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

Abstract

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.

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

“…Other attempts have been performed to align The Framework with other concepts (e.g. Careful Nursing Philosophy and Professional Practice Model©; Meehan et al, 2018) and, more recently, to discover, if any, synergies with nursing theories (Mudd et al, 2020): however, no empirical traces towards UNC have been documented to date. From their side, also UNC tools have never been based on The Framework, possibly also because they have been developed earlier.…”

“…Conceptually, the Fundamentals of Care Framework (hereinafter, The Framework) has been developed by the International Learning Collaborative, a network of nursing researchers, educators, clinicians and leaders including also client's representativeness meeting at the University of Oxford in 2008 (International Learning Collaborative, 2020). The three key dimensions capable of ensuring a high‐quality fundamental care delivery (Kitson et al, 2013) have been established as (a) a trusting nurse‐to‐patient relationship (= Relationship established ); (b) the integration of care, where nurses simultaneously address the individual physical, psychological and relational needs (= Integration of care ); and (c) the supportive care context (= Context of care ) (Feo, Conroy, et al, 2018; Feo & Kitson, 2016; Mudd et al, 2020). As recently documented, the innovation of The Framework has been recognised in considering the fundamental care as a multi‐dimensional and multi‐faced phenomenon (Mudd et al, 2020), thus introducing a change in thinking of fundamental care as a ‘complex multi‐dimensional construct’ (Feo, Kitson, et al, 2018, page 2224).…”

“…The three key dimensions capable of ensuring a high‐quality fundamental care delivery (Kitson et al, 2013) have been established as (a) a trusting nurse‐to‐patient relationship (= Relationship established ); (b) the integration of care, where nurses simultaneously address the individual physical, psychological and relational needs (= Integration of care ); and (c) the supportive care context (= Context of care ) (Feo, Conroy, et al, 2018; Feo & Kitson, 2016; Mudd et al, 2020). As recently documented, the innovation of The Framework has been recognised in considering the fundamental care as a multi‐dimensional and multi‐faced phenomenon (Mudd et al, 2020), thus introducing a change in thinking of fundamental care as a ‘complex multi‐dimensional construct’ (Feo, Kitson, et al, 2018, page 2224). This means overcoming its main view as a list of nursing activities (Feo, Kitson, et al, 2018, page 2189) or discrete tasks (Mudd et al, 2020) and by going towards the idea of ‘integrated activity predicted on establishing and maintaining a trusting relationship’ (Mudd et al, 2020, page 4).…”

“…As recently documented, the innovation of The Framework has been recognised in considering the fundamental care as a multi‐dimensional and multi‐faced phenomenon (Mudd et al, 2020), thus introducing a change in thinking of fundamental care as a ‘complex multi‐dimensional construct’ (Feo, Kitson, et al, 2018, page 2224). This means overcoming its main view as a list of nursing activities (Feo, Kitson, et al, 2018, page 2189) or discrete tasks (Mudd et al, 2020) and by going towards the idea of ‘integrated activity predicted on establishing and maintaining a trusting relationship’ (Mudd et al, 2020, page 4). The end result is that the nurse and the patient work together to meet the fundamental care needs in a kind of ‘established relationship’, that is the core dimension of the conceptual model (Kitson et al, 2013).…”

“…According to available studies testing this empirically (e.g. Feo, Conroy, et al, 2018; Feo & Kitson, 2016; Mudd et al, 2020) also in other context such as nursing education (Alderman et al, 2018), The Framework has been recognised as the best representation of fundamental care.…”