Embedding fundamental care in the pre-registration nursing curriculum: Results from a pilot study

Time spent on activities that can be delegated and reasons for not delegating among acute care nurses: A mixed-methods study

AIM

To describe the activities nurses perceived to be delegable to other staff (delegable activities) in order to estimate the time nurses spend on delegable activities and explore nurses' reasons for not delegating these activities.

DESIGN

Mixed-methods explanatory sequential.

METHODS

In total, 236 nurses from 27 medical and surgical wards of five hospitals in northern Italy completed a web-based survey during a single shift between June and July 2022. Minutes spent on delegable activities, staff member to whom participants could have delegated and reason(s) for not delegating were reported. Chief nurses provided specific wards' characteristics using a paper-and-pencil questionnaire. Twenty semi-structured interviews were conducted to explore delegable activities and reasons for not delegating. Quantitative and qualitative results were merged using joint displays.

RESULTS

Participants spent approximately one-quarter of their time performing delegable activities, mainly delegable to nurse aides or nurse clerks, and performed due to a lack/shortage of staff or their concurrent participation in other activities. Participants recognized that activities requiring clinical assessment and decision-making skills cannot be delegated, whereas technical activities and indirect care should be delegated. Organizational, structural and cultural factors, as well as patient characteristics, available staff and experience affected delegation, leading nurses to perform delegable activities to ensure patient care.

CONCLUSION

Nurses spend a considerable part of their time on delegable activities due to a lack of staff or support services and suboptimal organization, which could be addressed by optimal staff management, but also to the complexity of the contexts, including individual and cultural factors that should be addressed through policy interventions.

IMPACT

This study estimates the time nurses spend on delegable activities in acute care settings. Our findings highlighted the reasons that sustain the decision not to delegate that policymakers, healthcare managers, and nurse educators should consider to promote nurses' delegation skills.

REPORTING METHODS

MMR checklist.

PATIENT/PUBLIC CONTRIBUTION

None.

Evaluating fundamental care knowledge to inform educational leadership

AIM

To explore undergraduate nursing students' understanding of fundamental care and identify educational leadership opportunities to deepen students' understanding of fundamental care concepts.

DESIGN

Sequential-explanatory mixed methods study.

METHODS

We conducted a cross sectional survey (n = 202) and focus groups (n = 24) to explore undergraduate nursing students' ability to identify fundamental care needs. All data were collected between November 2020 and April 2021. Survey data were analysed using descriptive and inferential statistics and focus group data were thematically analysed.

RESULTS

Year One students scored significantly lower in their ability to identify fundamental care needs compared with students in other years, even after controlling for route, gender and age. Post-degree students scored significantly higher than direct entry or transfer students. Students ≤19 years of age had significantly lower scores compared with students ≥25 years of age. Our focus group findings highlighted that students were often unable to define fundamental care, but they identified learning about various components of fundamental care in a variety of ways. While students understood that fundamental care was required in all settings, they were challenged in providing this care in acute and virtual settings. Students shared several suggestions to support fundamental care skills development across the curriculum.

CONCLUSIONS

There is a need for a clear definition and description of the fundamentals of care that is used consistently by faculty, students and curriculum documents. It is important to encourage and support educators to share real-world nursing stories, offer students time to share their personal experiences, develop creative learning opportunities and foster student reflection to deepen students' understanding of the fundamentals of care.

IMPACT

Educators need support to meaningfully incorporate fundamentals of care learning opportunities across multiple care settings. Educational leaders can use these findings to develop or adapt their curricula to support fundamental care skill development.

Clinical supervisors' perceptions and use of the fundamentals of care framework in supervision of nursing students

AIM

To explore clinical supervisors' perceptions and use of the Fundamentals of Care framework in supervising nursing students in clinical placement in hospital settings.

DESIGN

A qualitative study using focus group interviews. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research.

METHODS

Twelve clinical nurse supervisors working in medical, surgical or psychiatric wards in hospitals in Denmark participated in four focus groups conducted from September to November 2020. Data were analysed using thematic analysis.

