University Medical Centre, Huispost 751, Postbus 9101, 6500 HB Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Huispost 160, Postbus 9101, 6500 HB Nijmegen, The Netherlands
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Jeffs L, Merkley J, Ronald K, Newton G, Yang L, Gray CS. Can fundamental care be advanced using the science of care framework? J Adv Nurs 2023; 79:991-1002. [PMID: 35957589 DOI: 10.1111/jan.15404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
- Lianne Jeffs
- Sinai Health, Toronto, Ontario, Canada
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Lily Yang
- Sinai Health, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Sinai Health, Toronto, Ontario, Canada
- Institute of Health Policy Management, University of Toronto, Toronto, Ontario, Canada
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11
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Stănesu-Yadav DN, Lillekroken D. Nurse preceptors' experiences of promoting and teaching fundamental care to undergraduate nursing students: A qualitative study. J Adv Nurs 2023; 79:1094-1106. [PMID: 35855499 DOI: 10.1111/jan.15372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/29/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
| | - Daniela Lillekroken
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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12
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Mainz H, Odgaard L, Kristensen PK. Nursing representatives in clinical quality databases and the presence of nursing-sensitive indicators of fundamental nursing care. J Adv Nurs 2023; 79:1129-1138. [PMID: 35938943 DOI: 10.1111/jan.15400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/28/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Hanne Mainz
- Department of Orthopaedic, Aarhus University Hospital, Aarhus, Denmark
| | - Lene Odgaard
- Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus University, Aarhus, Denmark
| | - Pia Kjaer Kristensen
- Department of Orthopaedic, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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13
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Mudd A, Feo R, Voldbjerg SL, Laugesen B, Kitson A, Conroy T. Nurse managers' support of fundamental care in the hospital setting. An interpretive description of nurse managers' experiences across Australia, Denmark, and New Zealand. J Adv Nurs 2023; 79:1056-1068. [PMID: 34997632 DOI: 10.1111/jan.15139] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022]
Abstract
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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Affiliation(s)
- Alexandra Mudd
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia.,International Learning Collaborative
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia.,International Learning Collaborative
| | - Siri L Voldbjerg
- International Learning Collaborative.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Laugesen
- International Learning Collaborative.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia.,International Learning Collaborative
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia.,International Learning Collaborative
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14
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Bahlman-van Ooijen W, van Belle E, Bank A, de Man-Van Ginkel J, Huisman-de Waal G, Heinen M. Nursing leadership to facilitate patient participation in fundamental care: An ethnographic qualitative study. J Adv Nurs 2023; 79:1044-1055. [PMID: 35748056 DOI: 10.1111/jan.15329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/25/2022] [Accepted: 05/07/2022] [Indexed: 11/28/2022]
Abstract
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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Affiliation(s)
| | - Elise van Belle
- Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Scientific center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center Nijmegen, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Arnold Bank
- Department of Nursing Staff, Tergooi Hospital, Hilversum, The Netherlands
| | - Janneke de Man-Van Ginkel
- Nursing Science, Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, The Netherlands.,Nursing Science Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Getty Huisman-de Waal
- Department of surgery, Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center Nijmegen, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Maud Heinen
- Scientific center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center Nijmegen, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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15
