Fundamental Care Research Articles

Fundamental care: An evolutionary concept analysis.

To report an analysis of the concept of fundamental care in the literature. An evolutionary concept analysis. PubMed and CINAHL Complete databases were consulted using the key terms: fundamental care, fundamentals of care, essential care, basic nursing care and basic care revised. Articles published from 2008 to 2022, in English and Italian, in scholarly/peer-reviewed nursing journals were included. Rodgers's Evolutionary Method of concept analysis was used. Our thematic analysis yielded common themes related to the concept, antecedents, attributes and consequences of fundamental care. A total of 50 articles were analysed. Thirty-eight attributes were identified, such as integration of care, patient and family centred care and trusting relationship; eight antecedents including nursing care, nursing practice and care context; and 17 consequences including the safety, quality and consistency of care. This review of literature reveals that there is no consistent definition of the concept of 'fundamental care'. Findings from this exploration of the literature emphasized the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality fundamental care. Our definition of this concept may help nurse leaders in practice, research, education, management and policy to promote and enhance the application of fundamental care. What problem did the study address? While numerous studies examine fundamental nursing care, various terms are used with no consensus on definitions emerging. Given the relevance of this topic, reaching a clear and agreed definition of fundamental care is essential. What were the main findings? Fundamental care encompasses the importance of communication, the contextual environment, leadership influence and nurse-patient relationship in providing effective and high-quality care. Where and on whom will the research have an impact? This definition of fundamental care will assist nurse leaders and researchers to promote and enhance the examination and application of fundamental care in clinical practice to ensure better care outcomes across all healthcare settings.

Nursing care of people with dementia in an orthopaedic acute care setting: An integrative literature review.

This integrative literature review is to collect what is known about the care of people with dementia when they require a hospital admission for an orthopaedic surgical procedure and to contribute to developing an evidence-base to support nursing practice when caring for people with dementia in an orthopaedic setting. People with a dementia diagnosis are increasingly common in acute orthopaedic care settings and the admission exposes people with dementia to risks during their hospital stay. In addition, nurses find people with dementia challenging to care for due to the complexity of dual conditions. Little is known specifically about the care requirements for people with dementia in orthopaedic settings. Integrative literature review. An integrative literature review and qualitative deductive content analysis using McCormack and McCance's theoretical nursing framework (Person-Centred Nursing Framework) of nine studies were undertaken. The process of the review was guided by PRISMA checklist. The care environment and resistance either in passive form, or through physical intervention, is common in orthopaedic nursing. Planning and delivering care for physical, cognitive and emotional needs is identified as being difficult, resulting in a lack of inclusion for patients, partly due to communication challenges. Finding ways to implement tailored care plans within standard ward routines proves difficult, and the consequence is a less than optimal care experience with adverse effects on patients characterised by an increase in dementia symptoms. Care for people with dementia in an orthopaedic setting is complex. It needs to be further studied so that more evidence and supporting literature can contribute to improved care for this group of patients. This study describes the complexity of providing fundamental care for people with dual conditions of dementia and orthopaedic injury and suggests opportunities for improvement.

Association between Socio-Demographic Factors and Owners' Beliefs and Attitudes to Pet Cats Fundamental Dietary and Physical Exercise Needs, in City of Belfast.

