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Edfeldt K, Nyholm L, Jangland E, Gunnarsson AK, Fröjd C, Hauffman A. Missed nursing care in surgical care- a hazard to patient safety: a quantitative study within the inCHARGE programme. BMC Nurs 2024; 23:233. [PMID: 38584285 PMCID: PMC10999080 DOI: 10.1186/s12912-024-01877-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Missed nursing care occurs globally, and the consequences are severe for the patients when fundamental care needs are not fulfilled, nor delivered in a person-centred way. This study aimed to investigate the occurrence and cause of missed nursing care, and the relationship between registered nurses' and nursing assistants' perceptions of missed nursing care, in a surgical care context. METHODS A quantitative study was performed using the MISSCARE survey, measuring missed nursing care and associated reasons, in three surgical wards with registered nurses and nursing assistants as the participants (n = 118), during May-November in 2022. The MISSCARE survey also covers background data such as job satisfaction and intention to leave. The survey was distributed paper-based and the response rate was 88%. RESULTS Aspects of nursing care rated to be missed the most were 'attending interdisciplinary care conferences', 'turning patient every 2 h', 'ambulation 3 times per day or as ordered', and 'mouth care'. Differences between registered nurse and nursing assistant ratings were detected for eight out of 24 items, where registered nurses rated more missed nursing care. The uppermost reasons for missed nursing care were 'inadequate number of staff' and 'unexpected rise in patient volume and/or acuity on the unit'. Registered nurses and nursing assistants rated differently regarding six of 17 items. Almost every fourth staff member (24.6%, n = 29) had the intention to leave within a year in the present department. CONCLUSIONS The occurrence of missed nursing care is frequent in the surgical context, and in combination with a high number of staff members intending to leave their employment, poses a hazard to patient safety. Registered nurses, holding higher educational levels, reported more missed care compared with the nursing assistants. The main reason for missed nursing care was an inadequate number of staff. These findings support a warranted investment in nursing within the organisation. The results can be used to form strategies and interventions, to reduce nurse attrition and optimise competence utilisation, and to achieve safe person-centered fundamental care.
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Affiliation(s)
- Katarina Edfeldt
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
| | - Lena Nyholm
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Eva Jangland
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna-Karin Gunnarsson
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Camilla Fröjd
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Anna Hauffman
- Dept of Surgical Sciences, Nursing Research, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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Lombardi Fortino D, Galazzi A, Chiappinotto S, Palese A. Nurse managers' strategies promoting a Fundamentals of Care-based approach among nurses: A scoping review. Ann Ig 2024; 36:26-40. [PMID: 37885356 DOI: 10.7416/ai.2023.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Introduction In the last few years, shortcomings in caring for patient needs have promoted a growing interest in the Fundamentals of Care (FoC) to promote the quality of nursing care. However, which strategies nurse managers should implement to facilitate a FoC-based nursing care approach have not been mapped to date; therefore, the intent of this study was to map those strategies related to the nurse manager role that have been documented as being capable of promoting (or hindering), a FoC-based approach among nurses. Methods A scoping review following the Preferred Reporting Items for Systematic Review and Meta-Analysis - Extension for Scoping Reviews (PRISMA-ScR) guidelines. The PubMed, CINAHL, Cochrane Library, Scopus and Web of Science databases and the conference proceedings of the International Learning Collaborative 2022 Annual International Conference were consulted. Studies exploring the relationship between FoC and nurse managers using any methodology, published from 2008 (year of birth of the FoC movement) to September 2022, in Italian or English, were eligible for inclusion. Findings were categorized narratively, according to their similarities and differences. Results Four qualitative studies, four discussion papers, two reviews and one mixed-method study, published from 2017 to 2021, predominantly in Australia, were included. Several strategies have emerged as promoting a FoC-based care approach by nurse managers. At the macro level, there is a need to disseminate a culture of attention towards patients that should be incorporated in the strategy of the entire system; moreover, synergies and effective leadership styles should be promoted by also providing education both in the undergraduate and continuing education settings. At the micro levels, among others, the required resources should be available, and the quality of the environment promoted. Conclusion Nurse managers may facilitate a FoC-based approach among nurses through a set of strategies that should be included and considered in their educational pathways.
