Reclaiming and redefining the Fundamentals of Care: Nursing's response to meeting patients' basic human needs

Abstract

Executive Summary: A group of nurse leaders, health policy, health care researchers and clinicians attended a seminar at Green Templeton College, University of Oxford in June 2012 to debate and draw up an action plan around integrating the fundamentals of care (FOC) into the patient centred care (PCC) agenda. Participants at the seminar acknowledged that despite significant improvements in delivering more compassionate and patient-centred care, health systems continue to face challenges in meeting the basic needs of many of our most vulnerable patients due to a range of complex factors. The invitational group, over the course of two days, discussed a number of initiatives being used by health systems to improve patient care in this area. These included issues around regulation of care; preparation and training of nurses; ways that factors such as dignity, compassion and kindness can be promoted in health systems; the use of techniques such as hourly rounding, patient involvement in systems redesign and a number of other innovations required to build and redesign the health system around the patient. A framework to guide and shape the ongoing debate has emerged from the meeting. This framework, called The Fundamentals of Care (FOC) Framework comprises three core dimensions: statements about the nature of the relationship between the nurse and the patient within the care encounter; the way the nurse and the patient negotiate and integrate the actual meeting of the fundamentals of care; and the system requirements that are needed to support the forming of the relationship and the safe delivery of the fundamentals of care. The group has produced an implementation plan which is meant to stimulate discussion and debate within key stakeholder groups. These suggested actions are an attempt to turn the more abstract parts of the framework into practical actions at the level of the care encounter between any nurse and any patient in any health system where nursing takes place. There are proposed actions for clinicians and managers; the educators of nurses; and for researchers and policy makers. The framework will be further refined as part of the ongoing work of the International Learning Collaborative (ILC),one of the core groups of nurse leaders and academics who are leading this international agenda. Feedback is welcomed on this position paper.