Delivering high-quality fundamental care in person-centered nursing

Delivering High Quality Fundamental Care The term fundamental care refers to the holistic patient-centered framework of care (Jackson & Kozlowska, 2018). The aspects of care that are considered to be fundamental are the ones that focus on personal safety, self-care, human dignity, and comfort in the context of healthcare. In most cases, these aspects of care require minimal technological intervention, and in case technology is required it is used as a tool for assisting the nurse to provide fundamental care, for example, recording body temperature (Meehan, Timmins, & Burke, 2018). Fundamental care places emphasis on the nurse-patient relationship and the nurse's ability to directly engage with the patient sensitively and respectfully. Some examples of fundamental care needs that are physical are assisting with toileting, mobility, and skincare (Feo, Conroy, Alderman, & Kitson, 2017). Those that are psychosocial are fostering calmness and hopefulness, and human dignity. The relational ones are nurses being emphatic, compassionate, and respectful (Feo & Kitson, 2016). Person-centered care means a nurse focuses care on the needs of the patient rather than the needs of the service. In most cases, people who are seeking healthcare services nowadays are not willing to sit back and let healthcare staff do what they think is best (Feo et al., 2017; Jackson & Kozlowska, 2018). Patients have their views and priorities. Therefore, as a nurse, one should be flexible to meet the needs of their patients (Feo & Kitson, 2016; Meehan et al., 2018). To achieve this, nurses must be prepared to include patients as equal partners in the planning of care, and nurses must be willing to respect the opinions of the patients (Feo & Kitson, 2016). It should be noted that this does not mean that whatever the patient says goes, but it means that nurses have to take into consideration what has been said. To be person-centered there is a need to think about the effect of the treatment plan on the patient as a whole when planning for care. Being person-centered means that a nurse is always having the patient's comfort and well-being in their mind at all times (Feo & Kitson, 2016).
The purpose of this essay is to critically discuss the statement "Delivering high-quality fundamental care is a key requirement for working with patients in a person-centered way". We plan on using the fundamental of care framework and evidence-based literature to support this statement and argument. We will also present counter-arguments for the statement. Fundamentals of Care Framework in Nursing The three dimensions of Fundamentals of Care Framework focus on delivering person-centered care to patients. Therefore, just by merely looking at the three dimensions one can see that fundamental care is vital if nurses are to work with patients in a person-centered way (Feo & Kitson, 2016; Grealish et al., 2019). To better understand how this is so we will analyze each dimension on its own. The first one is the nurse-patient relationship. This is the foundation upon which fundamental care is based. Patients should be able to have a trusting relationship with their caregiver. Without trust, it would not be possible to offer person-centered care to the patient as they will not be comfortable believing or following through with what the nurse advises (Feo et al., 2017). Once trust has been established, the nurse can now focus on the patient and anticipate the patient's needs so they can feel safe. The quality of the relationship should also be evaluated to determine where changes should be made. Establishing a nurse-patient relationship is an ongoing process and requires that trust be maintained once it has been established (Jackson & Kozlowska, 2018). Maintaining trust could be through engaging in interactions that reinforce trust (Feo et al., 2017). A good example to demonstrate this would be a case where a nurse cannot attend to his or her patient immediately due to a pressing reason and informs the patient that they will be back in ten minutes, the nurse must ensure that they do return within the timeframe specified. This will reinforce the nurse-patient relationship as the patient will see the nurse is trustworthy and truthful. By building trust, the nurse and patient can communicate effectively and the patient can share his or her preferences with the nurse, which now will center care around the patient (Feo et al., 2017).
The second dimension integration of care focuses on how the needs of the patient are met and how vital the nurse-patient relationship is in meeting the complex needs of the patient (Feo et al., 2017). Patients have various needs and a nurse must be able to meet these needs when they are caring for the patient. The needs could be physical, relational, or psychosocial. The nurse needs to discuss with the patient how they can best meet the needs of the patient while still taking into consideration the patient's level of mobility and independence (Richards, Hilli, Pentecost, Goodwin, & Frost, 2018). This will demonstrate that the nurse is caring and is thinking about the patient and not merely interested in performing his or her duties. By discussing with the patient, the nurse is now looking for ways of integrating care to suit the needs of the patient and not for the patient to fit into the needs of the healthcare system (Meehan et al., 2018). Patient-focused care demonstrates compassion, and respect, which allows patients to remain calm, dignified, and involved at all times. The complexity involved in ensuring that one performs their duty and at the same time they can think about how a patient will feel at any given time is what makes fundamental care to not be straightforward (Feo et al., 2017). In most cases, nurses forget to incorporate or to think about how a patient will feel when they are delivering care and this makes it hard for care to be patient-centered. Incorporating fundamental care into the process of care planning will allow a nurse to not only focus on delivering care but to also think about how all this makes the patient feel (Meehan et al., 2018).