Simple SummaryPet cats need their humans for shelter, food, water, and company while, humans are responsible for providing such standard of care so as to ensure good health and welfare of their animals. This study investigated if owners’ beliefs and perceptions of pet cats’ needs and selected behaviours are associated with socio-demographic factors, in order to assess standards of fundamental care provided to animals. We found that selected socio-demographic factors, e.g., owner’s occupation or gender, are significantly associated with the owner’s beliefs/opinions and practices of care provided to their pet cats, e.g., type and amount of food or exercise provided to pet cats. The results of this study indicate that some owners may not have sufficient knowledge to provide an appropriate level of care to their cats and thus additional training in fundamental care for non-professionals (as opposed to veterinary and animal science professionals) would benefit the animals.A cross-sectional survey questionnaire was developed in-house to investigate pet cat owners’ beliefs and attitudes related to the fundamental care of their pet cats. The questionnaire consisted of questions which were grouped into the following sections: (i) owners’ socio-demographics; (ii) cat(s) body weight and body condition monitoring; (iii) owners’ attitudes to cats’ dietary preferences, needs and satisfaction, (iv) owners’ perceptions of their cats’ physical exercise needs and satisfaction. The sample size of 376 was estimated to be required to represent the population of the given geographical location (Belfast, NI, UK). Hard copies of the questionnaires were distributed in January and February 2019 and in total 402 completed questionnaires were collected; questionnaires which included >20% of missing or incomprehensible responses were excluded from the database, resulting in 398 questionnaires being included in the final database. The study identified a number of socio-demographic factors associated with owners’ beliefs and attitudes that directly affect care provided to pet cats, e.g., the owner’s occupation has been identified as a factor associated with owner perception of certain cats’ behaviours, e.g., a cat brushing against the owner as food requests by their animal (Chi-Square 7.711 (df1), exact p = 0.006). Furthermore, most female respondents, aged 26–67 years and in an occupation not related to animals, reported selecting cat food based on their animal preferences (Chi-Square 10.332 (df1), exact p = 0.003). In contrast, female owners in animal and veterinary occupations were significantly more likely as compared to other respondents (Chi-Square 15.228 (df1), exact p < 0.001), to select cat food based on its perceived health benefit to the cat. Analysis of the respondents’ opinions of cats’ abilities to self-regulate physical activity showed that owners age was the main differentiating determinant, i.e., cat owners over 25 years old were significantly more likely than younger adults to believe that pet cats can regulate their own physical activity to keep healthy (Chi-Square 6.313 (df1), exact p = 0.025). Furthermore, respondents’ opinions of their cat’s ability to self-regulate feed intake were mainly associated with owner’s education level (Chi-Square 6.367 (df1), exact p = 0.036). The study results indicated that the attitude and beliefs behind the fundamental care practices provided to pet cats depends on particular demographic factors, especially owners’ education and occupation.

Invasiveness of Ventilation Therapy Is Associated to Prevalence of Secondary Bacterial and Fungal Infections in Critically Ill COVID-19 Patients.

Superinfections are a fundamental critical care problem, and their significance in severe COVID-19 cases needs to be determined. This study analyzed data from the Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS) cohort focusing on intensive care patients. A retrospective analysis of patient data from 840 cases of COVID-19 with critical courses demonstrated that co-infections were frequently present and were primarily of nosocomial origin. Furthermore, our analysis showed that invasive therapy procedures accompanied an increased risk for healthcare-associated infections. Non-ventilated ICU patients were rarely affected by secondary infections. The risk of infection, however, increased even when non-invasive ventilation was used. A further, significant increase in infection rates was seen with the use of invasive ventilation and even more so with extracorporeal membrane oxygenation (ECMO) therapy. The marked differences among ICU techniques used for the treatment of COVID-19-induced respiratory failure in terms of secondary infection risk profile should be taken into account for the optimal management of critically ill COVID-19 patients, as well as for adequate antimicrobial therapy.

Development and validation of the perioperative care and user participation (POUP) questionnaire.

To validate a Perioperative User Participation questionnaire (POUP) that measures elective adult surgical patient experiences and evaluation of the significance of selected perioperative care items. A generic perioperative user involvement questionnaire (POUP) was developed in the form of four psychometric scales based on the Fundamentals of Care (FoC) framework. The POUP is designed to capture patients' perceived and subjective importance of selected items of perioperative care. It was developed in Danish and comprehensive Danish-Norwegian translations were conducted. Face and content validation were conducted involving patients and expert nurses. The relevance of items was assessed by 68 patients, and the internal consistency of the scales was calculated. Danish and Norwegian patients assessed the POUP's face validity, and perioperative expert nurses reported no problems in clarity or ambiguity. However, a few reformulations of the questionnaire texts were suggested. None of the questions were reported as irrelevant or difficult to answer nor was any topic reported missing. Patients assessed all items as relevant, and the internal consistency for the three scales was between 0.8 and 0.9, and no differences between countries were found. The POUP questionnaire has four scales; the items are valid, but the scales need further statistical validation and refinement. At present, the POUP might provide insight into how elective adult surgical patients value the significance of perioperative care.

The Need for an Adult Intensive Care Unit Boot Camp for Residents and Fellows: A Cross-Sectional Survey among Intensive Care Unit Directors.