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Amaral N, Merkley J, Ronald K, Farquharson C, Ginty L, Heng D, Jeffs L. Focusing on fundamentals of care in an ICU setting during a pandemic. J Adv Nurs 2023; 79:970-979. [PMID: 35765250 DOI: 10.1111/jan.15333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
| | | | | | | | | | | | - Lianne Jeffs
- Bloomberg Faculty of Nursing, Sinai Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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16
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Feo R, Urry K, Conroy T, Kitson AL. Why reducing avoidable hospital readmissions is a 'wicked' problem for leaders: A qualitative exploration of nursing and allied health perceptions. J Adv Nurs 2023; 79:1031-1043. [PMID: 35332579 DOI: 10.1111/jan.15220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/18/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
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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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kristi Urry
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia.,Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
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17
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Kantek F, Yesilbas H, Aytur Ozen T. Leadership and care in nursing research: A bibliometric analysis. J Adv Nurs 2023; 79:1119-1128. [PMID: 36464784 DOI: 10.1111/jan.15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/14/2022] [Accepted: 11/25/2022] [Indexed: 12/09/2022]
Abstract
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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Affiliation(s)
- Filiz Kantek
- Department of Nursing Management, Faculty of Nursing, Akdeniz University, Antalya, Turkey
| | | | - Tangul Aytur Ozen
- Department of Nursing Management, Faculty of Health Science of Nursing, Suleyman Demirel University, Isparta, Turkey
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18
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Giulia O, Francesca N, Emma MM, Gianluca C, Milko Z, Giuseppe A, Fiona T, Loredana S, Annamaria B. Fundamental care: An evolutionary concept analysis. J Adv Nurs 2022; 79:2070-2080. [PMID: 36226779 DOI: 10.1111/jan.15451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/29/2022] [Accepted: 08/30/2022] [Indexed: 11/27/2022]
Abstract
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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Affiliation(s)
- Ottonello Giulia
- Department of Health Sciences, University of Genoa, Genova, Italy
| | | | - Musio Maria Emma
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Catania Gianluca
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Zanini Milko
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Aleo Giuseppe
- Department of Health Sciences, University of Genoa, Genova, Italy
| | - Timmins Fiona
- UCD School of Nursing, Midwifery and Health Systems, UCD, Dublin, Ireland
| | - Sasso Loredana
- Department of Health Sciences, University of Genoa, Genova, Italy
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Hope J, Schoonhoven L, Griffiths P, Gould L, Bridges J. 'I'll put up with things for a long time before I need to call anybody': Face work, the Total Institution and the perpetuation of care inequalities. Sociol Health Illn 2022; 44:469-487. [PMID: 35076086 PMCID: PMC9306934 DOI: 10.1111/1467-9566.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/01/2022] [Accepted: 01/05/2022] [Indexed: 06/01/2023]
Abstract
Failures in fundamental care (e.g. nutrition or pain-relief) for hospitalised patients can have serious consequences, including avoidable deaths. Policy rhetoric of 'shared decision-making' fails to consider how structural constraints and power dynamics limit patient agency in nursing staff-patient interactions. Goffman's concepts of face work, the presentation of self and the Total Institution shaped our analysis of interview and focus group data from hospital patients. Patients avoided threatening 'good' patient and staff face by only requesting missed care when staff face was convincing as 'caring' and 'available' ('engaged'). Patients did not request care from 'distracted' staff ('caring' but not 'available'), whilst patient requests were ignored in Total Institution-like 'dismissive' interactions. This meant patients experienced missed care with both 'distracted' and 'dismissive' staff. Patients with higher support needs were less able to carry out their own missed care to protect staff face, so experienced more serious care omissions. These findings show that many elements of the Total Institution survive in modern healthcare settings despite attempts to support individualised care. Unless nursing staff can maintain face as 'engaged' (despite organisational constraints that can reduce their capacity to do so) patient participation in care decisions will remain at the level of rhetoric.
