To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review

Abstract

Aims and objectives To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the ‘Integration of care’ dimension of The Fundamentals of Care Framework (The Framework). Background UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. Design A two‐step study: (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. Methods A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. Results A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the ‘Integration of care’ dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). Conclusion Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. Relevance to clinical practice Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.

Fundamental care: An evolutionary concept analysis

“…Attributes are described as the key aspects that describe a given concept (Rodgers, 2000). Based on our search, fundamentals of care could be described as a multidimensional and multifaceted phenomenon (Feo, Donnelly, et al, 2018) of nursing activities (Palese et al, 2021; Rey et al, 2020) based on patient and family centred care needs (Aspinall et al, 2020; Avallin et al, 2018; Jeffs et al, 2018; Pene et al, 2021; van Belle et al, 2020; Zwakhalen et al, 2018). The fundamentals of care are holistic (Avallin et al, 2018; Jackson & Kozlowska, 2018; Meehan et al, 2018), compassionate (Feo, Donnelly, et al, 2018; Jeffs et al, 2018), invisible, complex nursing activities (Parr et al, 2018) and yet they are straightforward for nurses to carry out (Feo et al, 2019; Feo, Donnelly, et al, 2018).…”

“…The fundamentals of care are holistic (Avallin et al, 2018; Jackson & Kozlowska, 2018; Meehan et al, 2018), compassionate (Feo, Donnelly, et al, 2018; Jeffs et al, 2018), invisible, complex nursing activities (Parr et al, 2018) and yet they are straightforward for nurses to carry out (Feo et al, 2019; Feo, Donnelly, et al, 2018). These different aspects were already expressed in the Fundamentals of Care Framework (Mudd et al, 2020; Palese et al, 2021; Voldbjerg et al, 2018) that was described by Kitson (2018) and identified as below. The centre of this framework is the relationship between nurse and patient based on trust (Aspinall et al, 2020; Feo, Donnelly, et al, 2018; Hansen & Jørgensen, 2020; Jeffs et al, 2018; Kitson, Dow, et al, 2013; Kitson, Robertson‐Malt, & Conroy, 2013; Meehan et al, 2018; Pavedahl et al, 2021; Pene et al, 2021; Pinero de Plaza et al, 2021) to establish a continued interaction; the 12 basic needs (Table 1) focus on the patient's physical care needs (nutrition and hydration, personal hygiene and physical comfort) (Feo, Donnelly, et al, 2018; Feo, Kitson, & Conroy, 2018; Kitson et al, 2010; Lillekroken, 2019; Vollman, 2009), and on the attention by the nurse for the patient's psychological and emotional needs (Kitson, 2018).…”

“…However, it is important to point out that the reason for not providing fundamental care is not always and necessarily due to the devaluation of these tasks or to the attention in conducting nursing care, but this could also be due to overload and several other factors such as work environment, nurse staff level and burnout (Liu et al, 2018; Pattison & Corser, 2022). Furthermore, fundamental care is often associated with missed care, since the most frequent nursing tasks that are left undone, when staff or time shortage occur, are elements of fundamentals of nursing care (Ball et al, 2018; Palese et al, 2021). Since missed nursing care also occurs when nurse staff levels are lower, it is also related to and influenced by staffing levels, which in turn effects patients' nursing‐sensitive outcomes and has patient safety implications (Ball et al, 2018).…”

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

“…In other words, the Framework can be reliably estimated and its variables are predictive of the integration of the care dimension. One previous study has attempted to hierarchically link the interaction of all the Framework variables together, but was unable to validate those factors or show a causal link between them and the context of care factors (Palease et al, 2021). This current study has also shown that the Framework is indeed a multi‐dimensional construct and reflects the inter‐relationships between the contexts of care variables and the integration of care variables.…”

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

“…Moreover, patients with unmet needs are more likely to experience poor quality of life (Bagnasco et al, 2019). The overlap between the terminology used to describe the various aspects of missed care / poor‐quality fundamental care (e.g., missed care, care left undone, implicitly rationed care, unfinished nursing care, unmet needs) has been explored elsewhere (Jones et al, 2015; Palese et al, 2021; Willis et al, 2021).…”