A Human-Centered Approach to Measuring the Impact of Evidence-Based Online Resources.

Evidence-based online resources aim to combat vulnerabilities associated with health misinformation, evidence misalignment, and science illiteracy. Yet, it is a challenge to measure and demonstrate their impacts beyond looking at proxies for success (e.g., numbers of followers and likes). Addressing this gap, we introduce an emerging evaluation and verify its functionality in delivering optimal impact and sustainability measures for an evidence-based video resource on frailty.

Wicked problems in a post-truth political economy: a dilemma for knowledge translation.

The discipline of knowledge translation (KT) emerged as a way of systematically understanding and addressing the challenges of applying health and medical research in practice. In light of ongoing and emerging critique of KT from the medical humanities and social sciences disciplines, KT researchers have become increasingly aware of the complexity of the translational process, particularly the significance of culture, tradition and values in how scientific evidence is understood and received, and thus increasingly receptive to pluralistic notions of knowledge. Hence, there is now an emerging view of KT as a highly complex, dynamic, and integrated sociological phenomenon, which neither assumes nor creates knowledge hierarchies and neither prescribes nor privileges scientific evidence. Such a view, however, does not guarantee that scientific evidence will be applied in practice and thus poses a significant dilemma for KT regarding its status as a scientific and practice-oriented discipline, particularly within the current sociopolitical climate. Therefore, in response to the ongoing and emerging critique of KT, we argue that KT must provide scope for relevant scientific evidence to occupy an appropriate position of epistemic primacy in public discourse. Such a view is not intended to uphold the privileged status of science nor affirm the "scientific logos" per se. It is proffered as a counterbalance to powerful social, cultural, political and market forces that are able to challenge scientific evidence and promote disinformation to the detriment of democratic outcomes and the public good.

An empirical analysis of the constructs of Fundamentals of Care Framework using structural equation modelling.

AIM: First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. DESIGN: A non-experimental research design using self-audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. METHODS: A multi-variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. RESULTS/FINDINGS: In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context-based factors. CONCLUSION: The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership.

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

AIM: To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area. DESIGN: An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ). METHODS: 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. RESULTS: 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). CONCLUSION: 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. IMPACT: 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. PATIENT OR PUBLIC CONTRIBUTION: This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care.

The Use of Digital Technologies in the Inpatient Setting to Promote Communication During the Early Stage of an Infectious Disease Outbreak: A Scoping Review.

Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies.

Measuring fundamental care using complexity science: A descriptive case study of a methodological innovation.

AIMS AND OBJECTIVES: This paper presents an exploratory account of an innovative methodology to record and evaluate fundamental care. Fundamental care is defined as the care required by everyone for survival, health and welfare. BACKGROUND: Fundamental care has been informed by the development and testing of the Fundamentals of Care Framework, which describes how fundamental care is complex and multidimensional, and consists of three interrelated dimensions and 38 elements. This accords with a broader re-examination of care provision as part of a complex adaptive system in which existing linear models of cause and effect are inadequate to describe the totality of activity. DESIGN: Informed by graph theory and complexity science, this paper presents a novel methodological innovation. It uses the Fundamentals of Care Framework to create a Matrix to quantify the relationships between different elements within the Framework. METHODS: We use a Matrix methodology to process care recipient narratives to generate three outputs: a heat map, a summary table and a network analysis. CONCLUSIONS: The three outputs serve to quantify and evaluate fundamental care in a multidimensional manner. They capture different perspectives (care recipients and their families, direct care providers and care managers) to improve care outcomes. The future aim is to advance this exploration into digitalising and operationalising the Matrix in a user-friendly manner for it to become a real-time mechanism to evaluate and potentially predict patterns of fundamental care.

Nurse managers' support of fundamental care in the hospital setting. An interpretive description of nurse managers' experiences across Australia, Denmark, and New Zealand.

AIMS: To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care. DESIGN: A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ). METHODS: Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants. RESULTS: Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs. CONCLUSION: This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas. IMPACT: Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes.

The trouble with personhood and person-centred care.

The phrase 'person-centred care' (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC.

Using a Complex Network Methodology to Track, Evaluate, and Transform Fundamental Care.

In this study, we drew on methods originating in complex adaptive systems and social network analysis to develop a novel way to quantify fundamental care. Data were obtained from a public statement from the Australian Royal Commission into Aged Care Quality and Safety. Results support the importance of using a systemic approach to assess the multiple dimensions of the fundamentals of care. Our method allows measurement of the problem within its system, providing a detailed quantification of care events and identifying excellence and improvement opportunities. We illustrate the strengths of this approach using principal component analysis and heat mapping. The application of the proposed methodology in healthcare decision-making, planning, and quality improvement is discussed.

Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts.

AIMS AND OBJECTIVES: To elucidate the synergies between fundamental care and seminal nursing theories. BACKGROUND: Nursing theories are often criticised for their limited clinical relevance, with the existence of a theory-to-practice gap widely acknowledged. Pervasive examples of poor-quality care, particularly for people's most fundamental needs, raise questions as to whether nursing theories sufficiently prioritise fundamental care. The Fundamentals of Care Framework (hereinafter "the Framework") represents a valid, comprehensive and evidence-based description of fundamental care. The Framework captures the complexity and multidimensionality of fundamental care delivery, predicated on the nurse-patient relationship; integration of physical, psychosocial and relational needs; and a supportive context. Despite strong face validity, the Framework's alignment with seminal nursing theories remains unexplored. DESIGN: Narrative review. METHOD: Twenty-nine seminal nursing theories were included. Categories for analysis were developed inductively and deductively, focusing on the themes of relationship, integration of care, context and the theories' ease of use. Results are reported in accordance with PRISMA-ScR guidelines. RESULTS: Though relationship, integration of care and context and were features shared across a number of nursing theories, no single theory depicts these collectively to the same extent as the Framework. In particular, integration of physical, psychosocial and relational aspects of care was found to be poorly described in the theories. CONCLUSION: Failure to account for integration of care means that nursing theories continue to conceptualise fundamental care as a series of discrete tasks. To ensure relevance at the point of care, future nursing theories must accurately reflect the complexities of fundamental care delivery, specifically the need to integrate multiple care needs simultaneously, alongside being straightforward to apply in practice. RELEVANCE TO CLINICAL PRACTICE: Bridging the theory-to-practice gap requires a nursing discourse that is relevant at the point of care. We provide suggestions for how future nursing theories can bridge this gap.