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Affiliation(s)
- Jo Hope
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisette Schoonhoven
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Peter Griffiths
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Lisa Gould
- Department of Surgery and CancerFaculty of MedicineInstitute of Global Health InnovationImperial College LondonLondonUK
| | - Jackie Bridges
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) WessexSouthamptonUK
- Faculty of Environmental and Life SciencesSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
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20
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Whear R, Abbott RA, Bethel A, Richards DA, Garside R, Cockcroft E, Iles‐Smith H, Logan PA, Rafferty AM, Shepherd M, Sugg HVR, Russell AM, Cruickshank S, Tooze S, Melendez‐Torres GJ, Thompson Coon J. Impact of COVID-19 and other infectious conditions requiring isolation on the provision of and adaptations to fundamental nursing care in hospital in terms of overall patient experience, care quality, functional ability, and treatment outcomes: systematic review. J Adv Nurs 2022; 78:78-108. [PMID: 34554585 PMCID: PMC8657334 DOI: 10.1111/jan.15047] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/02/2021] [Accepted: 09/05/2021] [Indexed: 01/28/2023]
Abstract
AIM This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. DESIGN Systematic review. DATA SOURCES In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID-19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. REVIEW METHODS We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID-19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non-professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. RESULTS Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub-themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. CONCLUSION To prepare for continuation of the COVID-19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence-based care to be provided in future. IMPACT Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics.
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Affiliation(s)
- Rebecca Whear
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Rebecca A. Abbott
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - Alison Bethel
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
| | - David A. Richards
- College of Medicine and HealthUniversity of ExeterExeterUK
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Ruth Garside
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Emma Cockcroft
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Heather Iles‐Smith
- School of Health and SocietyUniversity of SalfordSalfordUK
- Northern Care Alliance NHS GroupSalfordUK
| | - Pip A. Logan
- School of MedicineUniversity of NottinghamQueens Medical CentreNottinghamUK
| | - Ann Marie Rafferty
- Faculty of Nursing, Midwifery and Palliative CareKing’s College LondonLondonUK
| | - Maggie Shepherd
- NIHR Exeter Clinical Research FacilityRoyal Devon and Exeter NHS Foundation TrustExeterUK
- Institute of Biomedical and Clinical ScienceCollege of Medicine and HealthUniversity of ExeterExeterUK
| | | | | | | | - Susannah Tooze
- College of Medicine and HealthUniversity of ExeterExeterUK
| | | | - Jo Thompson Coon
- College of Medicine and HealthUniversity of ExeterExeterUK
- The National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula (PenARC)ExeterUK
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21
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Eekholm S, Samuelson K, Ahlström G, Lindhardt T. 'Stolen Time'-Delivering Nursing at the Bottom of a Hierarchy: An Ethnographic Study of Barriers and Facilitators for Evidence-Based Nursing for Patients with Community-Acquired Pneumonia. Healthcare (Basel) 2021; 9:1524. [PMID: 34828571 DOI: 10.3390/healthcare9111524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022] Open
Abstract
The research has reported a high prevalence of low-quality and missed care for patients with community-acquired pneumonia (CAP). Optimised nursing treatment and care will benefit CAP patients. The aim of this study was to describe the barriers and facilitators influencing registered nurses’ (RNs’) adherence to evidence-based guideline (EBG) recommendations for nursing care (NC) for older patients admitted with CAP. Semi-structured focus group interviews (n = 2), field observations (n = 14), and individual follow-up interviews (n = 10) were conducted in three medical units and analysed by a qualitative content analysis. We found a main theme: ‘‘stolen time’—delivering nursing at the bottom of a hierarchy’, and three themes: (1) ‘under the dominance of stronger paradigms’, (2) ‘the loss of professional identity’, and (3) ‘the power of leadership’. These themes, each comprising two to three subthemes, illustrated that RNs’ adherence to EBG recommendations was strongly influenced by the individual RN’s professionalism and professional identity; contextual barriers, including the interdisciplinary team, organisational structure, culture, and evaluation of the NC; and the nurse manager’s leadership skills. This study identified central factors that may help RNs to understand the underlying dynamics in a healthcare setting hindering and facilitating the performance of NC and make them better equipped for changing practices.
