Fundamental care guided by the Careful Nursing Philosophy and Professional Practice Model©

Effective nursing interventions in ADL care affecting independence and comfort - a systematic review

Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi-experimental studies described in systematic reviews. In three databases, we searched for systematic reviews that we used as a portal to select (quasi) experimental studies. After narratively summarizing the studies on characteristics, effects, and interventions, we assessed the risk of bias. Among the 31 included studies, 14 studies evaluated independence, 14 studies measured comfort, and three studies assessed both outcomes. Seven interventions significantly improved independence and seven interventions significantly improved comfort. The studies varied highly in intervention components, outcome measures, and quality. Evidence on ADL nursing interventions affecting independence and comfort remains fragmented and inconclusive, limiting guidance for nursing professionals.

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.

Relationship between nurses' professional values, empathy, and patience: A descriptive cross-sectional study

AIM

The aim of this study was to determine the relationships between the nurses' professional values and their empathy and patience levels, and the factors affecting them.

METHODS

This descriptive cross-sectional study was conducted with 215 nurses working at a university hospital between February and April 2021. Data were collected using the "Nurse Information Form," "Nurses' Professional Values Scale," "Patience Scale," and "The Toronto Empathy Questionnaire."

FINDINGS

Results of our study revealed that nurses had high scores for the perception of professional values, empathy levels, and patience levels.

CONCLUSIONS

Nurses had high scores for perceptions of professional values, empathy levels, and patience levels. Nurses' demographic characteristics influenced the scores.

Developing and validating the nursing presence scale for hospitalized patients

Aim

We developed and psychometrically tested the Nursing Presence Scale.

Background

Nursing presence is a foundation for professional nursing practice; therefore, it is critical to measure this concept.

Introduction

This instrument development study was designed to generate an itemized scale and psychometric testing using a sample of Iranian patients.

Methods

Based on both a concept development and literature review, and finally face and content validity 44-item draft scale was generated. During November 2018–2019, 774 patients were surveyed. Exploratory and confirmatory factor analyses were used to evaluate the scale’s construct validity; concurrent and predictive reliability of the nursing presence scale were also evaluated. We also examine the weighting to scale items.

Results

The analyses yielded a 36-item, 4-factor scale that adequately fit the data. Cronbach’s alpha coefficient for the whole instrument was 0.94. The intra class correlation coefficient was 0.91. Nursing Presence Scale scores were positively correlated with Revised Humane Caring Scale and predicted 25% of missed nursing care.

Conclusion

This 36-item has good reliability and validity, making it useful for measuring the current condition of nursing presence.

Implications for Nursing and Health Policy

Measuring the frequency of nursing presence allows for data-driven planning and upgrading the inpatient care services.

Unitary Caring Science: A Hermeneutic-Phenomenological Research Method

All phenomenological research, including descriptive phenomenological methods, are theory based. The knowledge in a discipline is built using discipline-specific methods. The purpose of this article is to develop and describe the processes of a mode of inquiry specific to caring in nursing theories housed within the unitary caring paradigm. Morgan's practical framework examining ontological-epistemological-methodological linkages was used to develop the unitary-caring hermeneutic phenomenological research method The method is specific to conducting hermeneutic phenomenological research within Watson's unitary caring science and Smith's theory of unitary caring. The method includes a process of linking and interpreting themes generated from the textual analysis of participant descriptions of the caring phenomena to concepts in the specific unitary caring theory that informs the researcher's a priori theoretical perspective to develop a theoretical understanding of the experience and contribute to the development of unitary caring nursing science.

Nurses’ views of fundamental relational skills used in clinical practice: a cross-sectional pilot study

Objective

Effective communication skills are one of the core competencies of nursing curricula internationally. Nurses are generally regarded as proficient. Despite our complete trust in the profession, deficiencies and gaps exist. However, it is not clear to which extent nurses use key communication skills in practice, and whether or not confident in using these skills compounds environmental issues that occur. This study explored nurse's confidence and application of relational skills competencies in nursing practice.

Methods

A 13-item online survey was used to collect data.

Results

Being self-aware on key areas where there was more uncertainty. Nurses also lacked confidence in exploring the impact of their personal feelings and values on their interactions. Nurses were also less confident on responding appropriately to instances of unsafe or unprofessional practice and using information and communication systems and technology.

Conclusions

Given the potential impact of poor relational skills on quality client care, an increased emphasis on caring and compassion, and the ever-expanding use of communication technologies, there is a need to explore the need for reflective practice to enhance continuous professional development for nurses to enhance their relational skills.

Comfort during the bed bath-A randomised crossover trial on the effect of washing without water versus water and soap in nursing students

AIMS AND OBJECTIVES

To compare the washing without water method with the water and soap method regarding comfort perceptions of the bed bath.

BACKGROUND

Bathing affects nurses' and care recipients' comfort. Bedridden care recipients can be bathed in bed with water and soap or with washing without water products. Little is known about the differences between these two bed bath methods regarding comfort perceptions among care recipients and nurses.

DESIGN

Crossover randomised laboratory-controlled trial, conducted from March 2018-November 2019, according to the CONSORT guidelines.