The concept of "see one, do one, teach one" raises concerns regarding patient safety in the intensive care unit (ICU) and highlights the need for prior preparation of residents/fellows for ICU rotation. This study assessed the need for an adult pre-ICU "boot camp" training course. An online questionnaire regarding the current ICU training and desirable course framework was distributed via e-mail to the ICU directors of 269 educational centers certified by the Japanese Society of Intensive Care Medicine. The response rate was 39% (106/269). The number of residents/fellows undergoing ICU rotation was 5.5 (IQR 2-12) /ICU/year, and the majority (63%) were second to fourth year post-graduate residents and fellows. ICU directors opined that of the fundamental critical care skills, residents/fellows performed well or very well in only seven out of 29 skills (24%). Only 18% of the ICU directors had an established ICU training curriculum. Overall, 72% of the directors were interested in the boot camp. The desirable course framework was 3-5 hours per day with simulations and lectures. The core skills that directors considered as important to acquire during ICU rotation were central venous catheter insertion, tracheal intubation, defibrillation, initiation of mechanical ventilation, physical examination of critically ill patients, and shock assessment. Residents/fellows began ICU rotations with suboptimal skills as reported by ICU directors. In addition, most of the ICUs had not established a training curriculum. Therefore, having an ICU boot camp is necessary to enhance critical care skills and to decrease medical errors.

Can fundamental care be advanced using the science of care framework?

This manuscript aims to provide a description of an evidence-informed Science of Care practice-based research and innovation framework that may serve as a guiding framework to generate new discoveries and knowledge around fundamental care in a more integrated manner. New ways of thinking about models of care and implementation strategies in transdisciplinary teams are required to accelerate inquiry and embed new knowledge and innovation into practice settings. A new way of thinking starts with an explicit articulation and commitment to the core business of the healthcare industry which is to provide quality fundamental care. This discursive paper delineates an iteratively derived Science of Care research and innovation framework (Science of Care Framework) that draws from a targeted literature review. The Science of Care Framework integrates caring science with safety and symptom sciences with implementation, improvement, innovation and team sciences. Each science dimension is described in terms of seminal and evolving evidence and theoretical explanations, focusing on how these disciplines can support fundamental care. The Science of Care Framework can serve as a catalyst to guide future efforts to propel new knowledge and discoveries around fundamental care and how best to implement it into clinical practice through a transdisciplinary lens. The Science of Care Framework can accelerate nursing discipline-specific knowledge generation alongside inter and transdisciplinary insights. The novel articulation of the Science of Care Framework can be used to guide further inquiries that are co-designed, and led, by nurses into integrated models of care and innovations in clinical practice.

Nursing representatives in clinical quality databases and the presence of nursing-sensitive indicators of fundamental nursing care.

To identify and describe nursing-sensitive indicators in Danish clinical quality databases and to examine the association between nurse representation on database steering committees and the presence of indicators related to aspects of fundamental care. This was a cross-sectional study. The STROBE checklist was employed to ensure reporting quality. We reviewed data from the latest annual report of 71 clinical quality databases in April 2021. Aspects of fundamental care were defined as the 12 nursing domains defined in the Danish Minimum Nursing Data framework. For each database, we recorded the number and type of indicators and identified indicators measuring fundamental care aspects. We used the prevalence ratio to estimate the likelihood of indicators related to aspects of fundamental care in databases with nurse representation on the steering committee. One-third of the databases included indicators related to aspects of fundamental care. The most common aspects were Respiration and circulation, Nutrition and Psychosocial conditions, whereas Skin and mucous membranes, Elimination and Pain were rarely measured. Nurse representation on the steering committee of a quality database increased the likelihood of having indicators related to aspects of fundamental care three-fold (prevalence ratio 3.25). Fundamental care was rarely monitored in Danish clinical quality databases, but databases with nurse representation on the steering committee had a higher likelihood of monitoring fundamental care. This study addressed the knowledge gap of how fundamental nursing care is measured in clinical quality databases. It introduces nurses to the measurement of fundamental care as a first step toward performing nursing intervention studies and investigating associations with patient outcomes. The increased likelihood of fundamental care monitoring in clinical databases with nurse representation on the steering committee indicates a feasible way for decision makers and nurse leaders to ensure a stronger focus on fundamental care to the patients' benefit.