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22
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de Foubert M, Cummins H, McCullagh R, Brueton V, Naughton C. Systematic review of interventions targeting fundamental care to reduce hospital-associated decline in older patients. J Adv Nurs 2021; 77:4661-4678. [PMID: 34240755 DOI: 10.1111/jan.14954] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/29/2021] [Accepted: 06/10/2021] [Indexed: 01/07/2023]
Abstract
AIMS To examine the effectiveness of targeted nursing interventions on mobilization, nutrition and cognitive engagement to reduce functional and hospital-associated decline (HAD) in older patients. DESIGN Systematic review of experimental studies using randomized and quasi-experimental designs. DATA SOURCES We searched electronic databases CINAHL, MEDLINE, EMBASE, Cochrane library, google scholar and BMJ quality reports from January 2009 to February 2020. REVIEW METHODS We reviewed intervention studies that targeted ward nursing teams to increase mobilization, nutrition or cognitive engagement of older adults. Inclusion criteria included older patients, acute care (medical, surgical and older adult wards) and reporting patient level outcomes. Quality appraisal included the Joanna Briggs Critical Appraisal Checklist for Quasi-Experimental Studies. RESULTS From 1729 papers, 18 studies using quasi-experimental and pre-post designs were selected. Study heterogeneity necessitated a narrative synthesis. The quality of evidence was low to moderate. All studies used multicomponent strategies, and 10 studies used evidence translation frameworks to align interventions to local barriers. Overall, 74% (n = 14) of studies reported a significant improvement in the stated primary outcome. Eight studies reported a significant increase in mobilization (e.g., sitting in a chair or walking), and four reported improved functional outcomes. Five studies improved nutrition outcomes (e.g., protein or energy intake), and three studies reported a significant reduction in delirium. CONCLUSION Acknowledging methodological limitations, the evidence indicates that nursing teams using evidence-translation frameworks can improve mobilization, nutrition and cognitive engagement in acute care settings. Future research requires higher-quality pragmatic trial designs, standardized outcomes, staff co-designed interventions, evidence-translation frameworks and patient engagement to make more confident inference about effectiveness. IMPACT Nursing teams with the support of hospital management have to address ward and system barriers to prioritize fundamental care to improve patient outcomes. There is sufficient evidence on multicomponent interventions and implementation strategies to inform nurse-led quality improvement.
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Affiliation(s)
- Marguerite de Foubert
- South Infirmary Victoria University Hospital, Cork, Ireland.,Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Cummins
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Valerie Brueton
- Formerly Florence Nightingale Faculty of Nursing and Midwifery, Kings College London, London, United Kingdom
| | - Corina Naughton
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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23
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Feo R, Kumaran S, Conroy T, Heuzenroeder L, Kitson A. An evaluation of instruments measuring behavioural aspects of the nurse-patient relationship. Nurs Inq 2021; 29:e12425. [PMID: 34076309 DOI: 10.1111/nin.12425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022]
Abstract
The Fundamentals of Care Framework is an evidence-based, theory-informed framework that conceptualises high-quality fundamental care. The Framework places the nurse-patient relationship at the centre of care provision and outlines the nurse behaviours required for relationship development. Numerous instruments exist to measure behavioural aspects of the nurse-patient relationship; however, the literature offers little guidance on which instruments are psychometrically sound and best measure the core relationship elements of the Fundamentals of Care Framework. This study evaluated the quality of nurse-patient relationship instruments by (1) assessing their content development and measurement properties (e.g. dimensionality, targeting, reliability, validity) and (2) mapping instrument content to the Framework's core relationship elements: trust, focus, anticipate, know, and evaluate. Twenty-seven instruments were evaluated. Findings demonstrated that patients and nurses were rarely involved in item development. Most instruments exhibited poor measurement properties, with only one instrument having complete information on all quality indicators. Instrument content focused primarily on nurses getting to know patients and earning their trust, with only 54, 18, and 1 item(s), respectively, measuring 'focus', 'anticipate' and 'evaluate'. Hence, there does not appear to be a robust instrument measuring behavioural aspects of nurse-patient relationships, nor one capturing the relationship elements of the Fundamentals of Care Framework.