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Affiliation(s)
- D Lombardi Fortino
- University of Tor Vergata, Rome, Italy
- Azienda Ospedaliera Universitaria delle Marche, Ancona, Italy
| | - A Galazzi
- Department of Medicine, University of Udine, Udine, Italy
| | - S Chiappinotto
- Department of Medicine, University of Udine, Udine, Italy
| | - A Palese
- Department of Medicine, University of Udine, Udine, Italy
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Savoie C, Rey S, Yokota S, Dallaire C, Kimura S, Takatani S, Yano Y. Fundamental Care's state of knowledge around the world: Where are we now? A scoping review. J Adv Nurs 2023; 79:865-884. [PMID: 35511714 DOI: 10.1111/jan.15278] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
AIMS To investigate and describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps. DESIGN A scoping review. DATA SOURCES CINAHL, Medline, PsycINFO and EMBASE databases were searched in April 2021 for eligible literature, published from January 2010, onwards. REVIEW METHODS This scoping review was built around the recommendations of Peters et al. (2020 version). Two researchers conducted the literature search, and three researchers independently screened the titles and abstracts of the retrieved studies' data, using the eligibility criteria and the review questions as a guide. RESULTS The search yielded 763 records, of which 107 were included. Results are presented under seven subheadings: (a) Countries and Continents, (b) Context, (c) Research Design, (d) Publishing/Journal, (e) Participants and Population, (f) Keywords and (g) Fundamental of Care Framework and Practice Process. All the retrieved articles describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps. CONCLUSION This scoping review highlighted the elevated number of articles that have been published since the beginning of the work on Fundamental Care, 10 years ago. The included articles are related to different dimensions of research, practice and teaching and to the Fundamentals of Nursing Care, but also to nursing theory. Finally, most of the articles had a nursing focus. IMPACT The results of this scoping review allow us to highlight the work from the past 10 years. This may be of interest to learn more about the research surrounding Fundamental Care. This scoping review allows us to better target the theoretical and empirical developments to focus on in the coming years.
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Affiliation(s)
- Camille Savoie
- Nursing Faculty, International Learning Collaborative (member), Laval University, Quebec City, Quebec, Canada
| | - Sylvie Rey
- Nursing Faculty, International Learning Collaborative (member), Laval University, Quebec City, Quebec, Canada
| | - Satoko Yokota
- Faculty of Global Nursing, Otemae University, Osaka, Japan
| | - Clémence Dallaire
- Nursing Faculty, Scientific Director of the Research Centre CISSS de Chaudière-Appalaches, International Learning Collaborative (member), Laval University, Quebec City, Quebec, Canada
| | - Satoko Kimura
- Faculty of Global Nursing, Otemae University, Osaka, Japan
| | | | - Yuko Yano
- Faculty of Global Nursing, Otemae University, Osaka, Japan
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Minton C, Burrow M, van der Krogt S, Manning C. Cultural safety and patient trust: The hui process to initiate the nurse-patient relationship. Contemp Nurse 2022; 58:228-236. [PMID: 35473582 DOI: 10.1080/10376178.2022.2070518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Claire Minton
- School of Nursing, Massey University, Private bag 11 222, Palmerston North 4442
| | - Marla Burrow
- School of Nursing, Massey University, Private bag 11 222, Palmerston North 4442
| | | | - Camille Manning
- School of Nursing, Massey University, Private bag 11 222, Palmerston North 4442
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Tegelberg A, Muntlin Å, Juhlin C, Jangland E. Engagement under difficult conditions: Caring for patients with acute abdominal pain across the acute-care chain: A qualitative study. Int Emerg Nurs 2020; 52:100910. [PMID: 32827935 DOI: 10.1016/j.ienj.2020.100910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/08/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies report that patients with acute abdominal pain do not always receive optimal care and can experience poor pain management, safety failures, and emotional harm. Deeper understanding of how health professionals experience care delivery is needed to improve care to patients with acute abdominal pain. AIM To explore, from the perspective of registered nurses and physicians, how care is provided for patients with acute abdominal pain in the acute care chain, and to identify barriers that they describe in the delivery of care. METHOD Registered nurses and physicians (n = 19) working in ambulance services, emergency departments, and surgical departments at five hospitals in Sweden were interviewed. A content analysis was performed. RESULTS Five categories were identified; interaction: a decisive moment, competence and resources: not always available, guidelines: limited use, medical care: a main focus, and feedback and collaboration: limited across acute care chain. CONCLUSION This study adds new insights relating to how health professionals reflect on patient needs and obstacles to satisfying them. To deliver high quality care and meet patients' fundamental needs, there is a need of general guidelines and close collaboration in the acute care chain.
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Affiliation(s)
- Alexander Tegelberg
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Sweden.
| | - Åsa Muntlin
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, Sweden; Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences/Clinical Epidemiology, Uppsala University, Uppsala, Sweden; Adelaide Nursing School, University of Adelaide, Adelaide, Australia.