The third dimension is the context of care. This dimension recognizes that organizations and healthcare systems where nurse work plays a critical role in enabling or hindering the delivery of care to the patient (Feo et al., 2017). Delivering care is not the sole responsibility of nurses. The organizations and healthcare systems should support nurses in delivering fundamental care to patients. For nurses to deliver fundamental care they should be provided with adequate physical resources like equipment and human resources (NS888, Conroy, & Alderman, 2017). This will ensure that a nurse can measure the temperature of a patient appropriately when they need to. There should also be support staff to assist the nurse whenever she needs the support. The culture, leadership, and policy are other aspects that are required if a nurse is to perform his or her duties appropriately. If either of these is missing, then a nurse would be hard-pressed when it comes to offering care to his or her patients. Nurses are human beings and they need all the support available if they are to perform their duties effectively. Therefore, ensuring that the organizations or healthcare system support the nurses should also be a priority if a nurse is to deliver person-centered care. When nurses are performing their difficult duties, they should not be stressed further due to a lack of support from management or due to a lack of vital equipment (NS888 et al., 2017). The context of care should be supportive of the activities that nurses have to perform when they are treating patients. Importance of Fundamental Care in Nursing Fundamental care is not only essential to patient comfort; it is also vital for patient safety. When fundamental care is missed numerous harms occur. When there is no fundamental care the cases of increased injuries, pressure injuries, and emotional harms tend to increase in a healthcare facility. This demonstrates that the failure to pay close attention to fundamental care results in avoidable injuries to the patients. Therefore, there is a need for nurses to be encouraged to practice and to adopt fundamental care in the performance of their daily duties and when planning care for patients. Even though it has been noted by Richards et al. (2018) that there is not enough evidence to support the usage of fundamental care, there is still a need to push for nurses to embrace it when delivering care to patients. In our current work environments, nurses are faced with numerous challenges and in most cases, they have competing demands that deny them the time needed to focus on delivering person-centered care to their patients (Meehan et al., 2018). Without fundamental care, a nurse can't offer person-centered care. This is because there is a direct link between the two and a lack of one will result in the failure of the other (Feo et al., 2018). Therefore, there need to educate and increase the knowledge of nurses in regards to fundamental care.
When a patient visits a healthcare facility they expect to spend the least amount of time in the facility. To achieve this, there is a need for nurses to practice fundamental care to reduce the time spent in hospital by patients. When fundamental care is practiced, it has been noted that the cases of hospital injuries have been reduced drastically (Richards et al., 2018). Patient satisfaction has increased and a survey of patients has shown that the level of satisfaction is high in healthcare facilities. Interaction with patients as they are undergoing treatment and when planning care gives the patient a chance to also air out their opinions and the nurse can decide to either incorporate the opinion if they are beneficial (Feo et al., 2018). By doing this the patient feels they are an equal partner and they can adhere to the instructions given by the nurse. Pressure injuries are avoidable injuries that are sustained by a patient who is immobile in the hospital. These patients need to be moved and turned to avoid these injuries. When fundamental care is appropriately being used the cases of these injuries have been reduced (Grealish et al., 2019). Nurses who are trained to offer fundamental care will be mindful of such patients and they will remember the schedule for turning the patient. Immobility does not mean that the patient is not speaking and for patients who can speak but they are immobile they can request assistance to be moved from time to time (Grealish et al., 2019). This would only be possible for cases where the patient-nurse relationship has been established and the patient is comfortable interacting with the nurse. Without the nurse-patient relationship being established, the patient would be scared to seek assistance from the nurse, and the patient would end up suffering and having to stay longer in the hospital (Grealish et al., 2019). Counter Arguments A lot of emphasis has been placed on nurses to make use of available researches and evidence. However, the lack of evidence is something that many people overlook. According to Jackson and Kozlowska (2018) it is assumed that the evidence is out there and nurses must go about and look for it. In reality, this is not the case. Nursing practice suffers because there is no rigorous evidence to support nursing practice. Fundamental care is one of the areas where there is no enough evidence supporting the crucial nature of most of the aspects of fundamental care. The linkage between patient outcomes and fundamental care is also lacking and nurses keep being asked to use evidence-based literature to support them when delivering care to patients. If we take the case of the patient whose mobility is impaired, this particular patient will need to be moved from time to time and this will be a crucial element of care (Moore & Cowman, 2015). However, even with all the evidence demonstrating the importance of turning the patient, there is little evidence that guides nurses on the optimal patterns and frequency of moving the patient for them to reduce pressure injuries (Gillespie et al., 2014; Moore & Cowman, 2015). This would be vital knowledge that would assist a nurse to know that after a certain timeframe the patient should be moved if we are to avoid pressure injuries. Insisting that nurses make use of available research and there is little to no evidence is not helpful to the nursing practice. Without this information and evidence, it becomes hard for nurses to adopt new and effective models of care, which results in patients being cared for based on the literature that is currently available. It should be noted that most healthcare professionals are in support of fundamental care, it is only that there is little evidence to support its usage in healthcare facilities (Feo et al., 2018). This results in a failure to make use of it and patient-centered care gets affected, considering that fundamental care is at the heart of patient-centered care.