Abstract
ObjectiveTo explore how nurses in hospitals enact person‐centred fundamental care delivery.BackgroundEffective person‐centred care is at the heart of fundamental nursing care, but it is deemed to be challenging in acute health care as there is a strong biomedical focus and most nurses are not trained in person‐centred fundamental care delivery. We therefore need to know if and how nurses currently incorporate a person‐centred approach during fundamental care.DesignFocused ethnography approach.MethodsObservations of 30 nurses on three different wards in two Dutch hospitals during their morning shift. Data were collected through passive observations and analysed using framework analysis based on the fundamentals of care framework. The COREQ guideline was used for reporting.ResultsSome nurses successfully integrate physical, psychosocial and relational elements of care in patient interactions. However, most nurses were observed to be mainly focused on physical care and did not take the time at their patients’ bedside to care for their psychosocial and relational needs. Many had a task‐focused way of working and communicating, seldom incorporating patients’ needs and experiences or discussing care planning, and often disturbing each other.ConclusionsThis study demonstrates that although some nurses manage to do so, person‐centred fundamental care delivery remains a challenge in hospitals, as most nurses have a task‐focused approach and therefore do not manage to integrate the physical, relational and physical elements of care. For further improvement, attention needs to be paid to integrated fundamental care and clinical reasoning skills.Relevance to clinical practiceAlthough most nurses have a compassionate approach, this study shows that nurses do not incorporate psychosocial care or encourage patient participation when helping patients with their physical fundamental care needs, even though there seems to be sufficient opportunity for them to do so.
Highlights
Kitson et al (2010) have defined the fundamentals of care (FoC) as the basic elements of nursing care
The FoC Framework (FoCF) was developed to demonstrate how the FoC is re‐ lated to the nurse–patient relationship and the care setting in which nursing care is to be delivered (Feo et al, 2018; Kitson, Conroy, Kaluski, Locock, & Lyons, 2013)
At the core of the FoCF lies the nurse–patient relationship, which is essential for effective nursing care
Summary
Kitson et al (2010) have defined the fundamentals of care (FoC) as the basic elements of nursing care. The FoC Framework (FoCF) was developed to demonstrate how the FoC is re‐ lated to the nurse–patient relationship and the care setting in which nursing care is to be delivered (Feo et al, 2018; Kitson, Conroy, Kaluski, Locock, & Lyons, 2013). Nurses who successfully use these relational elements of care can work effectively to meet the patient's fundamen‐ tal needs (Feo & Kitson, 2016). The literature suggests that the current acute healthcare setting does not enable effective patient participation (Tobiano, Marshall, Bucknall, & Chaboyer, 2016), as it has a strong biomedical focus and places little priority on fundamen‐ tal, person‐centred nursing care (Feo & Kitson, 2016), making patient participation hard to achieve (Hoglund, Winblad, Arnetz, & Arnetz, 2010; Ringdal, Chaboyer, Ulin, Bucknall, & Oxelmark, 2017). | 1935 objective was to gain insights into daily practice, by investigating person‐centredness and patient participation in fundamental care delivery by nurses in hospitals as a first step
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