Reflections on the implementation and evaluation of a system-wide improvement programme based on the fundamentals of care: Lessons learned.

To demonstrate how implementing a system-wide measurement and improvement programme can make the delivery of the Fundamentals of Care visible in practice. Discussion paper. A retrospective evaluation of the experience of implementing a system-wide peer review programme using the Promoting Action on Research Implementation in Health Services framework. Implementing this programme engages nursing leaders at all levels in fundamental care delivery, evaluation and improvement. It positions nursing leaders as accountable for and champions of fundamental care. The peer review programme offers a solution to the complex challenge of measuring the fundamentals of care in practice. Successful implementations of this programme at two New Zealand inpatient sites have shown positive results in improved care and patient experience. This makes it worthy of consideration for other health organizations. Nursing leadership has proven to be critical to success. The Promoting Action on Research Implementation in Health Services framework highlights the components that assist with successful implementation and assists in presenting a case for change. This paper addressed the problem of the lack of action and dearth of quality, integrated data, visibility of the patient experience and the contribution of nursing leadership in an inpatient setting. Findings indicate that the peer review programme is translatable, modifiable and sensitive to ethnicity and disability. Using the implementation framework to evaluate the process has provided a guide for future implementations.

Translation and cultural adaptation of the fundamentals of care framework: Are we there yet?

This paper aims to explore and describe the translation and cultural adaptation of the Fundamentals of Care framework to a Swedish context, and highlight the need for a translated version. An exploratory, descriptive approach was adopted. A structured forward-backward translation process and cultural adaptation were used, considering situation and recipient as recommended for such process. Data such as literature and documents were collected during 2019-2021. The authors took systematic steps in collaboration with a strategic sample of experts: professional language service providers, clinicians, educators and a linguist. The framework was mainly translated verbatim. A few fundamental care elements were adjusted to the Swedish language, context and clinical practice. Also, this work clarified the relational elements to be coherently seen as nursing actions. Addressing the need for a translated version was illustrated in activities in research, education and clinical practice. This paper highlights the importance of translating the Fundamentals of Care framework into a country's native language to gain acceptance and application there. Sharing the framework's translated version impacts nursing science, generating a consistent language in the development and conducting of research for the comparison and transferability or generalizability of findings. Together with a cultural adaptation, the translated framework can support and guide researchers, educators and nursing leaders in articulating fundamental nursing care for enacting change. By disseminating the first Swedish version of the framework we encourage a global discussion and sharing of examples of translation and cultural adaptation by others. The framework's English version has limitations in various context. This paper shows a systematic translation and cultural adaptation process of the framework. We proclaim that this is necessary for nursing leaders and nurses to be able to apply it in guiding nursing practice and leading change.

Eat Walk Engage: Enabling acute care teams to deliver consistent fundamentals of care for older people.

Fundamentals of care are particularly important for older people in acute inpatient settings, who are at increased risk of serious hospital-associated complications like delirium and functional decline. These complications occur due to interactions between clinical complexity and the complex processes and context of hospital care and can be reduced by consistent attention to the fundamentals of care. This paper aims to illustrate of how multi-level nursing leadership of fundamentals of care can be supported to emerge within complex multidisciplinary delivery systems in acute care. Discussion paper informed by clinical and organizational experience of a multidisciplinary leadership team and complexity leadership theory. We provide a series of vignettes as practical illustrations of a successful multidisciplinary improvement program called Eat Walk Engage which supports the delivery of better care for older inpatients, significantly reducing delirium. We argue that taking a broader complexity-based approach including collaborative multidisciplinary engagement, iterative and integrated interventions and appropriate knowledge translation frameworks can enable emergent leadership by nurses at all levels. This promising approach to improving care for older patients requires organizational support for facilitation and reflective practice, and for meaningful data to support change. Our discussion challenges nursing leaders to support the time, agency and connections their nursing staff need in order to emerge as local leaders in fundamental care. The debate around scope and responsibilities for fundamentals of care in hospital care has important practical implications for conceptualizing leadership and accountability for improvement. Our discussion illustrates how a structured multidisciplinary approach that acknowledges and navigates complexity can empower nurses to lead and improve outcomes of older patients in acute care.

Nurse preceptors' experiences of promoting and teaching fundamental care to undergraduate nursing students: A qualitative study.

