| 1. |
- Pavedahl, Veronica, 1980-, et al.
(författare)
-
Fundamentals of care in the emergency room – An ethnographic observational study
- 2021
-
Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 58
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is a strong biomedical focus within emergency care. However, while failure to meet patients’ fundamental care needs has severe consequences for the patient, there is limited knowledge on how nursing care is provided in emergency rooms and the related implications for patients. Aim: This study aims to explore how fundamental care needs of critically ill patients are met in emergency rooms. Methods: Non-participant observations at an emergency department in Sweden included 108 observations and field notes (150 h). Data were analysed using descriptive statistics. Results: Observations showed that registered nurses (RN) identified patients’ fundamental care needs and provided nursing care. However, the RNs’ focus on the patient decreased over time. When the RN communicated with the patient, the patients’ physical needs were met to a greater extent. The organisational structure and physical environment of emergency rooms limit RNs’ ability to meet patients’ fundamental care needs. Conclusion: Not all patients had their fundamental care needs optimally met. This study highlights the importance of RNs working in an integrated manner; an RN working bedside is crucial for establishing a patient–nurse relationship to meet the patient's physical, psychosocial, and relational needs.
|
|
| 2. |
- Pavedahl, Veronica, 1980-, et al.
(författare)
-
Prioritizing and meeting life-threateningly ill patients' fundamental care needs in the emergency room : An interview study with registered nurses
- 2022
-
Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 78:7, s. 2165-2174
-
Tidskriftsartikel (refereegranskat)abstract
- Aim To explore how registered nurses in the emergency room describe their work approach and prerequisites for meeting life-threateningly ill patients' care needs from the perspective of a person-centred fundamental care framework. Design A descriptive, qualitative interview study. Method Individual interviews were carried out with 14 registered nurses with experience of working in an emergency room in Sweden, during 2019. Data were analysed using thematic analysis, according to Braun and Clarke. The COREQ checklist was used for reporting the findings. Results Three themes were identified: Task-oriented nursing care based on structured guidelines and checklists; Fundamental care not being promoted or prioritized in the emergency room; and The organization and responsibilities for providing person-centred fundamental care are unclear. Results showed that registered nurses structure their work approach based on prevailing organizational prerequisites as well as personal ones. Meeting patients' fundamental care needs was not always prioritized; their physical needs were met to a greater extent than their relational and psychosocial needs. Registered nurses did not prioritize fundamental care when the organization did not. Conclusion From the registered nurses' perspective, they structured their work based on the prevailing conditions for meeting patients' fundamental care needs. The organizational structure does not clearly state that fundamental care should be performed in the emergency room, and the registered nurses' work approach there for meeting patients' fundamental care needs is not adapted to provide patients with person-centred care. Impact To date, little is known about registered nurses' work approach and prerequisites in meeting life-threateningly ill patients' fundamental care needs in the emergency room. Our findings indicate that the organizational structure is pivotal in supporting registered nurses to provide person-centred fundamental care. The knowledge from this study can be used in emergency care settings to facilitate person-centred fundamental care and thereby avoid fundamental care being missed.
|
|
| 3. |
- Ahlstedt, Carina, 1969-, et al.
(författare)
-
What makes registered nurses remain in work? : An ethnographic study
- 2019
-
Ingår i: International Journal of Nursing Studies. - : Elsevier Ltd. - 0020-7489 .- 1873-491X. ; 89, s. 32-38
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Registered nurses’ work-related stress, dissatisfaction and burnout are some of the problems in the healthcare and that negatively affect healthcare quality and patient care. A prerequisite for sustained high quality at work is that the registered nurses are motivated. High motivation has been proved to lead to better working results. The theory of inner work life describes the dynamic interplay between a person's perceptions, emotions and motivation and the three key factors for a good working life: nourishment, progress and catalysts. Objectives: The aim of the study was to explore registered nurses’ workday events in relation to inner work life theory, to better understand what influences registered nurses to remain in work. Design: A qualitative explorative study with an ethnographic approach. Methods: Participant observation over four months; in total 56 h with 479 events and 58 informal interviews during observation; all registered nurses employed at the unit (n = 10) were included. In addition, individual interviews were conducted after the observation period (n = 9). The dataset was analysed using thematic analysis and in the final step of the analysis the categories were reflected in relation to the three key factors in theory of inner work life. Results: Nourishment in a registered nurse context describes the work motivation created by the interpersonal support between colleagues. It was important to registered nurses that physicians and colleagues respected and trusted their knowledge in the daily work, and that they felt comfortable asking questions and supporting each other. Progress in the context of registered nurses’ work motivation was the feeling of moving forward with a mix of small wins and the perception of solving more complex challenges in daily work. It was also fundamental to the registered nurses’ development through new knowledge and learning during daily work. Catalysts, actions that directly facilitate the work, were highlighted as the possibility to work independently along with the opportunity to work together with other registered nurses. Conclusion: This study has a number of implications for future work and research on creating an attractive workplace for registered nurses. Working independently, with colleagues from the same profession, integrated with learning, visible progress, and receiving feedback from the work itself, contribute to work motivation.