METHODS

Nursing students were randomly allocated roles as a patient (who received both types of bed baths) or a nurse (who provided both types of bed baths). Also, the order in which the bed baths were received/provided was randomised. A total of 97 students were included in the analysis. Student patients filled out the Patient Evaluation of Emotional Comfort Experienced (PEECE) scale to measure emotional comfort and a single-item question on physical comfort after each bed bath. Student nurses filled out the Physical Demands scale after each bed bath to measure their physical comfort perceptions.

RESULTS

No differences were found between the two bed bathing methods regarding student patients' emotional or physical comfort levels. Among student nurses, the washing without water method was less physically demanding than the water and soap method.

CONCLUSIONS

Taking into account time-efficiency and physical comfort for nurses, washing without water seems to be a valuable alternative to water and soap from a care recipient comfort perspective, which should be assessed in a clinical setting in future research.

RELEVANCE TO CLINICAL PRACTICE

The washing without water method is less physically demanding for nurses and takes less time. It does not have a detrimental effect on care recipients' emotional and physical comfort. The trial is registered at www.trialregister.nl (ID = NL6787).

Nursing Care at the Service of Life: A model including charity, quality, and leadership

BACKGROUND

Nursing professional practice models allow the focus on care and qualification of hospital service by articulating the theory to the practice of nursing care with the final purpose of improving the patient's and family caregivers' quality of life.

OBJECTIVE

To describe the model "Nursing care at the service of life," built and validated in a Colombian clinic, 2019.

METHOD

A Nursing Methodology Research developed in four consecutive steps intended to identify the need to have a theoretical framework; to build it and validate it in a collective way that included the different members of the clinic nursing staff.

RESULTS

The main concepts and articulated assumptions of the nursing practice model were described. The model will help the nursing staff to achieve the institutional mission.

CONCLUSIONS

The professional practice Model "Nursing care at the service of life" reflects the nursing profession's charity, quality, and leadership, as a hospital care axis. The institution's nursing staff were able to identify themselves in the model's approach, also the expert criteria endorsed the construction process and content. The validation process done with the nurse's staff demonstrates that this model is accepted and useful to guide the nursing caring practices within the clinic.

Key Elements of Professional Nursing Practice: A Scoping Review

BACKGROUND: Professional nursing practice can be used as a standard reference for implementing nursing care to help nurses provide quality care in accordance with their authorities. AIM: The review is purposed to synthesis the pieces of literature telling the development and / or application and / or assessment of a professional nursing practice to determine the crucial elements. METHODS: This study was guided by the following framework for a scoping review, using electronic databases including ScienceDirect, EBSCO, ProQuest, Pubmed, and Google Scholar within keywords of professional nursing practice, model, nurse and conceptual framework. RESULTS: Of a total of 2870 paper found, 28 papers were selected. This study seven key elements: health system competency, professional value, reward and performance evaluation, leadership, nursing care, professional development, and basic care competency. CONCLUSION: A professional nursing practice would provide the minimum standard of quality nursing practice.

To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review

AIMS AND OBJECTIVES

To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework).

BACKGROUND

UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework.

DESIGN

A two-step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis.

METHODS

A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved.

RESULTS

A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%).

CONCLUSION

Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones.

RELEVANCE TO CLINICAL PRACTICE

Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.

A contribution to the ontology of the Fundamentals of Care framework from a wonder-based approach

AIM AND OBJECTIVES

To critically discuss the ontological framework of Fundamentals of Care (FoC), as developed by Uhrenfeldt, et al. (2018), Journal of Clinical Nursing, 27, 3197-3204; to suggest theoretical improvements by taking a wonder-based approach; and to show how this approach can be applied in healthcare sectors.

BACKGROUND

Based on a critical discussion of a discursive study on the ontology of FoC, studies in phenomenology of wonder and two action research projects involving "Wonder Labs," this article discusses whether the ontology and reflective practices behind FoC can be qualified further by an existential phenomenology of wonder and with practices of "Wonder Labs."

DESIGN

This is a discursive study critically discussing Uhrenfeldt et al.'s primary focus on dyadic and relational openness and person-oriented attentiveness in a nurse-patient relationship. This is done by unfolding the phenomenology of wonder and wonder experiences at a hospice and a hospital, and by critically examining the psychologically influenced interpretation of Heidegger.

CONCLUSION

The first attempts by Uhrenfeldt et al. to identify the philosophical roots and ontology of FoC by pointing to existential phenomenology and philosophy are acknowledged. However, in this article, we further elaborate this attempt by focusing on the phenomenology of wonder. We show that Heidegger speaking about "existential homecoming" referred to a philosophical practice focusing on the resonance with being, rather than on interpersonal and psychological relations. In conclusion, the article recognises the importance of integrating these two approaches described on the one hand as a person-oriented and lifeworld-led approach, and on the other hand as a being- and phenomenon-oriented approach to the nurse-patient relationship.

RELEVANCE TO CLINICAL PRACTICE

To be open to the "musicality" of the being dimension, as the core values of FoC, a wonder-based approach to value clarifications and phenomenological dialogues is pivotal for the presence of openness, trust and attentiveness of the nurse-patient relationship. The practices of the "Wonder Lab" may be an approach for training nurses in hearing the call of this "ontological resonance."