Tiffany Conroy

Defining the fundamentals of care.

Kitson A, Conroy T, Wengstrom Y, Profetto-McGrath J, Robertson-Malt S. International Journal of Nursing Practice 2010; 16: 423–434 Defining the fundamentals of care A three-stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a-narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self-care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.A three-stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a-narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self-care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.

Anything but basic : Nursing’s challenge in meeting patients' fundamental care needs

Purpose Nursing has not explored the fundamental aspects of patient care in a systematic, conceptually coherent, scientific way, and this has created a number of ongoing challenges. Organizing Construct Each challenge is identified and addressed in the form of a proposition, with evidence provided to support the arguments put forward and defend the proposed actions. Findings The challenges include: the need for an integrated way of thinking about the fundamentals of care from a conceptual, methodological, and practical perspective; the ongoing and unresolved tension in nursing practice between a depersonalized and mechanistic approach (termed a “task and time” driven culture) and the need for consistency around understanding and managing the dynamics of the nurse–patient relationship or encounter (termed a “thinking and linking” approach); and the need for a systematic approach to the fundamentals or basics of care that combines the physical, psychosocial, and relational dimensions of the care encounter within the wider context of the care environment. Pragmatic and practical frameworks are needed to ensure that the basic physical and psychosocial needs of patients are embedded not only in the practice but also in the thinking, reflection, and assessment processes of the nurse. Conclusions Nursings challenge to meet patients’ basic or fundamental needs is complex. Developing a knowledge base will include identifying researchable questions, using rigorous methodologies, ensuring the relational dimensions are not lost, and ensuring the new knowledge is applied in practice. This requires collaboration on an international scale to achieve improvements in care. Clinical Relevance To work collaboratively to generate, test, and implement meaningful ways of capturing nursing practice around basic or fundamental care in order to ensure more integrated, holistic patient care nursing practices.

Using holistic interpretive synthesis to create practice-relevant guidance for person-centred fundamental care delivered by nurses.

Nursing policy and healthcare reform are focusing on two, interconnected areas: person-centred care and fundamental care. Each initiative emphasises a positive nurse-patient relationship. For these initiatives to work, nurses require guidance for how they can best develop and maintain relationships with their patients in practice. Although empirical evidence on the nurse-patient relationship is increasing, findings derived from this research are not readily or easily transferable to the complexities and diversities of nursing practice. This study describes a novel methodological approach, called holistic interpretive synthesis (HIS), for interpreting empirical research findings to create practice-relevant recommendations for nurses. Using HIS, umbrella review findings on the nurse-patient relationship are interpreted through the lens of the Fundamentals of Care Framework. The recommendations for the nurse-patient relationship created through this approach can be used by nurses to establish, maintain and evaluate therapeutic relationships with patients to deliver person-centred fundamental care. Future research should evaluate the validity and impact of these recommendations and test the feasibility of using HIS for other areas of nursing practice and further refine the approach.

Identifying the fundamentals of care within Cochrane Systematic reviews: the role of the Cochrane Nursing Care Field Fundamentals of Care Node.

The role of the Fundamentals of Care (FoC) Node within the Cochrane Nursing Care Field (CNCF) is to identify universal aspects of patient care as they relate to and potentially affect the application of the results of systematic reviews. The CNCF was established to provide a nursing perspective of Cochrane reviews and to promote their dissemination and uptake. The core functions of the CNCF include identifying topics for nursing care not currently addressed by Cochrane Reviews, raising awareness of the Cochrane Collaboration and the resources it has that supports the delivery of nursing care and the dissemination of relevant reviews to the nursing care community. We outline how volunteers with an interest in the FoC can work to identify care-related aspects for specific clinical reviews. This article describes the development of a tool designed to guide the review of a Cochrane Systematic Review from the vantage of the FoC. The FoC Node is seeking volunteers to undertake this review work, and we have outlined the steps used to do this. We also show how using the FoC Template can inform the tagging and classifying of existing reviews within the Cochrane library.

SCHOLARLY PAPER: Defining the fundamentals of care

Kitson A, Conroy T, Wengstrom Y, Profetto-McGrath J, Robertson-Malt S. International Journal of Nursing Practice 2010; 16: 423–434 Defining the fundamentals of care A three-stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a-narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self-care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.A three-stage process is being undertaken to investigate the fundamentals of care. Stage One (reported here) involves the use of a met a-narrative review methodology to undertake a thematic analysis, categorization and synthesis of selected contents extracted from seminal texts relating to nursing practice. Stage Two will involve a search for evidence to inform the fundamentals of care and a refinement of the review method. Stage Three will extend the reviews of the elements defined as fundamentals of care. This introductory paper covers the following aspects: the conceptual basis upon which nursing care is delivered; how the fundamentals of care have been defined in the literature and in practice; an argument that physiological aspects of care, self-care elements and aspects of the environment of care are central to the conceptual refinement of the term fundamentals of care; and that efforts to systematize such information will enhance overall care delivery through improvements in patient safety and quality initiatives in health systems.