|
|
| 4. |
- Avallin, Therese, et al.
(författare)
-
Person-centred pain management for the patient with acute abdominal pain : An ethnography informed by the Fundamentals of Care framework
- 2018
-
Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 74:11, s. 2596-2609
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway.Background: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance.Design: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework.Methods: Participant observation and informal interviews (92hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged 18years seeking care for AAP at the ED and admitted to a surgical ward (N=31; aged 20-90years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N=198).Results: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics.Conclusions: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.
|
|
| 5. |
- Avallin, Therese, et al.
(författare)
-
Using communication to manage missed care : A case study applying the Fundamentals of Care framework
- 2020
-
Ingår i: Journal of Nursing Management. - : Hindawi Limited. - 0966-0429 .- 1365-2834. ; 28:8, s. 2091-2102
-
Tidskriftsartikel (refereegranskat)abstract
- AimTo explore, through the patient's perspective, how patient–provider communication is linked to missed nursing care vs. meeting patients’ fundamental care needs.BackgroundMissed 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.MethodsCase 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.ResultsCommunications 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.ConclusionCommunication 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 ManagementNursing managers can use this new knowledge of communication to facilitate person-centred fundamental care and thereby avoid missed nursing care.
|
|
| 6. |
- Donnelly, Frank, et al.
(författare)
-
The management of patients with acute abdominal pain in the emergency department : A qualitative study of nurse perceptions
- 2019
-
Ingår i: AUSTRALASIAN EMERGENCY CARE. - : ELSEVIER SCI LTD. - 2588-994X. ; 22:2, s. 97-102
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Acute abdominal pain is a common reason for presentation to the emergency department. Understanding the role of nurses involved in management of acute abdominal pain is important for improving patient care and outcomes. The aim of this study was to understand the perceptions of emergency nurses in the management of acute abdominal pain. Methods: Using a qualitative design, a purposeful sample (n=9) of experienced registered nurses was recruited from the emergency department of a large tertiary public hospital in South Australia. Semi-structured interviews, informed by literature describing the management of acute abdominal pain, were used to identify the perceptions of emergency nurses when caring for patients with acute abdominal pain. Results: Thematic analysis of interviews identified four themes: Centrality of Diagnosis; Busyness and Patient Management; Systems Issues; and Communication Challenges. Of the four themes, the Centrality of Diagnosis was especially important to the nurses' sense of contribution to patient care. Care was also affected by the busyness of the environment, the systems and processes in place to manage patients and communication in the emergency department. Conclusions: The management of patients with acute abdominal pain is influenced by how nurses participate in the diagnostic process. Nurses identified their role in this process and described how this role impacted their delivery of fundamental care. Further studies of the nursing contribution to diagnosis, communication, and the systems that affect care delivery in the emergency department are required.
|
|
| 7. |
- Ekermo, David, et al.
(författare)
-
Fundamental nursing actions for frail older people in the emergency department : A national cross-sectional survey and a qualitative analysis of practice guidelines
- 2023
-
Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 79:8, s. 3115-3126
-
Tidskriftsartikel (refereegranskat)abstract
- Aims To map how frailty among older people is assessed at Swedish emergency departments and to describe fundamental nursing care actions for these patients.Design Descriptive national survey and a qualitative analysis of text.Methods A majority (82%, n = 54) of the Swedish hospital-based emergency departments for adults were included, representing all six healthcare regions. An online survey was used to collect data, together with submitted local practice guidelines for older people at the emergency departments. Data were collected during February-October 2021. Descriptive and comparative statistics were performed together with a deductive content analysis framed by the Fundamentals of Care framework.Results Sixty-five per cent (35 of 54) of the emergency departments identified frailty, with less than half of them using an established assessment instrument. Twenty-eight (52%) of the emergency departments have practice guidelines containing fundamental nursing actions for the care of frail older people. The majority of nursing actions in the practice guidelines were related to patients' physical care needs (91%), followed by psychosocial care needs (9%). No actions could be identified as relational actions (0%) according to the Fundamentals of Care framework.Conclusion Many Swedish emergency departments identify frail older people, but they use a range of different assessment instruments. While practice guidelines directing fundamental nursing actions for frail older people are often in place, a holistic, person-centred view addressing the patient's physical, psychosocial and relational care needs is missing.Impact The population is growing older, and more people are needing more complex hospital care. Frail older people have an increased risk of negative outcomes. The use of a variety of assessment instruments for frailty may pose a challenge to equal care. To ensure a holistic, person-centred view of frail older people, the Fundamentals of Care framework can be used in developing and reviewing practice guidelines.
