Keywords: nursing; patients; theory. Over the course All care in nursing practice recognizes two basic prin- ciples. relationship, and must include listening skills, empathy, respect activities for assisting human beings in order to help, sup-. Abstract: Jean Watson's Theory of Human Caring and the caring . for the transpersonal relationship as the person moves toward self-actualization. . need to support nurses' skill development with their capacity to create .. Psychology of the Future: Lessons from Modern Consciousness Research. Sharing is caring. We can all use this reminder that we are human, which means that we Another good activity to encourage good listening skills and . students get a chance to work on their relationship skills with a wide.
However, there are many other related factors that can influence that perceptions. Level of nurse education in relation to their perception of caring and patient satisfaction Nurse education should emphasize a holistic, individualized, and client-centred nursing care Pajnkihar, Though it is also important, there is a lack of research relating caring perceptions to the personal characteristics of nurses, such as the level of education Patiraki et al.
Some researchers found no relationships between level of nurse education and patient satisfaction Patiraki et al. The characteristics of nurses contribute to the care delivered in healthcare organizations Idvall et al.
Our nursing educational system has been reformed several times in the last decades Prosen, We have had 2, 2. When referring to nurses in this research we mean nurses with an associate degree, diploma degree or master degree.
Nursing assistants are those with 4-year secondary school vocational education. Nursing teams are made up of members of both groups.
They are also involved in holistic patient care as team leaders at different levels of management. More specifically, this study aimed to: Methods This study was conducted using a descriptive cross-sectional survey design.
Sample and setting Due to the large size of the potential target population for the study and accessibility of the selected hospitals, convenience sampling was used for recruiting nurses and nursing assistants providing bedside care. Nurses working in management were excluded from the study. We collected data from four different healthcare institutions in Slovenia, ranging from large university clinical centers to small general hospitals and different units. The reason for this choice was the large regional coverage achieved by including the two largest secondary healthcare level institutions and two hospitals from other regions.
Fundamental nursing care: getting back to ‘basics’
Despite the small number of institutions included in the study, their geographical distribution contribute to better generalizability of the results. Questionnaires were distributed to 1, nursing assistants and nurses, representing The questionnaires returned gave an overall response rate of The same four health care institutions were used to collect data from patients who were discharged during the time of the study.
Questionnaires were distributed to 1, patients and questionnaires were returned, giving an overall response rate of Measures Two questionnaires were used, one for nurses and nursing assistants and another for patients. Questions were adapted to the local environment. The item questionnaire uses a 1-to-5 Likert scale. Respondents circle the number best corresponding to their belief concerning the statement where 1 represents not at all, 5 extremelyfrequency where 1 represents almost never, 5 almost always and satisfaction where 1 represents very unsatisfied, 5 very satisfied.
Items are grouped in the following ten carative factors: Humanism items 1—6 ; Hope items 7—13 ; Sensibility items 14—19 ; Helping relationship items 20—26 ; Expression of emotions items 27—32 ; Problem solving items 33—38 ; Teaching items 39—47 ; Environment items 48—54 ; Needs items 55—64 ; Spirituality items 65—70 Cossette, ; Cossette et al.
The mean score was calculated for each of ten carative factors with an additional overall caring score that was calculated by averaging the individual scores.
Developing effective and caring nurse-patient relationships
The reported Cronbach alpha coefficients between sub-scales varied from 0. Questionnaires were translated into the Slovene language by a professional translator. Translations were discussed in the group of six researchers and nursing experts, to assess content validity, acceptability and feasibility. We used questions related to satisfaction received from nurses during the hospital stay three questions.
For this part a 4-level scale was used with the following levels: Data collection and ethical considerations Data were collected in August All four health care institutions review boards gave written permission for the research. Participants were informed about the study aims prior to administration of the questionnaires. The researchers handed out questionnaires to members of nursing teams in different units in the four different health care institutions, including nursing assistants and nurses.
The completed questionnaires for nurses and nursing assistants were returned in a sealed box clearly identifiable in the ward. This box was regularly emptied by researchers.
