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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] [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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Avallin T, Jangland E, Kitson A, Muntlin Å. Measuring person-centred pain management: Development of a questionnaire using the fundamentals of care framework. J Adv Nurs 2023; 79:3923-3934. [PMID: 37209376 DOI: 10.1111/jan.15697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/21/2023] [Accepted: 04/23/2023] [Indexed: 05/22/2023]
Abstract
AIM To develop and test a questionnaire using the Fundamentals of Care framework to measure person-centred pain management. DESIGN Cross-sectional exploratory descriptive design. METHODS Development in three phases: (a) literature search for questionnaires measuring person-centred pain management, (b) seven-step process developing items using thematic analysis, (c) initial feasibility and validity testing. Theoretical and empirical evidence was used, including the 'Strategic and Clinical Quality Indicators in Postoperative Pain management' questionnaire, the Fundamentals of Care framework and person-centredness principles. Theoretical experts (n = 2) reviewed the questionnaire, further evaluated by providers (n = 5) and patients (n = 5) using a think-aloud process, and by additional questions in the questionnaire answered by n = 100 patients. The questionnaire was tested February to March 2021, at four surgical wards in a university hospital. RESULTS The evaluation showed initial support for feasibility and validity, and the questionnaire was found to represent and be sensitive to capture the patients' experiences of person-centred pain management and being easy to answer. The 100 patients with acute abdominal pain who answered the questionnaire (aged 18-89 years, 46 women and 54 men), identified missing elements of fundamental care in their pain management, indicating that the questionnaire is sensitive to capture specific areas for improvement. CONCLUSION This first attempt at transforming the essential components of person-centred pain management into measurable items in a questionnaire was found promising. The questionnaire is suggested to be further tested for psychometric properties and patient benefit to provide clinical guidance in acute surgical care to meet the patient care need of pain management. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The developed questionnaire addresses the need of nurses and nursing leaders to evaluate the delivery of person-centred pain management in acute surgical care, to relieve the patient from pain. PATIENT OR PUBLIC CONTRIBUTION Patients and providers were involved in testing the questionnaire.
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Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Åsa Muntlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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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: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [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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Mudd A, Feo R, McCloud C, Conroy T. Elucidating strategies used by clinical nurse leaders to facilitate fundamental care delivery: A qualitative study. J Adv Nurs 2023; 79:1069-1081. [PMID: 35819187 DOI: 10.1111/jan.15352] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/11/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022]
Abstract
AIM To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area. DESIGN An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ). METHODS Twenty-four self-identified nurse leaders from across Australia were interviewed between November 2020 and April 2021 to discuss their strategies for facilitating fundamental care. Data was analysed using inductive thematic analysis. RESULTS Nurse leaders' experience of facilitating fundamental care produced two major themes, delivery of fundamental care (comprising three sub-themes: valuing fundamental care, understanding and developing staff capacity and supportive relationships), and monitoring of fundamental care (including three sub-themes: visibility in the clinical area, embedding fundamental care in the practice setting and specific direct actions). CONCLUSION Facilitating fundamental care delivery is complex. This study highlighted the importance of nurse leaders' individual characteristics, and nurse leaders' ability to establish and maintain relationships alongside the role of informal and formal monitoring of fundamental care delivery. IMPACT Findings from this study build on existing research into fundamental care and contribute to our understanding of the role, characteristics and actions of nurse leaders to facilitate fundamental care. The results demonstrate the complexity and intricacy of nursing leadership to facilitate fundamental care, and that a dynamic 'thinking and linking' approach is required. The results show individualized practice which may create challenges for new nurse leaders seeking guidance, and for monitoring nurse leader activity. Further research is advocated to explore insights and tools to optimize nurse leaders' endeavours in facilitating fundamental care. PATIENT OR PUBLIC CONTRIBUTION This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care.
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Affiliation(s)
- Alexandra Mudd
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- International Learning Collaborative
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- International Learning Collaborative
| | - Christine McCloud
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Bedford Park, Adelaide, South Australia, Australia
- International Learning Collaborative
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Kitson AL, Conroy T, Jeffs L, Carr D, Huisman-Dewaal GJ, Muntlin A, Jangland E, Grønkjaer M, Parr J. 'No more heroes': The ILC Oxford Statement on fundamental care in times of crises. J Adv Nurs 2023; 79:922-932. [PMID: 36523232 DOI: 10.1111/jan.15533] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Abstract
AIM To outline the International Learning Collaborative (ILC) Oxford Statement, explicating our commitment to ensuring health and care systems are equipped to meet patients' fundamental care needs during times of unprecedented crisis. DESIGN/METHOD Discussion paper. The content was developed via a co-design process with participants during the ILC's international conference. KEY ARGUMENTS We, the ILC, outline what we do and do not want to see within our health and care systems when faced with the challenges of caring for patients during global pandemics and other crises. Specifically, we want fundamental care delivery to be seen as the minimum standard rather than the exception across our health and care systems. We want nursing leaders to call out and stand up for the importance of building fundamental care into systems, processes and funding priorities. We do not want to see the voices of nursing leaders quashed or minimized in favour of other agendas. In turn, what we want to see is greater recognition of fundamental care work and greater respect for the people who do it. We expect nurses to have a 'seat at the table' where the key health and care decisions that impact patients and staff are made. CONCLUSION To achieve our goals we must (1) ensure that fundamental care is embedded in all health and care systems, at all levels; (2) build on and strengthen the leadership skills of the nursing workforce by clearly advocating for person-centred fundamental care; (3) co-design systems that care for and support our staff's well-being and which foster collective resilience rather than overly rely on individual resilience; (4) improve the science and methodologies around reporting and measuring fundamental care to show the positive impact of this care delivery and (5) leverage the COVID pandemic crisis as an opportunity for transformational change in fundamental care delivery.
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Affiliation(s)
- Alison L Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Devin Carr
- Maine Medical Center, Portland, Maine, USA
| | - Getty J Huisman-Dewaal
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands.,Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Asa Muntlin
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden.,Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Nursing Research, Uppsala University, Uppsala, Sweden
| | - Mette Grønkjaer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg, Denmark
| | - Jenny Parr
- Counties Manukau District Health Board, Auckland, New Zealand
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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] [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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Freguia F, Danielis M, Moreale R, Palese A. Nursing minimum data sets: Findings from an umbrella review. Health Informatics J 2022; 28:14604582221099826. [PMID: 35634983 DOI: 10.1177/14604582221099826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study explores the evidence available on Nursing Minimum Data Sets (NMDSs) by summarising: (a) the main methodological and reporting features of the reviews published in this field to date; (b) the recommendations developed and published in such reviews regarding the NMDSs, and (c) the categories and items that should be included in the NMDSs according to the available reviews. METHODS An Umbrella Review was performed. A search of secondary studies published up to November 2021 that were focused on NMDSs for adult hospitalised patients was conducted using MEDLINE (via PubMed), CINAHL and Scopus databases. The included studies were critically evaluated by using the Checklist for Systematic Review and Research Syntheses. The full review process was performed according to the Preferred Reporting Items for Systematic reviews and the Meta-Analyses statement. RESULTS From the initial 1311 studies that were retrieved, a total of eight reviews published from 1995 to 2018 were included. Their methodological quality was variable; these reviews offered four types of recommendations, namely at the overall, clinical, research and management levels. Additionally, seven NMDSs emerged with different purposes, elements, target populations and taxonomies. A list of categories and items that should be included in NMDSs have been summarised. CONCLUSIONS Nurses are daily involved in the nursing care documentation; however, which elements are recorded is mainly defined at the local levels and relies on paper and pencil. NMDS might provide a point of reference, specifically in the time of health digitalisation. Alongside other priorities as underlined in available recommendations, and the need to improve the quality of the reviews in this field, there is a need to develop a common NMDS by establishing its core elements, deciding on a standardised language and identifying linkages with other datasets.
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Affiliation(s)
- Francesca Freguia
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
| | - Matteo Danielis
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
| | - Renzo Moreale
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
| | - Alvisa Palese
- School of Nursing, Department of Medical Sciences, 9316University of Udine, Udine, Italy
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Gartner JB, Lemaire C. Dimensions of performance and related key performance indicators addressed in healthcare organisations: A literature review. Int J Health Plann Manage 2022; 37:1941-1952. [PMID: 35288968 DOI: 10.1002/hpm.3452] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/23/2021] [Accepted: 02/12/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Performance measurement systems have become essential managerial tools for healthcare organisations in the last few decades. They allow hospital managers to pilot their institution and assess the development of the organisation in helping managers in decision-making and viewing the different impacts of these decisions. However, there is a need to investigate further the dimensions of performance those performance measurement systems address. METHODS A literature review was primarily conduced about performance measures in healthcare organisations. A comparative study was secondly made to identify the different performance dimensions that are present in the literature during the last decade. Forty-nine studies were considered and sixteen proposal frameworks were used to make the comparative analyses. RESULTS We classified dimensions depending on the frequency of mobilisation of their components in four categories: the stars, the first runners-up, the opportunists and the forgotten ones. For each of the dimensions presented in this classification, the main types of KPIs proposed in the theoretical frameworks are presented. A discussion on relevance and possible blind spots is then conducted. CONCLUSION Although they were a lot of proposal frameworks of KPI proposed in the last decades to assess healthcare organisations, some dimensions remain underrepresented. There is still a need to develop structure KPI and describe their links. To go further, the development of dashboards asks the question of the definition of KPI, the description of their interconnections and their temporality of driving, because static performance reporting systems are not able to completely satisfy healthcare manager's decision support needs.
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Affiliation(s)
- Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, Québec, Canada.,Centre de recherche en gestion des services de santé, Université Laval, Québec, Québec, Canada.,Centre de recherche du CHU de Québec, Université Laval, Québec, Québec, Canada
| | - Célia Lemaire
- Université de Strasbourg, EM Strasbourg-Business School, HuManiS, Strasbourg, Alsace, France
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Jakobsen DH, Høgdall C, Seibæk L. Postoperative mobilisation as an indicator for the quality of surgical nursing care. ACTA ACUST UNITED AC 2021; 30:S4-S15. [PMID: 33641401 DOI: 10.12968/bjon.2021.30.4.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Postoperative mobilisation is an important part of fundamental care. Increased mobilisation has positive effect on recovery, but immobilisation is still a challenge in postoperative care. AIMS To report how the establishment of a national nursing database was used to measure postoperative mobilisation in patients undergoing surgery for ovarian cancer. METHODS 'Mobilisation' was defined as at least 3 hours out of bed on postoperative day 1, with the goal set at achieving this in 60% of patients. Data entry was performed by clinical nurses on 4400 patients with ovarian cancer. FINDINGS 46.7% of patients met the goal for mobilisation on the first postoperative day, but variations in duration and type of mobilisation were observed. Of those mobilised, 51.8% had been walking in the hallway. CONCLUSIONS A national nursing database creates opportunities to optimise fundamental care. By comparing nursing data with oncological, surgical and pathology data it became possible to study mobilisation in relation to cancer stage, comorbidity, treatment and extent of surgery.
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Affiliation(s)
- Dorthe Hjort Jakobsen
- Clinical Head Nurse, Section of Surgical Pathophysiology, Copenhagen University Hospital, Denmark
| | - Claus Høgdall
- Professor, Department of Gynecology, Rigshospitalet, Juliane Marie Centre, Copenhagen University Hospital, Denmark
| | - Lene Seibæk
- Associate professor, Department of Gynaecology and Obstetrics, Aarhus University Hospital, Denmark
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Palese A, Longhini J, Danielis M. 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. J Clin Nurs 2020; 30:239-265. [PMID: 33113209 DOI: 10.1111/jocn.15543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/21/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Matteo Danielis
- Department of Medical Sciences, University of Udine, Udine, Italy
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Avallin T, Muntlin Athlin Å, Björck M, Jangland E. Using communication to manage missed care: A case study applying the Fundamentals of Care framework. J Nurs Manag 2020; 28:2091-2102. [PMID: 31985109 DOI: 10.1111/jonm.12963] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 01/21/2020] [Indexed: 12/22/2022]
Abstract
AIM To explore, through the patient's perspective, how patient-provider communication is linked to missed nursing care vs. meeting patients' fundamental care needs. BACKGROUND Missed nursing care causes severe consequences for patients. Person-centred fundamental care, in which communication is central, provides an approach to manage this challenge. However, the specific patient-provider communications linked to care outcomes are unknown. METHODS Case study using secondary analysis of observations and interviews. A purposeful sample of 20 patients with acute abdominal pain collected using ethnographic methodology at one emergency department and two surgical wards. The Fundamentals of Care framework guided the analysis. RESULTS Communications that included the patient as an equal member of the care team were observed to make a difference between adequate and missed nursing care. Four categories were identified: interpersonal respect, humanized context of care, available and accessible communication channels, and mutual holistic understanding of the care needs and care plan. CONCLUSION Communication can be an essential tool to avoid missed nursing care and address the critical need for nursing managers to restore the fundamentals of care. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers can use this new knowledge of communication to facilitate person-centred fundamental care and thereby avoid missed nursing care.
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Affiliation(s)
- Therese Avallin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Åsa Muntlin Athlin
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden.,Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden.,Department of Public Health and Caring Sciences/Health Services Research, Uppsala University, Uppsala, Sweden.,Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Martin Björck
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Kitson A, Carr D, Conroy T, Feo R, Grønkjær M, Huisman-de Waal G, Jackson D, Jeffs L, Merkley J, Muntlin Athlin Å, Parr J, Richards DA, Sørensen EE, Wengström Y. Speaking Up for Fundamental Care: the ILC Aalborg Statement. BMJ Open 2019; 9:e033077. [PMID: 31822543 PMCID: PMC6924742 DOI: 10.1136/bmjopen-2019-033077] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
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.
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Affiliation(s)
- Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Devin Carr
- University Hospital and Frankel Cardiovascular Center, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mette Grønkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Getty Huisman-de Waal
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Lianne Jeffs
- Lunenfeld-Tananbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Jane Merkley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tananbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Åsa Muntlin Athlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Jennifer Parr
- Patient Experience and Nursing, Counties Manukau District Health Board, Auckland, New Zealand
| | - David A Richards
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Erik Elgaard Sørensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Yvonne Wengström
- Division of Neurobiology Care Science and Society, Nursing, Karolinska Institutet, Stockholm, Sweden
- Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Murphy F, Doody O, Lyons R, Gallen A, Nolan M, Killeen A, Kavanagh P, Donegan J, Sezgin D. The development of Nursing Quality Care Process Metrics and Indicators for use in Older Persons Care Settings: A Delphi‐Consensus Study. J Adv Nurs 2019; 75:3471-3484. [DOI: 10.1111/jan.14126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/03/2019] [Accepted: 05/21/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Fiona Murphy
- Department of Nursing and Midwifery University of Limerick Castletroy Ireland
| | - Owen Doody
- Department of Nursing and Midwifery University of Limerick Castletroy Ireland
| | - Rosemary Lyons
- Department of Nursing and Midwifery University of Limerick Castletroy Ireland
| | | | - Mary Nolan
- Health Services Executive Dublin Ireland
| | | | | | | | - Duygu Sezgin
- College of Medicine, Nursing & Health Sciences National University of Ireland Galway Galway Ireland
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