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Affiliation(s)
- Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Sheela Kumaran
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Louise Heuzenroeder
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia.,Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
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24
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Wilson D, Moloney E, Parr JM, Aspinall C, Slark J. Creating an Indigenous Māori-centred model of relational health: A literature review of Māori models of health. J Clin Nurs 2021; 30:3539-3555. [PMID: 34046956 PMCID: PMC8597078 DOI: 10.1111/jocn.15859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/22/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Identify the key concepts, principles and values embedded within Indigenous Māori models of health and wellbeing; and determine how these could inform the development of a Māori-centred relational model of care. BACKGROUND Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing. DESIGN AND METHODS A qualitative literature review on Māori models of health and wellbeing yielded nine models to inform a Māori-centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews. RESULTS Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio-political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Māori is a holistic and relational concept. Building relationships that include whānau (extended family) is a cultural imperative. CONCLUSIONS This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust-based relationships with Māori. Key elements for a Māori-centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing). RELEVANCE TO CLINICAL PRACTICE Culturally-based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Māori-centred relational model of care to address inequity.
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Affiliation(s)
- Denise Wilson
- Taupua Waiora Māori Research Centre, Faculty of Health & Environmental Sciences, Auckland University of Technology, Manukau, Auckland, New Zealand
| | - Eleanor Moloney
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand
| | - Jenny M Parr
- Counties Manukau Health District Health Board, Middlemore Hospital, Auckland, New Zealand
| | - Cathleen Aspinall
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand.,Counties Manukau Health, Otahuhu, Auckland, New Zealand
| | - Julia Slark
- School of Nursing, University of Auckland, Grafton, Auckland, New Zealand
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25
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Lillekroken D. "A privilege but also a challenge." Nurse educators' perceptions about teaching fundamental care in a simulated learning environment: A qualitative study. J Clin Nurs 2020; 29:2011-2022. [PMID: 31889359 DOI: 10.1111/jocn.15177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 11/22/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES To explore nurse educators' perceptions about teaching fundamental care to undergraduate nursing students in a simulated learning environment. BACKGROUND Recent research has demonstrated that fundamental care is overlooked in nursing education, resulting in little empirical research on how to teach fundamental care within a simulated learning environment. DESIGN The study has a qualitative, explorative design. The principles of consolidated criteria for reporting qualitative research (COREQ) were applied for reporting the methods and findings. METHODS Data were collected through participant observations and focus group interviews with nursing students, clinical nurses and nurse educators. The data were analysed using the qualitative content analysis method. RESULTS The core category "A privilege but also a challenge" represents the overall perception of nurse educators' perceptions about teaching fundamental care in a simulated learning environment. The core category is supported by two subcategories: "Fundamental care is important to nursing education" and "To set a good example," which represent the attributes and the role nurse educators have in helping students achieve their fundamental care learning outcomes. CONCLUSIONS Fundamental care can be taught to students by engaging them in an interplay between lectures and learning activities that are designed to enhance their skills during simulations in simulated learning environments. RELEVANCE TO CLINICAL PRACTICE Nursing education should prepare students to develop the skills they will be applying when providing fundamental care in real life; thus, the students should learn how to deliver high-quality fundamental care.