RESULTS

Clinical supervisor's perceptions and use of the framework are described in three themes: structuring students' clinical learning, supporting tool for learning what nursing care is and developing own supervision practice.

CONCLUSION

Supervisors perceive the Fundamentals of Care framework positively and use it as a supporting tool to structure and facilitate students' reflection on what nursing is and requires. They perceive that having a shared framework across school and clinical setting contributes to a safe and positive learning environment. Furthermore, using the framework develops their own practice as clinical supervisors.

How do undergraduate nursing students learn about the fundamentals of care? A pilot cross-sectional attitudinal study

INTRODUCTION

Despite the growing importance of nursing fundamentals of care, nurses often overlook these aspects of care. In this study, we explored why this happens precisely where nursing education is initially provided. In fact, little is known about how undergraduate nursing students perceive the teaching of fundamentals of care and how they value them.

METHODS

This pilot cross-sectional study used a questionnaire adapted and validated in Italian to assess the perceptions of first, second, and third-year undergraduate nursing students (n=150) in an Italian university about the teaching of fundamentals of care during theoretical lessons and clinical practice.

RESULTS

In the first section of the tool, on general fundamentals of care (nutrition, hygiene, mobility, rest and sleep, the expression of sexuality, safety, etc), students reported high levels of agreement for all items: range between 61.2% (95% CI: 57.1-65.3) and 100%.In the section on nutrition, divided into nutrition, oral intake of fluids, and malnutrition high percentages of agreement from 53.1% (95% CI: 46.0-60.2) to 91.8% (95% CI: 87.9-95.7%) were obtained, but for questions regarding 'learning how to document food and fluid intake', first-year students reported low levels of agreement.With regard to the 'Communication Section', the item about 'learning how to inform minor patients' presented low percentages of agreement throughout the three-year programOf the first-year students, between 71.4% (95% CI: 64.9-77.9) and 77.6% (95% CI: 71.6-83.6) declared they had not received instructions about this.

CONCLUSIONS

Understanding how nursing students perceive the importance of learning of fundamentals of care during their curriculum and how their multidimensional nature is highlighted by teachers and clinical supervisors, will enable educators to address the gaps in the way they taught and prioritized within the curriculum.

Fundamental care: An evolutionary concept analysis

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.

Cultural safety and patient trust: The hui process to initiate the nurse-patient relationship

The Fundamentals of Care framework is recognised for its essential elements to provide quality patient-centred care. Connection and trust as a basis for a caring relationship is a central tenet of this framework. Indigenous people of Aotearoa New Zealand face barriers to health care that are historically and socially constituted. The Hui Process is a model informed by Māori values on connection; when used to inform the Fundamental of Care framework, offers a point of entry for nursing students to develop culturally safe fundamental nursing care. We offer the use of Hui Process and the Fundamental of Care framework as an accessible approach to teach new undergraduate nursing students' relationship-based nursing through culturally safe practice and communication. The Hui Process involves four culturally safe steps; mihi, whakawhanuangatanga, kaupapa and poroporoaki Students engage with the Fundamentals of Care and the Hui Process during their introduction to nurse-patient communication, to support their first steps towards developing culturally safe nursing praxis.Impact statementThe Hui Process and Fundamentals of Care Framework offers an approach to teach beginner nursing students culturally safe practice.

Using 360° Video to Enable Affective Learning in Nursing Education

BACKGROUND

The affective domain describes learning associated with feelings, values, and emotions. Although this domain was first described in the late 1960s, a significant emphasis on skills and knowledge still remains. This prominence is evident despite global concerns about standards of practice and the place for empathy and care in nursing education. The emergence of newer technologies, such as 360° video, provides an opportunity to revisit the design and delivery of affective learning.

METHOD

Using the taxonomy of the affective domain, a 360° video viewed through a virtual reality headset was developed to give nursing and medical students insight on the patient experience and an orientation to the operating room.

RESULTS

Careful planning and consideration of how the affective domain can inform design of learning and teaching materials resulted in an engaging and informative learning experience. Being aware of how each level of the domain informs the next is essential to develop effective affective teaching plans.