To explore nurse preceptors' experiences in promoting and teaching the delivery of fundamental care to nursing students during their clinical period at nursing homes. The study used a qualitative descriptive approach. Nine in-depth, semistructured interviews were conducted with clinical nurses employed at five different nursing homes. Data collection lasted from September 2020 to April 2021. The interviews were recorded and transcribed verbatim. Inductive, qualitative content analysis was employed to analyse the data. Qualitative content analysis yielded one main category-'Fostering nursing students' knowledge and understanding of fundamental care'-supported by two subcategories: (i) 'Raising awareness of the importance of fundamental care' and 'Providing for learning through exchange and cooperation', which are interpreted as the ways nurse preceptors enable students to learn how to provide fundamental care during their clinical period at nursing homes. By taking the role of nurse preceptors, clinical nurses act as enablers for students' learning of the provision of fundamental care within nursing homes as the learning context. Nurse preceptors possess the pedagogical skills to initiate and conduct nursing students' learning processes. The study reveals that nurse preceptors stress the importance of providing fundamental care to patients; hence, teaching students to provide fundamental care was also found to be important. Within a nursing home context, nurses are responsible for providing fundamental care; therefore, they play an essential role in both providing and teaching about caregiving. The study shows that because of their preceptorship, nurse preceptors can enhance students' awareness of the importance of learning to provide fundamental care to patients. In addition, the study reveals that nurse preceptors work to enhance student's reflection and critical thinking by targeting the student's zone of proximal development, which represents a preliminary phase in students' learning.

Establishing and leading a cross-institutional partnership to integrate fundamentals of care into clinical practice, nursing education and research.

The aim was to describe and discuss the process of establishing and leading a cross-institutional partnership to regain focus on and reconceptualize fundamental nursing care in clinical practice, nursing education and research in one region in Denmark. A discursive paper. The case study method is used as an adapted frame for describing and discussing the establishment and strategic decisions of a cross-institutional partnership. This discursive paper draws on the authors' experiences with establishing a cross-institutional partnership and related literature. The paper addresses the challenges surrounding fundamental care. Establishing cross-institutional partnerships can contribute to a reconceptualization of fundamental care and initiate discussions on what nursing care is and requires. The paper provides an example of how a cross-institutional partnership can be established and describes and discusses the opportunities and challenges in doing so. A key step in the process of establishing a partnership is to actively involve key stakeholders and stimulate their commitment to investing time and resources in the partnership. This requires commitment, clear strategic direction and leadership. Another key step is engaging and informing executive management leaders, and continuously nurture their interest. The paper aims to inform clinicians, educators, nursing leaders, researchers and policy makers on how to organize a formal partnership structured around a strategic research, development and implementation programme where the focal point of the collaboration is improving nursing care by integrating the conceptual FoC framework. Patients, service users, caregivers or members of the public were not involved in this study as it is a discursive paper based on the authors' experiences and relevant literature.

Elucidating strategies used by clinical nurse leaders to facilitate fundamental care delivery: A qualitative study.

To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area. An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Twenty-four self-identified nurse leaders from across Australia were interviewed between November 2020 and April 2021 to discuss their strategies for facilitating fundamental care. Data was analysed using inductive thematic analysis. Nurse leaders' experience of facilitating fundamental care produced two major themes, delivery of fundamental care (comprising three sub-themes: valuing fundamental care, understanding and developing staff capacity and supportive relationships), and monitoring of fundamental care (including three sub-themes: visibility in the clinical area, embedding fundamental care in the practice setting and specific direct actions). Facilitating fundamental care delivery is complex. This study highlighted the importance of nurse leaders' individual characteristics, and nurse leaders' ability to establish and maintain relationships alongside the role of informal and formal monitoring of fundamental care delivery. Findings from this study build on existing research into fundamental care and contribute to our understanding of the role, characteristics and actions of nurse leaders to facilitate fundamental care. The results demonstrate the complexity and intricacy of nursing leadership to facilitate fundamental care, and that a dynamic 'thinking and linking' approach is required. The results show individualized practice which may create challenges for new nurse leaders seeking guidance, and for monitoring nurse leader activity. Further research is advocated to explore insights and tools to optimize nurse leaders' endeavours in facilitating fundamental care. This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care.

