Abstract
Plain English summaryPlain English summaryThe aim of this project was to find out the priorities for research that could improve fundamental care. ‘Fundamental care’ covers all aspects of basic care in hospital wards, such as helping with core physical needs, building positive relationships and keeping patients safe.By setting the priorities with patients, carers, the public and health care professionals, research can look at the issues that really matter to people who are receiving or delivering care in hospital wards.Previously, prioritisation exercises have started with a menu of options and asked people to choose from that list. They have also been focused on specific health conditions. Traditionally, there has been little opportunity for patients, carers and the public to contribute to identifying the issues to be prioritised.To develop the priorities for research, we started by exploring what is meant by ‘fundamental care’, looking at patient and carer accounts and academic and policy reports. Patients, carers, staff, and members of the public were consulted via surveys, interviews and group discussions to share experiences and issues.A list of 15 topics was identified based on what was most commonly mentioned by patients, carers and healthcare professionals as well as what was practical for the CLAHRC Wessex team to research. A workshop with patients, carers and healthcare professionals was held, to decide the top 5 areas.The five priority areas identified were:Nurse staffingIndividualised patient careStaff communicationStaff attitudes and relationships with patientsInformation about care/communication Background The provision of high quality fundamental care in hospitals is a top priority for the NHS. Recent reports and investigations highlight that at times care has fallen below standard. It is unclear what research should be prioritised to improve care. The aim of this work is to involve patients/carers/public, clinicians and other stakeholders to identify issues that are priorities for research which could improve fundamental care in hospital. Methods Patient and public involvement was integral to this project, with a patient leader/service user being a member of the core team who designed and executed this research. After consideration of existing priority setting approaches, we developed an inclusive approach which consisted of six main phases: 1) Development of a conceptual framework of fundamental care, based on reports and literature 2) Consultation with a wide range of stakeholders through a survey, focus groups and interviews 3) Identifying themes from the responses to the consultation phase (76 themes identified) 4) Analysis to identify the 15 topics most frequently cited 5) Prioritisation of the top 15 themes through a half day workshop, which led to a shortlist of five themes 6) Development of the top 5 themes into research areas. Results Three hundred forty stakeholders (29 % of whom were patients/carers/public) completed the consultation survey. Analysis of the survey responses and of focus groups and interviews led us to identify 15 high scoring themes. We presented these at the prioritisation workshop, attended by 39 participants (23 of whom patients/carers/public). After a voting exercise, the 5 top research priorities which emerged were: nurse staffing; individualised patient care; staff communication; staff attitudes and relationships with patients; and information about care. Conclusions We involved a range of stakeholders in identifying topics for research to improve fundamental care and asked them to prioritise these. The process provided a means of reaching consensus as to the important issues for future research to focus on to improve fundamental care on hospital wards.
Highlights
The provision of high quality fundamental care in hospitals is a top priority for the NHS
In this paper we report on work to determine priorities for research to improve fundamental care as part of the work of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex (NIHR CLAHRC Wessex)
After an initial review of priority setting approaches, we set about developing an inclusive approach that would be suitable to determine areas for research to improve fundamental care on hospital wards
Summary
The provision of high quality fundamental care in hospitals is a top priority for the NHS. A series of investigations into high profile failures and numerous reports [2, 3] have highlighted substantial and significant variations in the quality of fundamental care provided to patients in NHS hospitals [4,5,6]. A number of initiatives have been proposed to improve the capacity of hospital nurses to deliver safe and effective fundamental care. These range from single interventions such as guidelines on specific aspects of care, through to organisational initiatives such as routine reporting of adverse events (e.g. the safety thermometer [9]), or quality improvement programmes such as the “productive ward” [10]. Few studies of nursing interventions to improve fundamental care use robust methodologies that allow the results to be applied to other contexts and there is little evidence of a programmatic approach [11]
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