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Affiliation(s)
- Daniela Lillekroken
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
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26
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van Noort HHJ, Witteman BJM, den Hertog-Voortman R, Everaars B, Vermeulen H, Huisman-de Waal G. A context analysis on how oral care is delivered in hospitalised patients: A mixed-methods study. J Clin Nurs 2019; 29:1991-2003. [PMID: 31793109 DOI: 10.1111/jocn.15130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/25/2019] [Accepted: 11/10/2019] [Indexed: 12/23/2022]
Abstract
AIMS AND OBJECTIVES To analyse oral care delivery in one hospital through exploring experiences from both nurses' and patients' perspectives and examining patients' oral health. BACKGROUND Oral health problems are associated with undernutrition and other general health outcomes. Although oral care belongs to the essentials of nursing, it is often neglected. Improving oral health may require behaviour change of both nurses and patients. Defining tailored strategies need a clear view on the context. DESIGN A context analysis in one hospital using a convergent parallel mixed-methods design was reported following the EQUATOR guidelines using two checklists: COnsolidated criteria for REporting Qualitative research (qualitative research) and STROBE (observational research). METHODS Semi-structured interviews were conducted with 19 nurses and 11 patients. The topic list was based on the Integrated Change Model. Prospective oral examination was performed among 91 surgical patients using the Oral Health Assessment Tool (OHAT). RESULTS Nurses acknowledged that they did not prioritise oral care in daily practice. Furthermore, they lacked knowledge and skills to identify and provide care for oral problems. Nurses mentioned helpful resources to perform oral care, like standardised language and instruments. However, they had no access to or were unaware of them. Patients admitted that they did not prioritise oral care due to their sickness during hospitalisation, were unaware of the importance of oral care, but felt responsible for their oral care. The most prominent oral problems identified with the OHAT were unclean mouths (n = 75, 82%), unhealthy gum and tissues (n = 55, 60%) and dry mouth (n = 42, 46%). CONCLUSIONS This context analysis identified inadequate oral care due to lack of positive attitude and knowledge in both nurses and patients, skills for nurses, and resources. RELEVANCE TO CLINICAL PRACTICE The behavioural factors indicate strategies for development of a multicomponent intervention to improve oral care in this hospital, nutritional status and general health outcomes.
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Affiliation(s)
- Harm H J van Noort
- Department of Nutrition, Physical Activity and Sports, Gelderse Vallei Hospital, Ede, The Netherlands.,Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Nursing, Christian University of Applied Sciences, Ede, The Netherlands
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, The Netherlands.,Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | | | - Babette Everaars
- Research Group Innovations in Preventive Care, University of Applied Sciences Utrecht, Utrecht, The Netherlands.,Department of Social Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University, Amsterdam, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands
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27
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Meehan TC, Timmins F, Burke J. Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model ©. J Clin Nurs 2018; 27:2260-2273. [PMID: 29399916 DOI: 10.1111/jocn.14303] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To propose the Careful Nursing Philosophy and Professional Practice Model© as a conceptual and practice solution to current fundamental nursing care erosion and deficits. BACKGROUND There is growing awareness of the crucial importance of fundamental care. Efforts are underway to heighten nurses' awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care. However, there remains a need for nursing frameworks which motivate nurses to bring fundamental care values to life in their practice and strengthen their commitment to provide fundamental care. DESIGN This descriptive position paper builds on the Careful Nursing Philosophy and Professional Practice Model© (Careful Nursing). Careful Nursing elaborates explicit nursing values and addresses both relational and pragmatic aspects of nursing practice, offering an ideal guide to provision of fundamental nursing care. METHOD A comparative alignment approach is used to review the capacity of Careful Nursing to address fundamentals of nursing care. CONCLUSIONS Careful Nursing provides a value-based comprehensive and practical framework which can strengthen clinical nurses' ability to articulate and control their practice and, thereby, more effectively fulfil their responsibility to provide fundamental care and measure its effectiveness. RELEVANCE TO CLINICAL PRACTICE This explicitly value-based nursing philosophy and professional practice model offers nurses a comprehensive, pragmatic and engaging framework designed to strengthen their control over their practice and ability to provide high-quality fundamental nursing care.
