Menzies Health Institute Queensland, Australia.
School of Nursing & Midwifery, Griffith University, Australia.
J Adv Nurs. 2023 Mar;79(3):1162-1173. doi: 10.1111/jan.15194. Epub 2022 Mar 14.
To understand the enablers and barriers for delivering fundamental care to hospitalized older patients.
Explanatory sequential mixed methods design, with qualitative data used to elaborate quantitative results.
Set in one medical and one surgical unit of a tertiary hospital in southeast Queensland, Australia. Observations of nursing practice using the Work Sampling Technique were conducted over two 2-week periods in 2019. Data were analyzed and presented to groups of nurses who appraised the findings of the observations.
There were 1176 and 1278 observations of care in the medical unit over two time periods and 1380 and 1398 observations over the same period in the surgical unit. Fundamental care activities were recorded in approximately 26% (i.e. medical) and 22% (i.e. surgical) of all observations. Indirect care was highest, recorded in 41% (i.e. medical) and 43% (i.e. surgical) of observations. Nurses prioritized the completion of reportable activities, which is perceived as a potential enabler of fundamental care. Potential barriers to fundamental care included frequent delays in indirect care and difficulty balancing care requirements across a group of patients when patients have high fundamental care needs.
The cultural acceptance of missed nursing care has the potential to erode public confidence in health systems, where assistance with fundamental care is expected. Relational styles of nurse leadership should focus on: (1) making fundamental care important work in the nurses' scope thereby offering an opportunity for organizational change, (2) promoting education, demonstrating the serious implications of missed fundamental care for older patients and (3) investigating work interruptions.
Fundamental care is necessary to arrest the risk of functional decline and associated hospital-acquired complications in older patients. However, nurses commonly report fundamental care as missed or omitted care. Understanding the challenges of implementing fundamental care can assist in the development of nurse leadership strategies to improve older patients' care. Fundamental care was observed between 22% (i.e. surgical) and 26% (i.e. medical) of all observations. Nurses explained that they were focused on prioritizing and completing reported activities, experienced frequent delays when delivering indirect care and found balancing care requirements across groups of patients more challenging when patients had fundamental care needs. Clinical nurses working in acute health services with increasing populations of older patients can lead improvements to fundamental care provision through relational leadership styles to demonstrate how this work is in nurses' scope of practice, promote education about the serious implications of missed fundamental care and investigate the root cause of work interruptions.
了解为住院老年患者提供基本护理的促成因素和障碍。
解释性顺序混合方法设计，使用定性数据阐述定量结果。
在澳大利亚昆士兰州东南部的一家三级医院的一个医疗和一个外科病房进行研究。在 2019 年的两个 2 周期间，使用工作抽样技术对护理实践进行了观察。对数据进行了分析，并向护理人员小组展示了观察结果。
在医疗病房的两个时间段内，分别有 1176 次和 1278 次观察到护理活动，而在同一时期的外科病房中，分别有 1380 次和 1398 次观察到护理活动。在所有观察中，基本护理活动约占 26%（即医疗）和 22%（即外科）。间接护理比例最高，分别占观察的 41%（即医疗）和 43%（即外科）。护士优先完成可报告的活动，这被认为是基本护理的潜在促成因素。基本护理的潜在障碍包括间接护理频繁延迟，以及当患者有较高的基本护理需求时，在一组患者中平衡护理需求的困难。
对护理遗漏的文化接受有可能削弱公众对卫生系统的信心，因为人们期望在卫生系统中得到基本护理的帮助。护士领导的关系风格应侧重于：（1）使基本护理成为护士职责范围内的重要工作，从而为组织变革提供机会；（2）促进教育，展示基本护理对老年患者的严重影响；（3）调查工作中断的原因。
基本护理对于阻止老年患者功能下降和相关医院获得性并发症的风险至关重要。然而，护士经常报告基本护理被遗漏或忽略。了解实施基本护理的挑战有助于制定护士领导策略，以改善老年患者的护理。在所有观察中，基本护理分别占 22%（即外科）和 26%（即医疗）。护士解释说，他们专注于优先完成和完成报告的活动，在提供间接护理时经常出现延误，并且当患者有基本护理需求时，在一组患者中平衡护理需求更具挑战性。在有越来越多老年患者的急性卫生服务机构工作的临床护士可以通过关系领导风格来改善基本护理服务，以表明这项工作在护士的职责范围内，促进对基本护理缺失的严重影响的教育，并调查工作中断的根本原因。