|
|
| 8. |
- Feo, Rebecca, et al.
(författare)
-
Providing high-quality fundamental care for patients with acute abdominal pain : A qualitative study of patients' experiences in acute care
- 2019
-
Ingår i: Journal of Health Organization & Management. - : EMERALD GROUP PUBLISHING LTD. - 1477-7266 .- 1758-7247. ; 33:1, s. 110-123
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery of fundamental care across the acute care delivery chain. The purpose of this paper is to describe how patients with AAP experienced fundamental care across their acute care presentation, and to explicate the health professional behaviours, reported by patients, that contributed to their positive experiences. Design/methodology/approach A qualitative descriptive study, using repeated reflective interviews, was analysed thematically (n=10 patients). Findings Two themes were identified: developing genuine, caring relationships with health professionals and being informed about one's care. Patients reported that health professionals established genuine professional-patient relationships despite the busy care environment but perceived this environment as impeding information-provision. Patients were typically accepting of a lack of information, whereas poor professional-patient relationships were seen as inexcusable.
|
|
| 9. |
- Feo, Rebecca, et al.
(författare)
-
Towards a standardised definition for fundamental care : a modified Delphi study
- 2018
-
Ingår i: Journal of Clinical Nursing. - : John Wiley & Sons. - 0962-1067 .- 1365-2702. ; 27:11-12, s. 2285-2299
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS: To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.BACKGROUND: There is poor conceptual clarity surrounding fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.DESIGN: Modified Delphi study.METHODS: Three phases: (1) engaging stakeholders via an interactive workshop; (2) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (3) gaining consensus on the definition and elements via a two-round Delphi approach (Round 1 n=38; Round 2 n=28).RESULTS: Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse-patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.CONCLUSIONS: This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users. This article is protected by copyright. All rights reserved.
|
|
| 10. |
- Frykman, Mandus, et al.
(författare)
-
The work is never ending : uncovering teamwork sustainability using realistic evaluation
- 2017
-
Ingår i: Journal of Health Organization & Management. - 1477-7266 .- 1758-7247. ; 31:1, s. 64-81
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeThe purpose of this paper is to uncover the mechanisms influencing the sustainability of behavior changes following the implementation of teamwork.Design/methodology/approachRealistic evaluation was combined with a framework (DCOM®) based on applied behavior analysis to study the sustainability of behavior changes two and a half years after the initial implementation of teamwork at an emergency department. The DCOM® framework was used to categorize the mechanisms of behavior change interventions (BCIs) into the four categories of direction, competence, opportunity, and motivation. Non-participant observation and interview data were used.FindingsThe teamwork behaviors were not sustained. A substantial fallback in managerial activities in combination with a complex context contributed to reduced direction, opportunity, and motivation. Reduced direction made staff members unclear about how and why they should work in teams. Deterioration of opportunity was evident from the lack of problem-solving resources resulting in accumulated barriers to teamwork. Motivation in terms of management support and feedback was reduced.Practical implicationsThe implementation of complex organizational changes in complex healthcare contexts requires continuous adaption and managerial activities well beyond the initial implementation period.Originality/valueBy integrating the DCOM® framework with realistic evaluation, this study responds to the call for theoretically based research on behavioral mechanisms that can explain how BCIs interact with context and how this interaction influences sustainability.
|
|
| 11. |
- Gunningberg, Lena, et al.
