Search

Objective: To explore how nurses in hospitals enact person-centred fundamental care delivery., Background: Effective 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., Design: Focused ethnography approach., Methods: Observations 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., Results: Some 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., Conclusions: This 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 Practice: Although 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., (© 2019 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.)

Aims and Objectives: To investigate potential barriers and enablers prior to the implementation of the Tell-us card., Background: Patient participation has the potential to improve quality of care and has a positive effect on health outcomes. To enhance participation of patients, adequate communication between patients, their relatives and healthcare professionals is vital. Communication is considered as a fundament of care according to the Fundamentals of Care Framework. A strategy to improve patient participation is the use of the Tell-us card; a communication tool that patients and relatives can use during hospitalisation to point out what is important for them during their admission and before discharge. Investigating barriers and enablers is needed before implementation., Design: A qualitative study., Methods: Semistructured, individual interviews with (head)nurses, nurse assistants and midwifes. Interviews were audio-recorded, transcribed and analysed using the framework analysis method. The COREQ checklist has been used., Results: The need to maintain control over care, reluctance to engage in in-depth conversations, fear of being seen as unprofessional by patients, fear of repercussions from physicians, the lack of insight in the meaning of patient participation and the lack of appreciation of the importance of patient participation appeared to be majors barriers. Participants also elaborated on several prerequisites for successful implementation and regarded the cooperation of the multidisciplinary team as an essential enabler., Conclusion: The identified barriers and enablers revealed that nurses and midwives are rather reluctant towards patient participation and actively facilitating that by using the Tell-us card communication tool., Relevance to Clinical Practice: A number of issues will have to be factored into the implementation plan of the communication tool. Tailored implementation strategies will be crucial to overcome barriers and to accomplish a successful and sustainable implementation of the Tell-us card., (© 2019 John Wiley & Sons Ltd.)

Aims and Objective: To gain insight into nurse practitioners' (NP) leadership roles in Dutch hospital care, by exploring the perceptions regarding their current leadership role and the differences with their previous role as a registered specialised nurse., Background: To meet today's challenges of the increasing healthcare demands, the employment of NPs is proliferating. NPs have the ideal position to play a pivotal role within healthcare reforms, yet full expansion of their scope of practice and expertise is having limited success. Long-term sustainability of NPs depends on the ability to perform and develop a leading role., Design and Methods: This qualitative descriptive study was conducted in fifteen Dutch hospitals. Data were collected from April-July 2018, and purposive sampling was used for eighteen semi-structured interviews. This study is conducted and reported according to the COREQ checklist., Results: Three main themes concerning NPs' current leadership role emerged, and they were all linked to a successful positioning of NPs. All themes seemed to be of influence on NPs' scope of daily practice. Direct patient care was emphasised, and leadership on other levels appeared to be underused. Most NPs desired to reshape their profession. However, unprofitable use of their leadership skills especially on professional and organisational level and lack of supportive factors seemed to hinder them., Conclusions: An adequate use of leadership is crucial for role development and positioning of NPs. Further development of the NP profession can help to better differentiate between the tasks of registered specialised nurses and NPs., Relevance to Clinical Practice: Leadership in nursing contributes to the improvement of the quality and efficiency of health care. Further positioning of the NP profession depends on a profitable use of leadership competencies. Besides, NPs should collaborate with healthcare organisations, educational institutions and professional associations to value the NP profession in the current healthcare system., (© 2019 John Wiley & Sons Ltd.)

