Bedside nurses’ perspective on the Fundamentals of Care framework and its application in clinical practice

Published by Åsa Muntlin, Eva Jangland, Brit Laugesen, Siri Lygum Voldbjerg, Lena Gunningberg, Kathleen Greenway, Clair Merriman, Mette Grønkjær, Maud Heinen, Getty Huisman-de Waal

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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. Participants: A 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.