(författare)
-
Pressure ulcer knowledge of registered nurses, assistant nurses and student nurses : a descriptive, comparative multicentre study in Sweden
- 2015
-
Ingår i: International Wound Journal. - : Wiley. - 1742-4801 .- 1742-481X. ; 12:4, s. 462-468
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe and compare the knowledge of registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs) about preventing pressure ulcers (PUs). PU prevention behaviours in the clinical practice of RNs and ANs were also explored. A descriptive, comparative multicentre study was performed. Hospital wards and universities from four Swedish county councils participated. In total, 415 participants (RN, AN and SN) completed the Pressure Ulcer Knowledge Assessment Tool. The mean knowledge score for the sample was 58·9%. The highest scores were found in the themes 'nutrition' (83·1%) and 'risk assessment' (75·7%). The lowest scores were found in the themes 'reduction in the amount of pressure and shear' (47·5%) and 'classification and observation' (55·5%). RNs and SNs had higher scores than ANs on 'aetiology and causes'. SNs had higher scores than RNs and ANs on 'nutrition'. It has been concluded that there is a knowledge deficit in PU prevention among nursing staff in Sweden. A major educational campaign needs to be undertaken both in hospital settings and in nursing education.
|
|
| 12. |
- Jangland, Eva, et al.
(författare)
-
Inadequate environment, resources, and values lead to missed nursing care : A focused ethnographic study on the surgical ward using the Fundamentals of Care framework
- 2018
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:11-12, s. 2311-2321
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: The purpose was to explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework.BACKGROUND: The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high- quality, person-centred care it is important to understand how these factors affect patients' experiences and care needs.DESIGN: A focused ethnographic approach.METHOD: A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis.RESULTS: The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety.CONCLUSION: Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership, and challenges to patients' safety. The findings highlight the crucial importance of prioritizing and valuing the patients' fundamental care needs for recovery.RELEVANCE TO CLINICAL PRACTICE: Nursing leaders and nurses need to take the lead to re-conceptualize the value of fundamental care in the acute care setting. To improve clinical practice the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery.
|
|
| 13. |
- Jeffs, Lianne, et al.
(författare)
-
Building the Foundation to Generate a Fundamental Care Standardized Data Set
- 2018
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:11-12, s. 2481-2488
-
Tidskriftsartikel (refereegranskat)abstract
- Considerable transformation is occurring in healthcare globally with organizations focusing on achieving the quadruple aim of improving the experience of care, the health of populations, and the experience of providing care while reducing per capita costs of health care. In response, health care organizations are employing performance measurement and quality improvement methods to achieve the quadruple aim. Despite the plethora of measures available to health managers, there is no standardized data set and virtually no indicators reflecting how patients actually experience the delivery of fundamental care, such as nutrition, hydration, mobility, respect, education, and psychosocial support. Given the linkages of fundamental care to safety and quality metrics, efforts to build the evidence base and knowledge that captures the impact of enacting fundamental care across the health care continuum and lifespan should include generating a routinely collected data set of relevant measures. This paper provides an overview of the current state of performance measurement, key trends, and a methodological approach to leverage in efforts to generate a standardized data set for fundamental care.
|
|
| 14. |
- Kitson, Alison, et al.
(författare)
-
Development and preliminary testing of a framework to evaluate patients' experiences of the fundamentals of care : a secondary analysis of three stroke survivor narratives.
- 2013
-
Ingår i: Nursing Research and Practice. - : Hindawi Limited. - 2090-1429 .- 2090-1437. ; 2013, s. 572437-
-
Tidskriftsartikel (refereegranskat)abstract
- Aim. To develop and test a framework describing the interrelationship of three key dimensions (physical, psychosocial, and relational) in the provision of the fundamentals of care to patients. Background. There are few conceptual frameworks to help healthcare staff, particularly nurses, know how to provide direct care around fundamental needs such as eating, drinking, and going to the toilet. Design. Deductive development of a conceptual framework and qualitative analysis of secondary interview data. Method. Framework development followed by a secondary in-depth analysis of primary narrative interview data from three stroke survivors. Results. Using the physical, psychosocial and relational dimensions to develop a conceptual framework, it was possible to identify a number of "archetypes" or scenarios that could explain stroke survivors' positive experiences of their care. Factors contributing to suboptimal care were also identified. Conclusions. This way of thinking about how the fundamentals of care are experienced by patients may help to elucidate the complex processes involved around providing high quality fundamentals of care. This analysis illustrates the multiple dimensions at play. However, more systematic investigation is required with further refining and testing with wider healthcare user groups. The framework has potential to be used as a predictive, evaluative, and explanatory tool.
|
|
| 15. |
- Kitson, Alison L., et al.
