Exploring person-centred fundamental nursing care in hospital wards: A multi-site ethnography

Elise van Belle, Jeltje Giesen, Tiffany Conroy, Marloes van Mierlo, Hester Vermeulen, Getty Huisman-de Waal, Maud Heinen

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Abstract

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.

Original languageEnglish
Pages (from-to)1933-1944
Number of pages12
JournalJournal of Clinical Nursing
Volume29
Issue number11-12
DOIs
Publication statusE-pub ahead of print - 13 Aug 2019

Bibliographical note

© 2019 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Keywords

  • acute care
  • clinical reasoning
  • ethnography
  • fundamentals of care
  • hospital
  • nursing
  • observation
  • patient participation
  • person-centred care

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    van Belle, E., Giesen, J., Conroy, T., van Mierlo, M., Vermeulen, H., Huisman-de Waal, G., & Heinen, M. (2019). Exploring person-centred fundamental nursing care in hospital wards: A multi-site ethnography. Journal of Clinical Nursing, 29(11-12), 1933-1944. https://doi.org/10.1111/jocn.15024