CONCLUSION

Affective learning traditionally has been difficult to deliver and assess. Technology such as 360° video provides an engaging, reproducible, and consistent platform for delivering a domain of education. [J Nurs Educ. 2020;59(7):409-412.].

"A privilege but also a challenge." Nurse educators' perceptions about teaching fundamental care in a simulated learning environment: A qualitative study

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.

Speaking Up for Fundamental Care: the ILC Aalborg Statement

OBJECTIVE

The International Learning Collaborative (ILC) is an organisation dedicated to understanding why fundamental care, the care required by all patients regardless of clinical condition, fails to be provided in healthcare systems globally. At its 11th annual meeting in 2019, nursing leaders from 11 countries, together with patient representatives, confirmed that patients' fundamental care needs are still being ignored and nurses are still afraid to 'speak up' when these care failures occur. While the ILC's efforts over the past decade have led to increased recognition of the importance of fundamental care, it is not enough. To generate practical, sustainable solutions, we need to substantially rethink fundamental care and its contribution to patient outcomes and experiences, staff well-being, safety and quality, and the economic viability of healthcare systems.

KEY ARGUMENTS

We present five propositions for radically transforming fundamental care delivery:Value: fundamental care must be foundational to all caring activities, systems and institutionsTalk: fundamental care must be explicitly articulated in all caring activities, systems and institutions.Do: fundamental care must be explicitly actioned and evaluated in all caring activities, systems and institutions.Own: fundamental care must be owned by each individual who delivers care, works in a system that is responsible for care or works in an institution whose mission is to deliver care.

RESEARCH

fundamental care must undergo systematic and high-quality investigations to generate the evidence needed to inform care practices and shape health systems and education curricula.

CONCLUSION

For radical transformation within health systems globally, we must move beyond nursing and ensure all members of the healthcare team-educators, students, consumers, clinicians, leaders, researchers, policy-makers and politicians-value, talk, do, own and research fundamental care. It is only through coordinated, collaborative effort that we will, and must, achieve real change.

Exploring nursing students' use of the Fundamentals of Care framework in case-based work

AIMS AND OBJECTIVES

To explore how nursing students perceive and use the conceptual Fundamentals of Care framework in case-based work in nursing education and furthermore to describe influencing factors on perceptions and use of the framework.

BACKGROUND

The Fundamentals of Care framework has been integrated in core courses in two Schools of Nursing in Region North Denmark in response to studies reporting that nursing students and newly graduated nurses lack the knowledge, skills and competencies to meet the challenges of delivering fundamental care in clinical practice. An integration of the framework in case-based work in nursing education has not previously been studied.

DESIGN AND METHODS

The study design was focused ethnography. Data were collected using participant observations, focus group interviews and individual interviews. Four groups of four to five nursing students participating in case-based work sessions and three faculty members from two Schools of Nursing were included. The study adhered to COREQ.

RESULTS

The results show an uncertainty among the students about how to understand and use the conceptual framework in case-based work. The uncertainties derive from diversities in faculty members' perceptions and curricular planning among others. However, the framework appears to support the students' learning about what nursing is and requires.

CONCLUSIONS

The study indicates that integrating Fundamentals of Care framework in case-based work may be one way of teaching nursing students the complexities of integrated fundamental nursing care. However, there is a need to consider how to support students in articulating Fundamentals of Care, and to draw attention to the influence of role models and curricular planning.

RELEVANCE TO EDUCATIONAL PRACTICE

The study provides knowledge relevant when customising future educational interventions regarding the integration of Fundamentals of Care in nursing education and may provide valuable knowledge of evaluation strategies.

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

A person living with Alzheimer's disease (PA) can experience difficulty during bodily care and therefore may show resistance to care behaviours (RTCBs). Nurses must take a clinical approach to planning care that meets the person's needs. Therefore, it is necessary to identify training strategies for bedside nurses and nursing students.