(författare)
-
‘No more heroes’ : The ILC Oxford Statement on fundamental care in times of crises
- 2023
-
Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 79:3, s. 922-932
-
Forskningsöversikt (refereegranskat)abstract
- AimTo 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/MethodDiscussion paper. The content was developed via a co-design process with participants during the ILC's international conference. Key ArgumentsWe, 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. ConclusionTo 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.
|
|
| 16. |
- Kitson, Alison, et al.
(författare)
-
Speaking Up for Fundamental Care : the ILC Aalborg Statement
- 2019
-
Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:12
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 17. |
- Muntlin Athlin, Åsa, Docent, 1971-, et al.
(författare)
-
Bedside nurses' perspective on the fundamentals of care framework and its application in clinical practice. : A multi-site focus group interview study
- 2023
-
Ingår i: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 145, s. 104526-104526
-
Tidskriftsartikel (refereegranskat)abstract
- Background: A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives.Objective: To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice.Design: A descriptive qualitative design informed by the Fundamentals of Care framework.Setting(s): The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019.ParticipantsA total sample of 53 registered nurses working at the bedside participated.Participants: had a wide variety of clinical experience and represented a range of different nursing practice areas.Methods: Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach.Results: Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership.Conclusions: The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework.Tweetable abstract: Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.
|
|
| 18. |
- Muntlin Athlin, Åsa, 1971-, et al.
(författare)
-
Descriptions of Fundamental Care needs in cancer care - an exploratory study
- 2018
-
Ingår i: Journal of Clinical Nursing. - : Wiley-Blackwell Publishing Inc.. - 0962-1067 .- 1365-2702. ; 27:11-12, s. 2322-2332
-
Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVES: To explore the experiences of the fundamentals of care for people with a cancer diagnosis, from diagnosis to after adjuvant treatment.BACKGROUND: More focus is needed on the experience of people living with cancer, as current cancer care more emphasises on independence and resilience without fully acknowledging that there will be moments in the cancer journey where patients will need 'basic nursing care' to manage their symptoms and care pathways.DESIGN: Secondary analysis of qualitative data.METHOD: Secondary thematic analysis of interview data from 30 people with a diagnosis of breast (n=10), colorectal (n=10) or prostate (n=10) cancer was undertaken.RESULTS: The findings revealed vivid descriptions of the fundamentals of care (i.e. basic needs) and participants described physical, psychosocial and relational aspects of the delivery of care. Both positive (e.g. supportive and kind) and negative (e.g. humiliating) experiences related to the relationship with the healthcare professionals were re-counted and affected the participants' experiences of the fundamentals of care. Participants' accounts of their fundamental care needs were provided without them identifying who, within the health care system, was responsible for providing these needs. Specific nursing interventions were seldom described.CONCLUSION: Some people with a cancer diagnosis have to strive for help and support from the nursing staff to manage to regain control over their recovery. Nurses in cancer care need to focus on the patients' fundamental care needs to optimise their patients' recovery. This article is protected by copyright. All rights reserved.
|
|
| 19. |
|
|
| 20. |
- Muntlin Athlin, Åsa, 1971-
(författare)
-
Methods, metrics and research gaps around minimum data sets for nursing practice and fundamental care : A scoping literature review
- 2018
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 27:11/12, s. 2230-2247
-
Tidskriftsartikel (refereegranskat)abstract
- Aims and objectivesTo examine and map research on minimum data sets linked to nursing practice and the fundamentals of care. Another aim was to identify gaps in the evidence to suggest future research questions to highlight the need for standardisation of terminology around nursing practice and fundamental care.BackgroundAddressing fundamental care has been highlighted internationally as a response to missed nursing care. Systematic performance measurements are needed to capture nursing practice outcomes.DesignOverview of the literature framed by the scoping study methodology.MethodPubMed and CINAHL were searched using the following inclusion criteria: peer‐reviewed empirical quantitative and qualitative studies related to minimum data sets and nursing practice published in English. No time restrictions were set. Exclusion criteria were as follows: no available full text, reviews and methodological and discursive studies. Data were categorised into one of the fundamentals of care elements.ResultsThe review included 20 studies published in 1999–2016. Settings were mainly nursing homes or hospitals. Of 14 elements of the fundamentals of care, 11 were identified as measures in the included studies, but their frequency varied. The most commonly identified elements concerned safety, prevention and medication (n = 11), comfort (n = 6) and eating and drinking (n = 5).ConclusionStudies have used minimum data sets and included variables linked to nursing practices and fundamentals of care. However, the relations of these variables to nursing practice were not always clearly described and the main purpose of the studies was seldom to measure the outcomes of nursing interventions. More robust studies focusing on nursing practice and patient outcomes are warranted.
|
|
| 21. |
- Tegelberg, Alexander, 1974-, et al.