Aims and Objectives: To describe and discuss the "Basic Care Revisited" (BCR) research programme, a collaborative initiative that contributes to evidence-based basic nursing care and raises awareness about the importance of basic nursing care activities., Background: While basic nursing care serves nearly all people at some point in their lifetime, it is poorly informed by evidence. There is a need to prioritise and evaluate basic nursing care activities to improve patient outcomes and improve the quality of care., Design: Discussion paper METHOD: The discussion presented in this paper is based on nursing literature and theory and supported by the authors' clinical and research experiences. We present the developmental process and content of a research programme called "Basic Care Revisited" (BCR) as a solution to move forward and improve basic nursing care., Discussion: To prioritise basic nursing care, we propose a research programme entitled "Basic Care Revisited" that aims to create awareness and expand knowledge on evidence-based basic nursing care by addressing four basic nursing care themes (bathing and dressing, communication, mobility, and nutrition) in different settings. The paper discusses a pathway to create a sustainable and productive research collaborative on basic nursing care and addresses issues to build research capacity., Relevance to Clinical Practice: Revaluation of these important nursing activities will not only positively influence patient outcomes, but also have an impact on staff outcomes and organisational outcomes., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To explore the perspectives of nursing students on their education concerning basic nursing care, learned either during theoretical education or clinical placement, with a specific focus on nutrition and communication., Background: Basic care activities lie at the core of nursing, but are ill-informed by evidence and often poorly delivered. Nursing students' education on basic care might be lacking, and the question remains how they learn to deliver basic care in clinical practice., Design: Descriptive study, using an online questionnaire., Methods: Nursing students at the vocational and bachelor level of six nursing schools in the Netherlands were invited to complete an online questionnaire regarding their perception of basic nursing care education in general (both theoretical education and clinical placement) and specifically in relation to nutrition and communication., Results: Nursing students (n = 226 bachelor students, n = 30 vocational students) completed the questionnaire. Most students reported that they learned more about basic nursing care during clinical placement than during theoretical education. Vocational students also reported learning more about basic nursing care in both theoretical education and clinical practice than bachelor students. In terms of nutrition, low numbers of students from both education levels reported learning about nutrition protocols and guidelines during theoretical education. In terms of communication, vocational students indicated that they learned more about different aspects of communication during clinical practice than theoretical education and were also more likely to learn about communication (in both theoretical education and clinical practice) than were bachelor students., Conclusion: Basic nursing care seems to be largely invisible in nursing education, especially at the bachelor level and during theoretical education., Relevance to Clinical Practice: Improved basic nursing care will enhance nurse-sensitive outcomes and patient satisfaction and will contribute to lower healthcare costs. This study shows that there is scope within current nurse education in the Netherlands to focus more systematically and explicitly on basic nursing care., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To describe the tailoring of the Tell-us Card intervention for enhanced patient participation to the Dutch hospital setting using Intervention Mapping as a systematic approach., Background: Even though patient participation is essential in any patient-to-nurse encounter, care plans often fail to take patients' preferences into account. The Tell-us Card intervention seems promising, but needs to be tailored and tested before implementation in a different setting or on large scale., Design: Description of the Intervention Mapping framework to systematically tailor the Tell-us Card intervention to the Dutch hospital setting., Methods: Intervention Mapping consists of: (i) identification of the problem through needs assessment and determination of fit, based on patients and nurses interviews and focus group interviews; (ii) developing a logic model of change and matrices, based on literature and interviews; (iii) selection of theory-based methods and practical applications; (iv) producing programme components and piloting; (v) planning for adoption, implementation and sustainability; and (vi) preparing for programme evaluation., Results: Knowledge, attitude, outcome expectations, self-efficacy and skills were identified as the main determinants influencing the use of the Tell-us Card. Linking identified determinants and performance objectives with behaviour change techniques from the literature resulted in a well-defined and tailored intervention and evaluation plan., Conclusions: The Tell-us Card intervention was adapted to fit the Dutch hospital setting and prepared for evaluation. The Medical Research Council framework was followed, and the Intervention Mapping approach was used to prepare a pilot study to confirm feasibility and relevant outcomes., Relevance to Clinical Practice: This article shows how Intervention Mapping is applied within the Medical Research Council framework to adapt the Tell-us Card intervention, which could serve as a guide for the tailoring of similar interventions., (© 2017 John Wiley & Sons Ltd.)