Fundamentals of care in pre-registration nursing curricula: Results of a national survey

The Fundamentals of Care is a conceptual framework, grounded on the nurse establishing a relationship with the patient to enable the integration of physical, psychological, and relational aspects of nursing to deliver essential patient care. There is an imperative on schools of nursing to teach and assess nursing students to achieve clinical competency. The Nursing Council of New Zealand provide schools of nursing with an educational framework to guide how nursing students are educated. However, curricular content specific to fundamentals of care (FoC) is minimally researched, making areas of strength or gaps in curricula unclear. This paper provides a national overview of undergraduate pre-registration nursing curricula in Aotearoa New Zealand exploring what and how schools of nursing teach and assess FoC. This was achieved using a cross-sectional descriptive survey. Survey responses were received from 17 course coordinators and involved completing an online anonymous questionnaire. Data was collected between July 2019 and February 2020 and analysed using descriptive statistics. Data analysis revealed variations in how FoC is taught and suggests that the FoC curriculum is non-standardised. Schools appear to design their own curricula and individually decide the educational approaches they use to teach and assess FoC. Furthermore, while mouth and general skin care are commonly featured across FoC teaching, there was a limited focus on eye and perineal care. This study highlights the variance in how FoC is taught and the non-standardised design approach used by schools of nursing in Aotearoa New Zealand. Knowing this, provides schools of nursing and the Nursing Council of New Zealand with an opportunity to discuss and potentially develop a national evidenced-based FoC education strategy. Collaborating with international nursing councils could enhance the development of such a strategy.

Dialogue is a prerequisite for the nurse-patient relationship in nutritional care: A secondary analysis using the fundamentals of care framework.

Providing good nutritional care is complex as it goes beyond assessing and ensuring the patients' dietary needs. So far, nutritional research has mainly focused on establishing evidence for the nutritional treatment, while less attention has been on the complexity of providing nutritional care. The Fundamentals of Care (FoC) describes five elements (focus, knowledge, anticipate, evaluate and trust) essential for establishing a nurse-patient relationship as a foundation for quality care. By studying how these elements shape nutritional care and dialogue, we can explore and describe the complexity of nutritional care. By using the FoC framework as an analytic framework, this study explores how the nurse-patient relationship shapes the nutritional care of orthopaedic patients. This study is a secondary analysis using deductive content analysis of interviews with patients undergoing major orthopaedic surgery, nursing staff and observations of interactions between nursing staff and patients. The core dimension of the FoC framework, 'Establishment of relationship,' was used as an analytic framework. The nurses perceived serving meals and providing nutritional supplements as an essential part of the nutritional care. Still, the nutritional care was organised as a routine task to be less time-consuming. Appropriate care was initiated when the nursing staff explored patients´ food preferences. When the nursing staff failed to familiarise themselves with the patient's preferences, the patients interpreted nutritional care as unrelated to their needs, resulting in a lack of trust. The need for efficiency within nutritional care must not compromise the patients' need for dialogue with the nurse. Establishing a trusting relationship between nurses and patients prevents nutritional care from becoming a routine task unrelated to the patients' needs.

Focusing on fundamentals of care in an ICU setting during a pandemic.

This manuscript aims to describe one acute care hospital's ICU journey during the COVID-19 pandemic and how fundamental care was central to the implementation of team-based models of care. Over the course of the COVID-19 pandemic, team-based and alternative models of care are being employed to manage and address global shortages and surge capacity. Employing these alternate models of care required attention to ensure fundamental care needs of patients were being met. The following paper describes an ICU's journey of focusing on the delivery of the fundamentals of care through the implementation of team-based models of care to address the surge in patient care demands experienced in response to our global pandemic. The implementation of an evidence-informed approach to optimizing models of care and staffing in the ICU amid the evolving COVID-19 waves in one acute-care hospital is provided. This local approach focused on meeting patients' fundamental care needs throughout the necessary introduction of team-based care models and staffing changes and drew from evolving evidence, the ILC Fundamentals of Care Framework, and regulatory guidance.

Enculturating, embedding and investing in fundamental care in an academic health science centre.

