The Fundamentals of Care in Practice: A Qualitative Contextual Inquiry.

Empirical evidence on the Fundamentals of Care framework and its relevance to practice is increasing. However, there is a need to understand the evidence in practice and determine how best to evaluate caring activities. This exploratory study aimed to understand current nursing practice with the Fundamentals of Care framework, how nurses understand the framework, and what is essential to patients receiving care. The objectives were (1) to observe nurses in practice and record nurse-patient interactions against the Fundamentals of Care framework dimensions, (2) to probe the nurse's understanding of the framework, (3) to explore what is important to patients when receiving care from nurses, (4) to explore the nurse's and patient's understanding of culture and spirituality, and (5) to identify the barriers and facilitators to delivering integrated care. The study identified four key findings: (1) nurse-patient interactions centred around completing tasks and the physical aspects of care, (2) there are crucial gaps in nurses' ability to connect with their patients and establish a good nurse-patient relationship, (3) integrated fundamental care was not evident in the behaviours and narratives of the nurses, and (4) the context in which care is delivered significantly impacts how nurses work particularly the challenges of using technology and electronic records. Healthcare organisations and nursing leaders need to consider the implications of nurses prioritising the organisation's efficiency-driven requirements over establishing a therapeutic relationship and integrating the patient's care needs. More work is required to support nurses in delivering integrated fundamental care.