AIMS AND OBJECTIVES

To describe and discuss how the FOC practice process (FOC-PP) can help nurses understand PAs who show RTCBs during bodily care.

BACKGROUND

Resistance to care behaviour phenomenon and the importance of bodily care as fundamental care are described. The FOC-PP enables nurses to apply the FOC framework in their practice.

DESIGN

This discursive paper is based on the literature of the FOC framework and PP.

METHOD

A clinical scenario that develops through the five stages of the FOC-PP.

RESULTS

The scenario centres on Mrs. Emily Morgan, 81, who lives in a nursing home and is not receiving the bodily care that she needs. Camille, a nursing student, and her supervisor Florence collaborate with Mrs. Morgan's family to improve the quality of her care. Three particular aspects of nursing practice based on the FOC-PP are described: the critical thinking process, relational process and pedagogical process.

CONCLUSION

The FOC-PP promotes holistic care centred on the person and his or her needs and encourages the nurse to use his or her skills and knowledge. All these dimensions are fundamental for high-quality nursing care.

RELEVANCE TO CLINICAL PRACTICE

Mrs. Morgan's scenario enables us to perceive that the FOC-PP is very useful for nursing students and bedside nurses. However, given the amount of specific and diverse knowledge required by the FOC-PP, it is necessary to identify avenues for teaching them. Using clinical scenarios could facilitate the integration of the FOC-PP, with taking into account the specific characteristics of individual clients.

Nursing students' perceptions towards being taught the fundamentals of care by clinical nurses within a simulated learning environment: A qualitative study

Research in nursing education demonstrates that the fundamentals of care are paid less attention in this field resulting in negative consequences for students' learning outcomes. The aim of this qualitative study was to explore nursing students' perceptions towards being taught the fundamentals of care by clinical nurses within a simulated learning environment. The study has a qualitative explorative design. Data was collected through participant observation and focus group interviews and analysed using qualitative content analysis. The analysis revealed two main categories indicating how the students gained knowledge in the research setting: 'Getting the best of both worlds', and 'Having it in many ways'. The findings are discussed against Vygotsky's theory of cognitive development suggesting that the students were content with being taught the fundamentals of care by clinical nurses within an simulated learning environment.

"It's just common sense": Preconceptions and myths regarding fundamental care

Fundamental care has come under increased scrutiny due to high-profile reports globally of poor nursing care. The reasons for these documented care failures are widely debated, with some scholars identifying issues with how fundamental care is valued within healthcare systems and by nurses. During focus groups designed to evaluate a fundamental care education intervention, we identified a perception commonly held by first-year pre-registration (pre-licensure) students that appeared indicative of a de-valuing of fundamental care: students routinely described fundamental care as 'common sense' and doubted that such care should form a key part of their education. In this paper, we explore this perception and its potential consequences for nursing education, clinical practice, and research. We argue that a perception of fundamental care as 'common sense' is a myth; it undermines the inherent complexity of providing such care to a consistently high standard and has negative implications for nursing education and continuing professional development, patient experiences and outcomes, and the advancement of nursing science. It is a perception that must be challenged.

Prioritizing the Fundamentals of Care Within the Prelicensure Nursing Curriculum

BACKGROUND

Little empirical research exists on how best to teach fundamentals of care to prelicensure nursing students. This pilot aims to develop this evidence base.

METHOD

A 6-week intervention embedded fundamentals of care explicitly, focusing on the integrated nature of such care, within a first-year prelicensure nursing curriculum at an Australian university. The intervention involved two components: (a) using the fundamentals of care framework to structure and guide teaching and shape students' conceptual understanding of the fundamentals of care, and (b) restructuring clinical skills sessions to reinforce this conceptual understanding.

RESULTS

Preliminary observations show that the intervention offers a practical and effective way to teach the fundamentals of care to prelicensure students, helping them to see the value of the fundamentals of care and to provide quality care for patients' fundamental needs.

CONCLUSION

Explicitly embedding the fundamentals of care within accredited nursing curricula is feasible and has observable, positive effects. [J Nurs Educ. 2018;57(8):498-501.].