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Affiliation(s)
- Therese Connell Meehan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Fiona Timmins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jacqueline Burke
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Granero-Molina J, Fernández-Sola C, Mateo-Aguilar E, Aranda-Torres C, Román-López P, Hernández-Padilla JM. Fundamental care and knowledge interests: Implications for nursing science. J Clin Nurs 2018; 27:2489-2495. [PMID: 29119685 DOI: 10.1111/jocn.14159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To characterise the intratheoretical interests of knowledge in nursing science as an epistemological framework for fundamental care. BACKGROUND For Jürgen Habermas, theory does not separate knowledge interests from life. All knowledge, understanding and human research is always interested. Habermas formulated the knowledge interests in empirical-analytical, historical-hermeneutic and critical social sciences; but said nothing about health sciences and nursing science. DESIGN Discursive paper. RESULTS The article is organised into five sections that develop our argument about the implications of the Habermasian intratheoretical interests in nursing science and fundamental care: the persistence of a technical interest, the predominance of a practical interest, the importance of an emancipatory interest, "being there" to understand individuals' experience and an "existential crisis" that uncovers the individual's subjectivity. CONCLUSIONS The nursing discipline can take on practical and emancipatory interests (together with a technical interest) as its fundamental knowledge interests. Nurses' privileged position in the delivery of fundamental care gives them the opportunity to gain a deep understanding of the patient's experience and illness process through physical contact and empathic communication. RELEVANCE TO CLINICAL PRACTICE AND NURSING RESEARCH In clinical, academic and research environments, nurses should highlight the importance of fundamental care, showcasing the value of practical and emancipatory knowledge. This process could help to improve nursing science's leadership, social visibility and idiosyncrasy.
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Affiliation(s)
- José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - Ester Mateo-Aguilar
- Escuela Superior de Ciencias de la Salud Tecnocampus. Centro adscrito a la Universidad Pompeu Fabra, Barcelona, Spain
| | | | - Pablo Román-López
- Department of Nursing, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
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Abstract
AIMS AND OBJECTIVES To explore patients', families' and health professionals' experiences of a long-stay patient in an intensive care unit. BACKGROUND The fast-paced technologically driven intensive care unit environment, designed for a short patient stay, supports the provision of complex physiologically focused care for those with life-threatening illnesses. Long-stay patients with pronounced fundamental care needs fall outside predicted patient pathways, and nurses can find caring for these patients challenging. DESIGN AND METHODS A longitudinal, qualitative, multicase study of six cases from four New Zealand units. Case participants were patients, family members, nurses and other health professionals. Data collection methods included observation, conversations, interviews and document review. Data were analysed using thematic analysis, vignette development and trajectory mapping. RESULTS Challenges and successes of providing fundamental care for long-stay ICU patients are attributed to two interlinked factors. First, the biomedical model influences ICU nursing practices, resulting in prioritising tasks and technology for patient survival while simultaneously devaluing relational and comfort work. Fundamental psychosocial needs such as family presence, comfort, relationships and communication may be unmet. Second, the unit environment and culture have a significant impact on long-stay patients' ICU experiences and form physical and psychological barriers to families being present and involved. Some nurses negotiated these challenges to provide fundamental, patient- and family-centred care by adopting an approach of knowing the patient and these nurses reported satisfaction when seeing patients' positive responses. CONCLUSION The care environment and culture provide challenges to the provision of patient- and family-centred care for long-stay patients; however, when nurses prioritise knowing their patient these challenges can be overcome and patient and family distress reduced with the potential to improve patient outcomes. RELEVANCE TO CLINICAL PRACTICE Recognition that patients have fundamental care needs irrespective of the setting where they receive care. Intensive care environments and cultures create challenges for nurses when there is such a heavy burden of physiological needs to be met and technological tasks to be undertaken, with a focus on acuity; however, improving provision fundamental care can result in positive patient outcomes.
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Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Palmerston North, New Zealand
| | - Lesley Batten
- College of Health, Massey University, Palmerston North, New Zealand
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Richards DA, Hilli A, Pentecost C, Goodwin VA, Frost J. Fundamental nursing care: A systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene. J Clin Nurs 2018; 27:2179-2188. [PMID: 29156087 PMCID: PMC6001513 DOI: 10.1111/jocn.14150] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs. BACKGROUND Patient 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. DESIGN Systematic review. METHODS We 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. RESULTS We 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. CONCLUSIONS The 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 PRACTICE Researchers 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.
