Nordaunet O M, Gjevjon E R, Aagaard H, Olsson C, Borglin G
Karlstad University, Institute of Health Sciences, Department of Nursing. Universitetsgatan 2, 651 88 Karlstad, Sweden.
Lovisenberg Diaconal University College, Department of Bachelor Education (Nursing). Lovisenberggata 15B, NO-0456 Oslo, Norway.
Int J Nurs Stud Adv. 2025 May 6;8:100346. doi: 10.1016/j.ijnsa.2025.100346. eCollection 2025 Jun.
Nursing practice addressing the physical, psychosocial, and relational needs of older people - the three core dimensions of the fundamentals of care framework along with its overarching dimension, commitment to care - is a complex yet vital aspect of nurses' scope of practice. However, it is underrepresented in the clinical context of facility-based care, such as nursing homes. Consequently, there is limited understanding of to what extent nurses engage in activities targeting older people's fundamentals of care needs, the applicability of the framework in practice, and what acts as contextual modulators. Furthermore, contextual modulators of practice require greater attention, especially within increasingly complex healthcare systems, where nursing practice should be studied as a part of a larger system.
To explore nursing practice, its contextual modulators, and the clinical decision-making processes, as aligned with the nursing process of nurses targeting older people's fundamentals of care needs in nursing homes.
An exploratory study.
Four nursing homes across three Norwegian municipalities.
Structured direct observations were conducted. Thus, observations was supported by a protocol developed from established theoretical frameworks and concepts identified in the nursing literature as relevant to practice or as modulators of practice. Data analysis incorporated both textual and numerical analyses in a multimethod approach.
A total of 4351 framework activities were observed during 411 sessions (189 hours). On average, nurses engaged in 10.58 activities per observation, often addressing multiple dimensions of the framework simultaneously. Activities related to the dimension were less frequently observed than those in the other three dimensions. We found that most observations showed nurses initiating care with activities targeting , which often expanded to include psychosocial and relational dimensions Registered nurses primarily focused on the assessment phase of the nursing process. Nursing practice was found to be influenced by a lack of risk management, an unsupportive working environment, and unclear leadership and management of care.
This is one of the first studies exploring nursing practice targeting the fundamentals of care framework in this context. We have highlighted the intricate nature of nursing practice, its relationship with clinical decision-making processes, and the functional and performance levels of nursing activities. Contextual modulators were found to negatively influence nursing practice, suggesting the need for improved risk management, a supportive work environment, and clear nursing leadership.
护理实践关注老年人的身体、心理社会和人际关系需求——护理基本框架的三个核心维度及其总体维度，即护理承诺——是护士实践范围中复杂而重要的方面。然而，在诸如养老院等机构护理的临床环境中，它的体现并不充分。因此，对于护士在多大程度上参与针对老年人护理基本需求的活动、该框架在实践中的适用性以及哪些因素作为情境调节因素，人们的了解有限。此外，实践的情境调节因素需要更多关注，尤其是在日益复杂的医疗保健系统中，在这种系统中，护理实践应作为一个更大系统的一部分来研究。
探讨与针对养老院中老年人护理基本需求的护士护理过程相一致的护理实践、其情境调节因素以及临床决策过程。
一项探索性研究。
挪威三个自治市的四家养老院。
进行结构化直接观察。因此，观察得到了一个协议的支持，该协议是根据护理文献中确定的与实践相关或作为实践调节因素的既定理论框架和概念制定的。数据分析采用多方法，包括文本分析和数值分析。
在411次观察（189小时）期间共观察到4351项框架活动。平均而言，每次观察护士参与10.58项活动，这些活动通常同时涉及框架的多个维度。与该维度相关的活动比其他三个维度的活动观察到的频率更低。我们发现，大多数观察结果显示护士以针对该维度的活动开始护理，这些活动通常会扩展到包括心理社会和人际关系维度。注册护士主要关注护理过程的评估阶段。研究发现，护理实践受到风险管理不足、工作环境不支持以及护理领导和管理不明确的影响。
这是在此背景下探索针对护理基本框架的护理实践的首批研究之一。我们强调了护理实践的复杂性、其与临床决策过程的关系以及护理活动的功能和绩效水平。发现情境调节因素对护理实践有负面影响，这表明需要改进风险管理、营造支持性的工作环境以及明确护理领导。
