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Aspinall C, Slark J, Parr J, Pene BJ, Gott M. The role of healthcare leaders in implementing equitable clinical academic pathways for nurses: An integrative review. J Adv Nurs 2024; 80:3119-3133. [PMID: 38186212 DOI: 10.1111/jan.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIM To identify and synthesize empirical evidence on the role of healthcare leaders in the development of equitable clinical academic pathways for nurses. DESIGN Integrative literature review. DATA SOURCES Literature was searched using CINAHL, PubMed, ProQuest and Google Scholar databases. REVIEW METHODS A total of 114 eligible articles published between 2010 and2022 were screened, 16 papers were selected. RESULTS Results highlighted the need for consistent national, regional, and organizational policy approaches to developing clinical academic careers for nurses. Government health departments and National Health boards must focus on increasing engagement in research and evidence-based nursing practice for high-quality patient care. Discriminatory practices and attitudes were identified as barriers. Discrimination due to gender was evident, while the impact of race, ethnicity, and other social categories of identity are under-researched. Educational leaders must unravel misconceptions about research, highlighting its relevance to patient care and bedside nurses' work. Academic leaders together with executive nurses, research funders and professional nursing bodies must create appropriately remunerated career structures. Transformative approaches are required to develop the clinical academic nurse role and understand its value in clinical practice. CONCLUSION Multiple elements exist within complex systems that healthcare leaders can navigate collaboratively to develop and implement clinical nurse academic roles. This requires vision, acknowledgement of the value of nursing research and the importance of evidence-based research infrastructures. IMPACT Findings highlight the collaborative role of healthcare leaders as critical to the success of critical academic careers for nurses. This review can inform those still to formalize this innovative role for nurses. REPORTING METHOD The review complies with the PRISMA guidelines for reporting systematic reviews. This paper contributes evidence about the healthcare leader's role in developing clinical academic pathways for nurses to the wider global clinical community. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was included in this review.
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Affiliation(s)
- Cathleen Aspinall
- School of Nursing, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Julia Slark
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Jenny Parr
- School of Nursing, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Bobbie-Jo Pene
- School of Nursing, University of Auckland, Auckland, New Zealand
- Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Trundle C, Phillips T. Defining focused ethnography: Disciplinary boundary-work and the imagined divisions between 'focused' and 'traditional' ethnography in health research - A critical review. Soc Sci Med 2023; 332:116108. [PMID: 37531908 DOI: 10.1016/j.socscimed.2023.116108] [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: 05/03/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023]
Abstract
This article offers the first critical review of focused ethnography, an increasingly popular research method across health disciplines. Focused ethnographers, we argue, exemplify the practice of methodological boundary work, defining their method in contrast to the 'traditional' ethnographic approach of anthropology and sociology. To examine this boundary work, we collected two samples of health research articles published over the last decade and compared how focused ethnographers and medical anthropologists described, justified, and practised ethnography. We found that the core characteristics most often asserted to differentiate focused ethnography from conventional ethnography were: a more limited study timeframe and scope; a limited subpopulation sample; more concentrated research questions; the inclusion of insider researchers; and more orientation towards applied results. We show, however, that these are imagined binaries that fail to map onto actual differences of practice in the two samples and which obscure many similarities between them. By contrast, we identified four alternative differences between the two methods of ethnography. These centre on understandings of 'research time'; the very meaning of ethnography; the relationship of researchers to 'data'; and the presumed best method of social intervention. We therefore define focused ethnography as a versatile method of ethnography that attends to specific epistemological expectations within the health sciences regarding valid proof and empirical description, the boundaries of research, the nature of research relationships, and the duty to improve biomedicine. Ultimately, our study highlights that methodological boundary-work matters, because assumed differences and unexpressed misunderstandings can prevent productive dialogue and fruitful collaboration between disciplines to address pressing health problems.
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Jangland E, Gunnarsson AK, Hauffman A, Edfeldt K, Nyholm L, Fröjd C. Effective learning activity to facilitate post-graduate nursing students' utilization of nursing theories - Using the fundamentals of care framework. J Adv Nurs 2023; 79:1082-1093. [PMID: 35352387 DOI: 10.1111/jan.15238] [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: 09/30/2021] [Revised: 01/28/2022] [Accepted: 03/15/2022] [Indexed: 12/29/2022]
Abstract
AIMS To explore how postgraduate nursing students used the Fundamentals of Care framework in a written assignment based on a clinical situation, and describe their learning process in using the framework. DESIGN A qualitative descriptive study design applying the Fundamentals of Care framework. METHODS Postgraduate nursing students' theoretical written assignments (n = 35) based on self-experienced clinical cases were included. The data were collected in 2021 in five specialties in a postgraduate nursing programme in Sweden. The data were analysed using content analysis. RESULTS Applying the framework to a self-experienced clinical case illuminated the importance of nurse-patient relationships and clarified the meaning of person-centred care. The students assessed the framework as easy-to-use bedside as a guide to providing nursing care. By using the framework, the students were aided in reasoning about the fundamental values of care such as ethics, equality in healthcare and patient rights. When students reflected on their learning process, they stated that the assignment taught them how to use the framework, as well as paving the way for finding and applying other theories of nursing. CONCLUSION Learning activities with an opportunity to practice analysing nursing care guided by a theory, combined with a self-evaluating element, are conducive to deepening students' learning and improving their ability to use theories in clinical practice. IMPACT The framework illuminated the importance of the nurse-patient relationship in nursing care to the students and made them recognize and value the clinical use of theories. It is the responsibility of leaders in nurse education and healthcare to provide the next generation of specialist nurses-future nursing leaders-with regular opportunities to analyse nursing care through theories and frameworks. Nurses call for continuous learning on theories; leaders in nurse education and healthcare must meet these needs.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Anna Hauffman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Edfeldt
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Nyholm
- Department of Neuroscience, neurosurgery, Uppsala University, Uppsala, Sweden
| | - Camilla Fröjd
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Nowell L, Davidson S, Gospodinov J, Laing C, Shajani Z, Dewell S, Conroy T, Button D. Evaluating fundamental care knowledge to inform educational leadership. J Adv Nurs 2023; 79:1174-1188. [PMID: 35467759 DOI: 10.1111/jan.15279] [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: 09/28/2021] [Revised: 04/04/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Lorelli Nowell
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Sandra Davidson
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Catherine Laing
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Zahra Shajani
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Sarah Dewell
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Tiffany Conroy
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Didy Button
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
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Grønkjaer M, Voldbjerg SL, Jørgensen L, Kusk KH, Laugesen B. Establishing and leading a cross-institutional partnership to integrate fundamentals of care into clinical practice, nursing education and research. J Adv Nurs 2023; 79:951-960. [PMID: 35841335 DOI: 10.1111/jan.15366] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/19/2022] [Accepted: 07/05/2022] [Indexed: 01/30/2023]
Abstract
AIM The aim was to describe and discuss the process of establishing and leading a cross-institutional partnership to regain focus on and reconceptualize fundamental nursing care in clinical practice, nursing education and research in one region in Denmark. DESIGN A discursive paper. The case study method is used as an adapted frame for describing and discussing the establishment and strategic decisions of a cross-institutional partnership. DATA SOURCES This discursive paper draws on the authors' experiences with establishing a cross-institutional partnership and related literature. IMPLICATIONS FOR NURSING The paper addresses the challenges surrounding fundamental care. Establishing cross-institutional partnerships can contribute to a reconceptualization of fundamental care and initiate discussions on what nursing care is and requires. The paper provides an example of how a cross-institutional partnership can be established and describes and discusses the opportunities and challenges in doing so. CONCLUSION A key step in the process of establishing a partnership is to actively involve key stakeholders and stimulate their commitment to investing time and resources in the partnership. This requires commitment, clear strategic direction and leadership. Another key step is engaging and informing executive management leaders, and continuously nurture their interest. IMPACT The paper aims to inform clinicians, educators, nursing leaders, researchers and policy makers on how to organize a formal partnership structured around a strategic research, development and implementation programme where the focal point of the collaboration is improving nursing care by integrating the conceptual FoC framework. NO PATIENT OR PUBLIC CONTRIBUTION Patients, service users, caregivers or members of the public were not involved in this study as it is a discursive paper based on the authors' experiences and relevant literature.
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Affiliation(s)
- Mette Grønkjaer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Siri Lygum Voldbjerg
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,School of Nursing, University College of Northern Denmark, Hjørring, Denmark
| | - Lone Jørgensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Clinic for Surgery and Oncology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Centre of Clinical Guidelines, Aalborg University, Aalborg, Denmark
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Voldbjerg SL, Nielsen GN, Klit MO, Larsen KL, Laugesen B. Clinical supervisors' perceptions and use of the fundamentals of care framework in supervision of nursing students. J Adv Nurs 2022; 78:4199-4209. [PMID: 35957536 PMCID: PMC9805130 DOI: 10.1111/jan.15408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/24/2022] [Accepted: 07/05/2022] [Indexed: 01/09/2023]
Abstract
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.
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Affiliation(s)
- Siri Lygum Voldbjerg
- Clinical Nursing Research UnitAalborg University HospitalAalborgDenmark,Department of Clinical MedicineAalborg UniversityAalborgDenmark,Department of Nursing EducationUniversity College North DenmarkAalborgDenmark
| | | | | | - Karen Lyng Larsen
- Department of Quality and Patient SafetyNorth Denmark Regional HospitalAalborgDenmark
| | - Britt Laugesen
- Clinical Nursing Research UnitAalborg University HospitalAalborgDenmark,Center for Clinical Guidelines, Department of Clinical MedicineAalborg UniversityAalborgDenmark
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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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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: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [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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