Factors influencing nurses’ delivery of the fundamentals of care in acute hospital wards

Abstract

Background There is an ongoing challenge facing the nursing profession in ensuring that the ‘basics’ of care are carried out optimally. These ‘basics’ or ‘fundamentals’ - which include ensuring appropriate nutrition, hydration, personal hygiene, sleep, rest and dignity to name but a few - traditionally have been the responsibility of the nurse on behalf of the healthcare team. There is evidence from patients, the public and nurses themselves that the nursing profession has not been able to provide quality basic nursing – or the fundamentals of care – as consistently or adequately as needed. The Fundamentals of Care Framework was developed to illustrate the need to develop a trusting nurse-patient relationship and to integrate the patients physical, psychosocial and relational needs. However, there had not yet been an empirical exploration of the factors that influence nurses’ delivery of the fundamentals of care. This study aimed to address this gap. Aim and research questions The aim of the study was to explore the factors that facilitate or hinder the delivery of the fundamentals of care in the acute care setting by answering the following questions: • What factors are observed to influence the delivery of the fundamentals of care in an acute care hospital? • What factors do nurses working in an acute care hospital describe as influencing the delivery of the fundamentals of care? • What factors do patient representatives from an acute care hospital describe as influencing the delivery of the fundamentals of care? Methods A focused ethnography, utilising a three-stage iterative approach was undertaken. Stage 1 consisted of direct observation of nurse-patient interactions related to the delivery of the fundamentals of care in the acute care setting. Stage 2 involved focus groups of patient representatives and nurses to explore their respective perceptions of factors influencing the delivery of the fundamentals of care using scenarios derived from stage 1 as a prompt. Stage 3 involved interviews with clinically based nursing leaders to explore their strategies for moderating some of the factors influencing the delivery of the fundamentals of care. Findings and Conclusions Complex interactions between and among the physical, relational, psychosocial and contextual elements involved in delivering the fundamentals of care were observed. Although each focus group provided its own perspective on the factors influencing the delivery of the fundamentals of care, there was consistency in the factors they described. These factors include the influence of the nurse-patient relationship, nursing leadership and the context of care delivery. Also described was the importance of involving patients and ensuring they understand their care, while respecting their care choices. Other factors include the need for good communication and the ability to negotiate priorities for care while recognising the specific care needs and characteristics of the patient. The influence of nursing leadership on these and other factors was noted and explored with clinical nursing leaders. This enabled the generation of an empirically based set of evidence-based strategies that can be used by clinical nursing leaders to promote delivery of the fundamentals of care in the acute care setting.