(författare)
-
Engagement under difficult conditions : Caring for patients with acute abdominal pain across the acute-care chain: A qualitative study
- 2020
-
Ingår i: International Emergency Nursing. - : ELSEVIER SCI LTD. - 1755-599X .- 1878-013X. ; 52
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 22. |
- Tegelberg, Alexander, 1974-
(författare)
-
Managers and health professionals in the acute care chain : – A need for a shared understanding in the care of patients with acute abdominal pain
- 2021
-
Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Managers and health professionals, so-called stakeholders, at the system and clinical level in the acute care chain, are responsible for providing safe and high-quality care encompassing both nursing and medical aspects. In patients with acute abdominal pain (AAP), high-quality nursing care has been described as not always being delivered across the entire acute care chain. This patient group frequently seeks care across the acute care chain and the care procedures and quality may differ widely. The quality of nursing care provided to patients can be understood through the framework Fundamentals of Care. The framework is divided into three dimensions: establishing a relationship with the patient, integration of the patient’s fundamental care needs, and context of care. Stakeholders are one important part of the context of care and a prerequisite for delivery of high-quality care. Aim: The overall aim was to explore managers’ and health professionals’ understanding of managing and conducting care of patients with AAP across the acute care chain. Method: Individual interviews with open-ended questions were used in two studies and data were analysed with a conventional qualitative content analysis method. Participants represented ambulance services, emergency departments, and surgical departments. Managers at head nurse level (n=11) and operational level (n=6) at four hospitals were included in Study I. Registered nurses (n=11) and physicians (n=8) at five hospitals were included in Study II.Results: In Study I, managers described the adult patient group as challenging and heterogenous. The managers reflected on themselves as role models. Guidelines were used to organise care, but they often had a medical focus and the managers referred to others as being responsible for the guidelines. Managers who were registered nurses focused on the medical care of patients with AAP, while managers who were physicians underlined the value of nursing care to improve patient outcome. In Study II, health professionals described dedication to applying evidence-based practices. However, they used personal experience over guidelines in care provision. They described organisational barriers to delivering high-quality care, such as varying competence among colleagues, lack of available patient beds, and lack of collaboration across the acute care chain. Conclusion: The stakeholders’ perspectives complemented each other, but their descriptions of managing and conducting care of patients with AAP did not always fit together, which revealed a gap in the everyday clinical practices as well as structural issues at the system level. These empirical descriptions of differing understanding may reveal some of the reasons why patients with AAP do not always experience high-quality care. To optimise patient care across the acute care chain, stakeholders need a shared understanding to meet patients’ fundamental care needs and enable provision of high-quality nursing and medical care.
|
|
| 23. |
- Tegelberg, Alexander, 1974-, et al.
(författare)
-
Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain
- 2019
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 28:19-20, s. 3641-3650
-
Tidskriftsartikel (refereegranskat)abstract
- Aim and objectives: To describe managers' perspectives on the care of patients with acute abdominal pain and explore how they influence the care.Background: Patients with acute abdominal pain form a common group of patients who often report poor pain management. Managers are key actors in ensuring that patients receive high‐quality care. This stresses the need to deepen the understanding of their perspectives on these patients, in order to provide high‐quality fundamental care across the acute care chain.Design: Qualitative descriptive semi‐structured interview study, with an inductive approach. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used.Methods: Individual interviews were conducted with managers (n = 17) from ambulance services, emergency departments and surgical departments at four hospitals in Sweden, representing managers at the micro‐ and macrolevels across the acute care chain.Results: The patient group was described as a challenging heterogeneous group, with a focus on medical care, shaped by clinical practice guidelines, for which others were responsible. Managers with a physician background expressed that nursing care was important for the outcome of the care, while managers with a nursing background focused solely on the medical care. Additionally, the managers described that they affected the care by providing resources and serving as role models.Conclusions: The solely medical perspective is worrying. By being a stakeholder, the managers' responsibility should be to highlight the patient perspective in the care and promote and support all health professionals in redesigning the care, where achieving higher quality both in nursing and in medical care for patients with acute abdominal pain becomes a shared goal.Relevance to clinical practice: Managers should use their leadership to bridge the gap between medicine and nursing care by highlighting patients' need for fundamental care, and to support health professionals in providing evidence‐based and high‐quality care.
|
|