Developing effective and caring nurse-patient relationships

Establishing positive and trusting therapeutic relationships with patients has long been recognised as an essential component of nursing practice and is important for effective care. There are various challenges in clinical practice that make it increasingly difficult to deliver effective care centred on such relationships. Understanding and addressing these challenges is crucial to ensure a positive experience of care for patients, families, carers and nurses. This article outlines how nurses can use a framework to develop therapeutic relationships with patients and use the best available evidence to deliver effective care. It also explores the challenges in developing effective therapeutic relationships with patients at the healthcare system level, and considers how these challenges can be addressed.

A beginner’s guide to ethnographic observation in nursing research

Background Observation is mentioned in most ethnographic textbooks, but specific details about how it should be conducted and the practicalities to be considered in ethnographic nursing research are not always explicit. This paper explores the experiences of and challenges faced by a novice nurse researcher who used observation to collect data. Aim To provide a novice researchers perspective of observation in ethnographic nursing research and to highlight the associated challenges. Discussion Challenges that arose in observation began with determining which perspective to take, followed by rehearsing observation, developing and maintaining a constructive relationship with the observation site, being aware of the influence of the observer, managing interactions between the observed and the observer, and responding to ethical issues. Conclusion Novice nurse researchers considering using observation to collect data should be aware of the potential challenges they might encounter. Implications for practice The information presented in this paper will enable novice researchers to anticipate these issues and develop strategies to prevent or address them.

The Prevention and Management of Complications associated with established Percutaneous Gastrostomy Tubes in Adults: A Systematic Review

Objective This systematic review aimed to summarise the best available evidence relating to the prevention and management of complications associated with established percutaneous gastrostomy tubes in adults. Inclusion criteria This review considered studies investigating the effectiveness of strategies to prevent and/or manage complications associated with established percutaneous gastrostomy (PEG) tubes in adults where care was provided in the hospital, aged care or community setting. Complications included PEG stoma site infection, occlusion, site excoriation and inadvertent removal. Search strategy The search strategy aimed to find published and unpublished studies and was limited to reports published in the English language. Reference lists of studies that met the inclusion criteria were searched for additional studies. Company representatives were also contacted for information about ongoing or unpublished studies. Methodological quality Study reports selected for retrieval were assessed by two independent reviewers for methodological quality prior to inclusion in the review using a critical appraisal instrument developed specifically for this review. Results There were 40 studies that met the inclusion criteria for this review. Thirty‐five were excluded after critical appraisal. The five remaining studies contained information regarding strategies for the prevention and/or management of site infection, occlusion and inadvertent removal. There were no studies include that addressed excoriation at the stoma site. Reported strategies for the prevention of complications included regular follow‐up, the provision of pre discharge instructions and programmed tube changes. Strategies reported for the management of site infection included local antibiotic therapy, skin care and intravenous antibiotic therapy. Reported interventions for the management of occlusion included the use of enzymes, guidewires, flushing, replacement and removal. The only intervention reported for the management of inadvertent removal was replacement. Conclusion The research regarding the prevention and management of complications associated with PEG tubes is sparse and potentially of poor quality. Interventions are often poorly described and few comparative studies are published. While few recommendations for practice can be made a range of recommendations for future research are provided. There is an urgent need for further research examining many aspects of the prevention and management of complications associated with PEG tubes.

Role of effective nurse-patient relationships in enhancing patient safety

Ensuring and maintaining patient safety is an essential aspect of care provision. Safety is a multidimensional concept, which incorporates interrelated elements such as physical and psychosocial safety. An effective nurse-patient relationship should ensure that these elements are considered when planning and providing care. This article discusses the importance of an effective nurse-patient relationship, as well as healthcare environments and working practices that promote safety, thus ensuring optimal patient care.

Child and adolescent mental health nurses’ perceptions of their professional identity: an exploratory study

Purpose Nurses with specialised knowledge, experience and education are needed to provide specific care in nursing subspecialties such as child and adolescent mental health (CAMH) nursing. However, some of these attributes are implicit and not clear to the wider nursing community. The purpose of this paper is to explore the applicability of a conceptual framework for CAMH inpatient nursing practice to other areas of CAMH nursing practice. This paper presents an exploratory study regarding the applicability of the framework to two small cohorts of CAMH nurses. This study was conducted in Tasmania, Australia and Northern Denmark. These settings were chosen due to the self-perceived knowledge gap surrounding the role and professional identity of these Australian and Danish CAMH nurses. Design/methodology/approach An exploratory qualitative study within the social constructivist paradigm was undertaken. The method of data collection was two focus groups of CAMH nurses in Tasmania, Australia and Northern Denmark. The data were analysed using an adaptation of a six-phase thematic analysis process. Findings The analysis of the data resulted in three themes: individual preparation and experience of CAMH nurses, knowledge transfer and nurses’ perceptions of their individual and team roles. The findings have contributed new knowledge of CAMH nursing. Originality/value The findings of this study may support the applicability of the conceptual framework with participants’ endorsing that it reflects their role.