This manuscript aims to provide a discursive description of how one academic health care centre is enculturating, embedding and investing in the fundamental care framework and lessons learned that can serve as a blueprint for other organizations. A call to action to focus on fundamental care is not new as the initial Fundamentals of Care (FoC) Framework has been evolving over the last decade through efforts lead by the International Learning Collaborative (ILC). Now more than ever, there is a pressing need for leaders to influence a humane, compassionate evidence-informed approach to the COVID-19 pandemic and beyond by embedding an FoC framework and focusing on fundamental care as part of their academic mandate and daily care practices. This discursive paper delineates an evolving and ongoing enculturation, embeddedness and investment in advancing fundamental care as part of a larger academic practice strategy and quality improvement plan that is evidence-informed and collaborative in nature. The action framework (value, talk, do, own and research fundamental care) developed by ILC guides efforts to how the FoC framework was embedded into one academic health science centre's strategic directions, academic practice strategy, professional practice model, quality plan and research and innovation platform. An overview of how we leveraged the FoC and ILC Leadership frameworks in our efforts to enculturate, embed and invest in advancing fundamental care and lessons learned that may inform other healthcare organizations in their efforts. Underpinning all of our efforts is the integral value we place on fundamental care to guide how we practice, educate and learn, discover and innovate and lead at x. We shared how we value, talk, do, own and research fundamental care by having it embedded into our strategic directions, academic practice strategy, professional practice model, quality aims and research and innovation platform. No Patient or Public Contribution.

Nursing leadership to facilitate patient participation in fundamental care: An ethnographic qualitative study.

To explore and describe hospital nurses' perceptions of leadership behaviours in facilitating patient participation in fundamental care. An ethnographic interview study. Individual semi-structured interviews with 12 nurses with a bachelor's or master's degree working at a university medical centre were conducted between February and April 2021. The interview data were analysed using thematic analysis. Six themes were derived from the data: (1) nursing leadership; (2) patient participation; (3) using patients' preferences; (4) building relationships; (5) task-focused nursing; (6) need for role modelling. Nurses indicated leadership behaviour to facilitate patient participation in fundamental care as inviting patients to participate and eliciting and supporting patients' preferences. Although nurses also regarded leadership as motivating colleagues to act and enhancing evidence-based practice, they appeared not to practise this themselves about patient participation. Role modelling was indicated as a need for improvement. The findings established that not all leadership behaviours mentioned were used in practice about patient participation in fundamental care. Role modelling and the use of evidence-based practice are needed to increase patient participation. Further research will be necessary to develop and test leadership interventions to improve patient participation in fundamental care.

The impact of the Fundamental Critical Course on knowledge acquisition in Rwanda.

Background Emerging critical care systems have gained little attention in low- and middle-income countries. In sub-Saharan Africa, only 4% of the healthcare workforce is trained in critical care, and mortality rates are unacceptably high in this patient population. Objectives We sought to retrospectively describe the knowledge acquisition and confidence improvement of practitioners who attend the Fundamental Critical Care Support (FCCS) course in Rwanda. Methods We conducted a retrospective study in which we assessed survey data and multiple-choice question data that were collected before and after course delivery. The purpose of these assessments at the time of delivery was to evaluate participants’ perception and acquisition of critical care knowledge.Results Thirty-six interprofessional clinicians completed the training. Performance on the multiple-choice questions improved overall after the course (mean score pre-course of 56.5% to mean score post-course of 65.8%, p-value <0.001) and improved in all content areas with the exception of diagnosis and management of acute coronary syndrome and acute respiratory failure/mechanical ventilation. Both physicians and nurses improved their scores significantly (68.9% to 75.6%, p-value = 0.031 and 52.0% to 63.5%, p-value <0.001, respectively). Self-reported confidence in level of knowledge also increased in all areas. Survey respondents indicated on open-answer questions that they would like the course offerings at least annually, and that further dissemination of the course in Rwanda was warranted. Conclusion Deploying the established FCCS course improved Rwandan healthcare provider knowledge and confidence across most critical care content areas. Therefore, this course represents a good first step in bridging the gaps noted in emerging critical care systems. Contributions of the study Critical care education in sub-Saharan Africa is limited and few staff have formal training. The aim of the study was to determine whether a focused course delivered in Rwanda on critical care management improved knowledge in key areas. Our retrospective study on results from a multiple choice question test and survey indicate that short courses may improve knowledge of critical care management.