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Affiliation(s)
- David A Richards
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Angelique Hilli
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Claire Pentecost
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Victoria A Goodwin
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
| | - Julia Frost
- Institute of Health Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK
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Lewis A, Edwards S, Whiting G, Donnelly F. Evaluating student learning outcomes in oral health knowledge and skills. J Clin Nurs 2017; 27:2438-2449. [PMID: 28940933 DOI: 10.1111/jocn.14082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To evaluate whether a set of oral health resources designed for workforce training was relevant for students undertaking an entry-level nursing or aged care qualification. BACKGROUND Oral health is one of the most neglected aspects of nursing care experienced by older people. Despite efforts to improve aged care worker oral health knowledge and skills, one-off training and rapid staff turnover have hindered the success of workplace programmes. Inadequate oral health content in entry-level nursing and aged care qualifications has perpetuated this. DESIGN Kirkpatrick's training and evaluation model was used to evaluate the resources developed by a project called Building Better Oral Health Communities. Students used them as prescribed study materials and completed pre- and postintervention questionnaires. Educators were interviewed to obtain their feedback. Quantitative data were analysed using descriptive and inferential statistics. Qualitative data were collated according to relevance to learning, presentation style and interest. RESULTS Evaluation showed high levels of student and educator satisfaction. Student learning outcomes demonstrated consistently positive attitudes and significant self-reported improvements in oral health knowledge and skills. Irrespective of course type, students gained similar levels of oral health knowledge and skills following use of the resources. CONCLUSION Nurses and care workers must be able to provide consistent standards of oral health care as a fundamental part of caring for patients. Validated as an effective learning and teaching package, it is recommended that these resources be used to strengthen the oral health content of entry-level nursing and aged care qualifications. RELEVANCE TO CLINICAL PRACTICE Building the oral health capacity of nurses and care workers is one way of reversing oral health neglect and improving the quality of care provided to older people.
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Affiliation(s)
- Adrienne Lewis
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia
| | - Suzanne Edwards
- Data, Design and Statistics Service, Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, SA, Australia
| | | | - Frank Donnelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia
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Abstract
Ensuring and maintaining patient safety is an essential aspect of care provision. Safety is a multidimensional concept, which incorporates interrelated elements such as physical and psychosocial safety. An effective nurse-patient relationship should ensure that these elements are considered when planning and providing care. This article discusses the importance of an effective nurse-patient relationship, as well as healthcare environments and working practices that promote safety, thus ensuring optimal patient care.
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Affiliation(s)
- Tiffany Conroy
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia
| | - Rebecca Feo
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia
| | - Rose Boucaut
- University of South Australia, Adelaide, South Australia
| | - Jan Alderman
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia
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33
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Abstract
Modern healthcare environments are becoming increasingly complex. Delivering high-quality fundamental care in these environments is challenging for nurses and has been the focus of recent media, policy, academic and public scrutiny. Much of this attention arises from evidence that fundamental care is being neglected or delivered inadequately. There are an increasing number of standards and approaches to the delivery of fundamental care, which may result in confusion and additional documentation for nurses to complete. This article provides nurses with an approach to reframe their thinking about fundamental care, to ensure they meet patients' care needs and deliver holistic, person-centred care.
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Affiliation(s)
- Rebecca Feo
- Adelaide Nursing School, University of Adelaide, Australia
| | - Tiffany Conroy
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Jan Alderman
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
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Abstract
Establishing positive and trusting therapeutic relationships with patients has long been recognised as an essential component of nursing practice and is important for effective care. There are various challenges in clinical practice that make it increasingly difficult to deliver effective care centred on such relationships. Understanding and addressing these challenges is crucial to ensure a positive experience of care for patients, families, carers and nurses. This article outlines how nurses can use a framework to develop therapeutic relationships with patients and use the best available evidence to deliver effective care. It also explores the challenges in developing effective therapeutic relationships with patients at the healthcare system level, and considers how these challenges can be addressed.
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