Using communication to manage missed care: A case study applying the Fundamentals of Care framework.

AIM: To explore, through the patient's perspective, how patient-provider communication is linked to missed nursing care vs. meeting patients' fundamental care needs. BACKGROUND: Missed nursing care causes severe consequences for patients. Person-centred fundamental care, in which communication is central, provides an approach to manage this challenge. However, the specific patient-provider communications linked to care outcomes are unknown. METHODS: Case study using secondary analysis of observations and interviews. A purposeful sample of 20 patients with acute abdominal pain collected using ethnographic methodology at one emergency department and two surgical wards. The Fundamentals of Care framework guided the analysis. RESULTS: Communications that included the patient as an equal member of the care team were observed to make a difference between adequate and missed nursing care. Four categories were identified: interpersonal respect, humanized context of care, available and accessible communication channels, and mutual holistic understanding of the care needs and care plan. CONCLUSION: Communication can be an essential tool to avoid missed nursing care and address the critical need for nursing managers to restore the fundamentals of care. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers can use this new knowledge of communication to facilitate person-centred fundamental care and thereby avoid missed nursing care.

Person-centred pain management for the patient with acute abdominal pain: An ethnography informed by the Fundamentals of Care framework.

AIMS: To explore and describe the impact of the organizational culture on and the patient-practitioner patterns of actions that contributes to or detract from successful pain management for the patient with acute abdominal pain (AAP) across the acute care pathway. BACKGROUND: Although pain management is a recognized human right, unmanaged pain continues to cause suffering and prolong hospital care. Unanswered questions about how to successfully manage pain relate to both organizational culture and individual practitioners' performance. DESIGN: Focused ethnography, applying the Developmental Research Sequence and the Fundamentals of Care framework. METHODS: Participant observation and informal interviews (92 hr) were performed at one emergency department (ED) and two surgical wards at a University Hospital during April-November 2015. Data include 261 interactions between patients, aged ≥18 years seeking care for AAP at the ED and admitted to a surgical ward (N = 31; aged 20-90 years; 14 men, 17 women; 9 with communicative disabilities) and healthcare practitioners (N = 198). RESULTS: The observations revealed an organizational culture with considerable impact on how well pain was managed. Well-managed pain presupposed the patient and practitioners to connect in a holistic pain management including a trustful relationship, communication to share knowledge and individualized analgesics. CONCLUSIONS: Person-centred pain management requires an organization where patients and practitioners share their knowledge of pain and pain management as true partners. Leaders and practitioners should make small behavioural changes to enable the crucial positive experience of pain management.

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: Nursing's 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.