| | - Claes Juhlin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Voldbjerg SL, Lyng Larsen K, Nielsen G, Laugesen B. Exploring nursing students' use of the Fundamentals of Care framework in case-based work. J Clin Nurs 2019; 29:1968-1980. [PMID: 31532034 DOI: 10.1111/jocn.15070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/16/2019] [Accepted: 08/31/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Siri Lygum Voldbjerg
- Clinical Nursing Research Unit, Aalborg University Hospital and School of Nursing, University College Nordjylland, Aalborg, Denmark
| | - Karen Lyng Larsen
- Clinic of Surgery - Woman and Child Diseases, North Denmark Regional Hospital, Hjørring, Denmark
| | - Gitte Nielsen
- School of Nursing, University College of Northern Denmark, Hjørring, Denmark
| | - Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Voldbjerg SL, Laugesen B, Bahnsen IB, Jørgensen L, Sørensen IM, Grønkjaer M, Sørensen EE. Integrating the fundamentals of care framework in baccalaureate nursing education: An example from a nursing school in Denmark. J Clin Nurs 2018; 27:2506-2515. [PMID: 29575165 DOI: 10.1111/jocn.14354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2018] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To describe and discuss the process of integrating the Fundamentals of Care framework in a baccalaureate nursing education at a School of Nursing in Denmark. BACKGROUND Nursing education plays an essential role in educating nurses to work within healthcare systems in which a demanding workload on nurses results in fundamental nursing care being left undone. Newly graduated nurses often lack knowledge and skills to meet the challenges of delivering fundamental care in clinical practice. To develop nursing students' understanding of fundamental nursing, the conceptual Fundamentals of Care framework has been integrated in nursing education at a School of Nursing in Denmark. DESIGN AND METHODS Discursive paper using an adjusted descriptive case study design for describing and discussing the process of integrating the conceptual Fundamentals of Care Framework in nursing education. RESULTS The process of integrating the Fundamentals of Care framework is illuminated through a description of the context, in which the process occurs including the faculty members, lectures, case-based work and simulation laboratory in nursing education. Based on this description, opportunities such as supporting a holistic approach to an evidence-based integrative patient care and challenges such as scepticism among the faculty are discussed. CONCLUSION It is suggested how integration of Fundamentals of Care Framework in lectures, case-based work and simulation laboratory can make fundamental nursing care more explicit in nursing education, support critical thinking and underline the relevance of evidence-based practice. The process relies on a supportive context, a well-informed and engaged faculty, and continuous reflections on how the conceptual framework can be integrated. RELEVANCE TO CLINICAL PRACTICE Integrating the Fundamentals of Care framework can support nursing students' critical thinking and reflection on what fundamental nursing care is and requires and eventually educate nurses in providing evidence-based fundamental nursing care.
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Affiliation(s)
- Siri Lygum Voldbjerg
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,School of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Britt Laugesen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Iben Bøgh Bahnsen
- School of Nursing, University College of Northern Denmark, Aalborg, Denmark
| | - Lone Jørgensen
- Clinic for Surgery and Oncology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Mette Grønkjaer
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Jangland E, Mirza N, Conroy T, Merriman C, Suzui E, Nishimura A, Ewens A. Nursing students' understanding of the Fundamentals of Care: A cross-sectional study in five countries. J Clin Nurs 2018. [PMID: 29526052 DOI: 10.1111/jocn.14352] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVE To explore the accuracy with which nursing students can identify the fundamentals of care. BACKGROUND A challenge facing nursing is ensuring the fundamentals of care are provided with compassion and in a timely manner. How students perceive the importance of the fundamentals of care may be influenced by the content and delivery of their nursing curriculum. As the fundamentals of care play a vital role in ensuring patient safety and quality care, it is important to examine how nursing students identify these care needs. DESIGN Cross-sectional descriptive design. METHODS A total of 398 nursing students (pre- and postregistration) from universities in Sweden, England, Japan, Canada and Australia participated. The Fundamentals of Care Framework guided this study. A questionnaire containing three care scenarios was developed and validated. Study participants identified the fundamentals of care for each of the scenarios. All responses were rated and analysed using ANOVA. RESULTS The data illustrate certain fundamentals of care were identified more frequently, including communication and education; comfort and elimination, whilst respecting choice, privacy and dignity were less frequently identified. The ability to identify all the correct care needs was low overall across the pre- and postregistration nursing programmes in the five universities. Significant differences in the number of correctly identified care needs between some of the groups were identified. CONCLUSIONS Nursing students are not correctly identifying all a patient's fundamental care needs when presented with different care scenarios. Students more frequently identifying physical care needs and less frequently psychosocial and relational needs. The findings suggest educators may need to emphasise and integrate all three dimensions. RELEVANCE TO CLINICAL PRACTICE To promote students' ability to identify the integrated nature of the fundamentals of care, practising clinicians and nurse educators need to role model and incorporate all the fundamental care needs for their patients.
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Affiliation(s)
- Eva Jangland
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Noeman Mirza
- School of Nursing, Thompson Rivers University, Kamloops, BC, Canada
| | - Tiffany Conroy
- Adelaide Nursing School, University of Adelaide, Adelaide, South Australia, Australia
| | - Clair Merriman
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Emiko Suzui
- New Department Preparatory Office, Otemae University, Kobe, Japan
| | - Akiko Nishimura
- Department of Nursing School of Nursing, Hyogo University of Health Sciences, Kobe, Japan
| | - Ann Ewens
- Centre of Excellence in Healthcare Education, Staffordshire University, Stoke-on-Trent, UK
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