The questionnaires for patients were completed after leaving the ward. On the day of their discharge each patient received a questionnaire in an envelope. The completed questionnaires were sealed in return envelopes addressed to the principal investigator. The core barrier is that care identified as fundamental is invisible across the healthcare system, including in education, practice, research and policy. How do you know what is important to them, to their wellbeing and to help them with their recovery goals?
Is this sort of information valued and visible in your clinical setting? Other barriers include medical dominance and the healthcare system structures.
Medical dominance Dominance of the medical model creates a potent barrier to the provision of fundamental cares in many practice settings. Consider how often you see the following in your practice setting: The biomedical model prioritises interventions for diagnosis and cure first.
The biomedical model devalues fundamental care as less important to illness and recovery. Physical problems, needs and care e. Relationships formed with compassion and empathy are thought to add little to cure. Physical tasks are assigned to different allied healthcare professionals, and to non-regulated workers, without a comprehensive care planning approach. When using the Fundamentals of Care Framework the nurse acknowledges the causes and consequences of illness at multiple levels, including recognising the biological, psychological, cultural and social aspects of illness.
Healthcare system The healthcare system provides both barriers and enablers to the provision of fundamental cares: Nursing work can be conceptualised as technical and physical work, at the expense of relational components.
The metric approach to patient outcomes relates to risk, and not positive patient experiences — both are needed. Only physical fundamental cares are visible — the psychological and relational aspects are often poorly documented, therefore invisible and unmeasurable.
Task-based capacity demand systems can result in nurses becoming disengaged from patients and devaluing fundamental cares, used for falls and pressure injury planning. Caring is not always rewarded or recognised, resulting in some nurses devaluing it or becoming morally distressed when they cannot deliver care they identify as essential. Nursing devaluing fundamental cares There are also components within the structure of nursing that create barriers: Highly specialised and technical care is seen as more prestigious.
The division in labour, with experienced nurses carrying out technical tasks such as administration of complex medication, and fundamental skills are delegated to unregulated healthcare assistants. Student nurses may be paired with healthcare assistants to learn fundamental nursing cares early in their undergraduate degrees. There is a lack of research evidence about the importance of fundamental care and a lack of clear definitions about what constitutes fundamental care.
We all need to challenge these barriers through valuing and developing evidence-based practice on how to deliver effective fundamental cares and changing organisational cultures for improved patient outcomes1.
Consider Suzie scenario below. Patient populations include those after a stroke, admitted to intensive care, cancer patients, and patients with acute abdominal pain that resulted in hospitalisation.
Narratives from these patients demonstrate how the three dimensions of physical, psychosocial and relational care are entwined within their experiences. As patients strived to regain control of their life, the relationship with a nurse was essential. Their engagement with the nurse affected how fundamental cares were experienced. When patients felt a rapport with the nurse, and the nurse understood their individual needs, their fundamental care needs were met and this provided motivation in the recovery process, After a stroke patients identified the impact of their illness, particularly their loss of mobility, and how this affected managing fundamental cares.
However, relationships developed with nurses were important in maintaining their dignity, privacy and self-esteem.
Loss of independence and the emotional trauma of having to rely on others was hard to bear. Kitson et al14 p. Interestingly some cancer patients, in contrast to patients post-stroke, described dignified care, when one nurse performed a simple act of washing attentively: What enabled this nurse to overcome the barriers to demonstrate this caring? Caring nurse-patient relationships for those undergoing surgery provided patients with feelings of safety: When they show me that they care about me.
It is the caring that is important. It is so important to feel that you are seen. Dividing care into levels of basic and essential can have unintended consequences that do negatively affect patient experiences and outcomes.
The Fundamentals of Care Framework provides nurses and nursing with a way to refocus on what elements of nursing care must be provided with the system level changes needed, together with the work that is related to diagnosis and treatment. Recommended resources The International Learning Collaborative: Their programmes help create open and compassionate organisational cultures and provide tools and support to bring about radical change within your workplace.
Yvonne Sawbridge argues that the caring professionals undertake hard, emotional labour which needs the same recognition by management that physical labour is given.
Developing effective and caring nurse-patient relationships
Promoting patient-centred fundamental care in acute healthcare systems. International Journal of Nursing Studies 57, Journal of Nursing Scholarship 46 5 WHO global strategy on people-centred and integrated health services: Accessed 24 June from www. Towards a standardised definition for fundamental care: