AIMS:To describe the development and refinement of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice through stakeholder feedback. The tool, based on the Fundamentals of Care Framework, supports healthcare leaders and clinicians in assessing fundamental care in a practical and user-friendly manner that embraces rather than minimises the inherent complexity of this care delivery as it occurs in practice. DESIGN:Multi-method study informed by participatory action principles. METHODS:Data collection involved an anonymous online survey and cognitive interviews with key stakeholders internationally to gauge perspectives on the clarity, usability, and acceptability of the tool. Data were collected between October-December 2023. Quantitative, categorical data were analysed using descriptive statistics. Qualitative data were analysed via content analysis. RESULTS:Participants described the Tool as Comprehensive, Practical, and Useful. Participants liked the visual representation of results in the form of bar and radar diagrams, which aided in interpreting the outcomes. The main suggestions for improvement were: (1) Simplifying items relating to the 'Context of Care' dimension of the Fundamentals of Care Framework; (2) Reducing similarity between some items; (3) Separating or simplifying items with multiple components; and (4) Clarifying terminology. CONCLUSION:Based on stakeholder feedback, the Flinders Fundamentals of Care Assessment Tool for Clinical Practice is now digitised and includes a comprehensive instruction manual and definitions for each element of the Fundamentals of Care Framework assessed within the tool. The tool supports healthcare leaders and clinicians to assess fundamental care delivery at multiple levels-individual, team, unit/ward, organisational-identifying areas of strength and improvement to inform decision-making, planning, and quality improvement. The tool offers a way of assessing fundamental care holistically as a multi-dimensional construct rather than as a series of disaggregated tasks, better reflecting and capturing the complex reality of fundamental care delivery. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:The Flinders Fundamentals of Care Assessment Tool for Clinical Practice supports real-time feedback (i.e., immediate visualisation of results), facilitating its integration in clinical practice to support enhanced fundamental care delivery. IMPACT:Seeking stakeholder feedback has enhanced the relevance, acceptability, and feasibility of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice, facilitating its use as a decision-making and planning tool to support improved fundamental care delivery across clinical settings. REPORTING METHOD:This study is reported using the CROSS and SRQR guidelines. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.

Objective:This scoping review aims to identify and map the use of the Fundamentals of Care Framework in nursing education to provide insights into curriculum development that can benefit educators, health care professionals, and policymakers in educational contexts.Introduction:The Fundamentals of Care Framework offers a comprehensive approach for conceptualizing and delivering high-quality, person-centered fundamental care. Use of the framework in education has been shown to enhance critical thinking, establish a shared language for nursing care, and increase understanding of person-centered care.Inclusion criteria:This scoping review will consider sources such as discussion papers, qualitative and quantitative primary research studies, and review articles that report on activities relating to use of the Fundamentals of Care Framework in nursing education. The focus will be on nursing education internationally, including but not limited to, theoretical learning and clinical learning contexts that provide training for nursing students.Methods:The proposed review will use the 3-step search strategy recommended in the JBI methodology for scoping reviews. CINAHL Ultimate, Embase, PubMed, and PsycINFO will be searched, with no limitations on language or year. Only sources accessible through scientific databases will be considered for inclusion. The reference lists of included sources will be searched for additional sources. Three independent reviewers will screen titles, abstracts, and full texts of retrieved sources and extract relevant data. Data will be presented descriptively, supported by tables and charts, and accompanied by a narrative summary.Review registration:Open Science Framework https://osf.io/4xe2c

AIM:To explore nurses' perceptions of reasons for missed nursing care. DESIGN:A multicentre qualitative descriptive study was undertaken from August 2022 to January 2023. METHODS:Interpretive description methodology was used. Individual interviews were conducted with 36 registered nurses and eight licensed practical nurses working in medical, surgical and intensive care units at three public university hospitals in Denmark. Using a semi-structured interview guide, nurses were asked to share their perceptions of reasons for missed care. The analysis was guided by an inductive thematic approach. RESULTS:The nurses' immediate responses to reasons for missed nursing care circulated around limited time and busyness. However, further analysis unfolded layers of reasons described within three themes: being challenged by workload and patients' diverse care needs; falling short on competencies; and being governed by organisational structures and decisions. CONCLUSIONS:The study underlines that reasons for missed nursing care are multiple and complex and extend from an individual to an organisational level. They can therefore not be seen nor targeted isolated. Furthermore, there is a need to draw attention to organisation of care and nurses' clinical decision-making to ensure that patient's fundamental care needs are met. IMPLICATIONS FOR THE PROFESSION:Reducing missed nursing care calls for interventions that require nurses to change their working practices, roles and value perceptions. This study provides valuable insight into nurses' perspectives on reasons for missed nursing care, which is pertinent for designing interventions targeting missed nursing care. IMPACT:The study provides insight into nurses' perceptions on reasons for missed nursing care within hospital settings. The findings of the study show that reasons for missed nursing care are multiple and complex and cannot be limited to time and busyness. The findings can be used to inform future interventions aimed at reducing missed nursing care. REPORTING METHOD:The reporting of the study followed the consolidated criteria for reporting qualitative research. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Literature reviews are essential to scientific research; but abstract screening is time intensive, subject to human error and is a non-creative task, arguably impeding research development. Publicly available generative AI is revolutionising human activity creating new opportunities alongside new challenges for academic research. Studies have illustrated the power of AI in abstract screening for discrete exact science projects. However, individual researchers or small research teams, may lack the skills to independently use AI tools in a systematic, reproducible, transparent, and expandable manner. Also, AI’s capabilities to explore complex human activity is unclear. Here we demonstrate ChatGPT’s abilities to screen abstracts examining complex problems intersecting education, language, and human activity, in a manner that is systematic, reproducible, and transparent. We further demonstrate how coding-naïve researchers can use publicly available education in AI prompt engineering and Python computer coding using ChatGPT as a knowledgeable companion alongside assistance from interdisciplinary colleagues to use ChatGPT effectively. The result is an efficient first-line screening tool for academic researchers. We share our publicly available Python computer coding script with interdisciplinary colleagues to facilitate their exploration with AI as a screening tool.

The aim of this study was to explore registered nurses’ experiences of non-nurses being involved in nursing care of hospitalised patients at a Danish university hospital. A total of 16 registered nurses from 12 different inpatient wards where non-nurses were employed (employees without a nursing education) participated in five focus groups. The data were examined using thematic analysis. This article followed the COREQ guidelines. Three themes were generated: (1) balancing support: RNs’ experiences with non-nurses in indirect and direct nursing care; (2) managing complexity: RNs’ experiences with delegating nursing care to non-nurses; and (3) navigating responsibility: RNs’ experiences with coordinating patient care amidst non-nurse involvement. Replacing registered nurses with non-nurses makes delivery of nursing care complex. On the one hand, involving non-nurses in the delivery of indirect nursing care eases nurses’ workloads and releases time to spend with patients. Furthermore, quality of care can be improved if the competencies of the non-nurses’ match patients’ care needs. On the other hand, the involvement of non-nurses in direct nursing care complicates nurses’ delegation practice and causes uncertainty about their nursing role.

OBJECTIVE:The objective of this review is to identify and synthesize the best available evidence on nurses' perceptions of the reasons for missed nursing care in hospitals. INTRODUCTION:Missed nursing care in hospitals is a complex and global problem affecting patients, nurses, and the health care system. An in-depth understanding of reasons for missed nursing care is essential to prevent it from happening in hospitals. Nurses' perceptions of reasons for missed nursing care in hospitals are related to the care environment, such as staff levels, nurses' workload, levels of experience and competencies, incomplete communication, and poor teamwork. The reasons are multifaceted, and there is a need to synthesize qualitative evidence on nurses' perceptions of the reasons for missed nursing care in hospitals. INCLUSION CRITERIA:The phenomenon of interest is nurses' perceptions of reasons for missed nursing care, which is defined as care that is either delayed or partially or entirely missed. Studies of nurses with any level of experience, training, or education will be eligible for inclusion. This systematic review will consider qualitative studies that include the perceptions of nurses working in hospital settings, either inpatient or outpatient settings. METHODS:Following an initial search in PubMed, a full search strategy will be conducted in CINAHL (EBSCOhost), PubMed, Embase, Scopus, Google Scholar, and GreyNet International. The JBI approach will inform study selection, critical appraisal, data extraction, and meta-aggregation. Confidence in the findings will be assessed in accordance with the ConQual approach. REVIEW REGISTRATION:PROSPERO CRD42023438198.

BACKGROUND The commitment of nurses to their profession and workplace is closely linked to the delivery of high-quality patient care. Existing literature highlights the positive impact of commitment on care quality and patient outcomes. Conversely, a lack of commitment can lead to nurse burnout and disengagement. However, it remains unclear whether and how cultural beliefs and practices influence newly graduated nurses' commitment to the nursing profession and their workplace. AIM To explore the cultural beliefs and practices influencing newly graduated nurses' commitment to the profession and commitment to their workplace during their first year of employment. DESIGN A focused ethnographic study. METHODS Data consisted of field notes from 94 h of participant observations and 10 semi-structured interviews with newly graduated nurses working in acute care settings in Denmark. Data were analysed using ethnographic content analysis. Data were collected between March and June 2022. RESULTS The findings reveal a major theme, termed 'A State of Transience among Newly Graduated Nurses', consisting of two themes: 'Newly Graduated Nurses' Pursuit of Professional Development and Supportive Work Environments' and 'A Lack of Formal Agreements or Conditions to Meet Expectations for Professional Development.' CONCLUSION Hospitals and nurse managers need to support newly graduated nurses in their first employment after registration by providing a range of clinical experiences through job rotation opportunities within the same organization, deliver on promises for onboarding support and foster a culture of trust. These strategies will help maintain the motivation, commitment and ability of newly graduated nurses to deliver high-quality patient care, thereby reducing the likelihood of turnover. RELEVANCE FOR CLINICAL PRACTICE A trusting and supportive work environment is fostered by providing diverse clinical experiences and consistent support for newly graduated nurses. To address potential high turnover associated with job rotation, hospitals need to rethink how retention is defined and measured, moving beyond hospital unit-level models and measures. REPORTING METHOD This study reports to the SRQR guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.

Nurses are imperative for healthcare systems’ ability to effectively function during pandemics, yet multiple factors may affect their willingness and preparedness to work. The aim of the present cross-sectional survey was to identify factors associated with registered nurses’ (RN) willingness and preparedness to work during the novel coronavirus disease (COVID-19) pandemic. The study was reported following the STROBE guidelines. A total of 358 nurses completed a self-administered online questionnaire. The participants were a part of a COVID-19 task force at a Danish university hospital during spring 2020. The results showed that the majority of RNs felt a professional obligation to engage in clinical work during the pandemic; however, their willingness and preparedness to work were affected by multiple factors, such as being relocated voluntarily, being prepared for the task and feeling safe. This study highlights that these factors are essential for the hospital management and nurse leaders to take responsibility for.

Ineffective use of the early warning score (EWS) can compromise recognition and response to patients’ deteriorating condition. This study explores nurses’ and physicians’ ideas on initiatives for supporting the effective use of the EWS in a hospital setting. Participatory workshops were conducted, and data were analyzed using content analysis. Ideas generated for integrating new functions into the EWS protocol to facilitate effective use are described. Also recommended was that all users receive training and an update on how to use the EWS score to support acceptance and confidence using the protocol and thereby increase adherence to the EWS. Further research is needed on the efficiency of incorporating nurses’ clinical judgment in the EWS protocol within different specialties and the effect on adherence to the tool.

AIM:To explore factors influencing newly graduated nurses' delivery of direct care in acute care hospital settings.DESIGN:Qualitative study using focused ethnography.METHODS:During the period from March to June 2022, a total of ten newly graduated nurses were purposively sampled, and data were collected through 96 h of participant observation as well as ten semi-structured interviews. This research took place in a large hospital located in Denmark. Data were analysed using LeCompte and Schensul's ethnographic content analysis.RESULTS:Three main structures were developed from the data: 'Contrasting Intentions and Actions for care delivery', 'Organizational Constraints Block Interpersonal Aspects of Nursing Care' and 'Newly Graduated Nurses' Suppressed Need for Support Constitutes Delay in Care Actions'.CONCLUSION:Newly graduated nurses were committed to delivering high-quality care but were aware they sometimes provided compromised care. The paradox between a commitment to care and compromised care delivery was borne out of tensions between newly graduated nurses' professional beliefs and nursing values, a desire to integrate patients' needs and preferences, and organizational constraints on everyday practices where newly graduated nurses often worked alone without the support of a more experienced nurse. Critical reflection on cultural, social and political forces that influence direct care delivery might support newly graduated nurses to deliver direct patient care more intentionally.RELEVANCE TO CLINICAL PRACTICE:Establishment of onboarding programs and other support activities for newly graduated nurses to cope with contrasting intentions and actions that must address organizational constraints is essential. These development programs should include how critical reflection competency is supported to address value inconsistencies and emotional distress to ensure high-quality patient care.REPORTING METHOD:The reporting adhered to the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: 'No Patient or Public Contribution'.

Relatives are an important resource to hospitalised patients and hence to nursing. During the COVID-19 pandemic, visiting restriction policies were implemented in healthcare settings globally, unwillingly excluding relatives from visiting the bedsides of their loved ones. The aim of the present study was to explore how the visiting restrictions influenced relatives’ relationships with patients and collaboration with registered nurses at non-pandemic hospital wards. In total, 13 relatives were interviewed. The study was reported following the COREQ guidelines and checklist. Content analysis led to three themes: 1) being excluded from providing care and support; 2) being excluded from conveying person-centred and situational relevant knowledge to registered nurses; and 3) being excluded from assessing the health status of the hospitalised loved one. Together they describe relatives feeling worried and powerless regarding the health of their hospitalised loved one and the performed nursing care. Findings from studies such as this are pivotal to any future national or global health crisis, where visiting restriction policies are implemented.

BACKGROUND:A changing nursing workforce and an increase in demands for care together with more complex care, raise arguments that leading and guiding nursing practice is more challenging than ever. Therefore, nurses need to have a shared agenda and a common language to show the importance of nursing care and the consequences of not addressing this in an appropriate way. In response to this the Fundamentals of Care framework was developed to also contribute to the delivery of person-centred care in an integrated way. However, to gain acceptance and applicability we need to ensure the framework's relevance to clinical practice from bedside nurses' perspectives. OBJECTIVE:To describe bedside nurses' perspectives on the Fundamentals of Care framework and how it can be applied in clinical practice. DESIGN:A descriptive qualitative design informed by the Fundamentals of Care framework. SETTING(S):The study was undertaken at seven hospitals in Sweden, Denmark and the Netherlands during 2019. PARTICIPANTS:A total sample of 53 registered nurses working at the bedside participated. Participants had a wide variety of clinical experience and represented a range of different nursing practice areas. METHODS:Twelve focus group interviews were used to collect data and analysed with a deductive content analysis approach. RESULTS:Bedside nurses perceived that the Fundamentals of Care framework was adequate, easy to understand and recognised as representative for the core of nursing care. The definition for fundamental care covered many aspects of nursing care, but was also perceived as too general and too idealistic in relation to the registered nurses' work. The participants recognised the elements within the framework, but appeared not to be using this to articulate their practice. Three main categories emerged for implications for clinical practice; guiding reflection on one's work; ensuring person-centred fundamental care and reinforcing nursing leadership. CONCLUSIONS:The Fundamentals of Care framework is perceived by bedside nurses as a modern framework describing the core of nursing. The framework was recognised as having clinical relevance and provides bedside nurses with a common language to articulate the complexity of nursing practice. This knowledge is crucial for bedside nurses both in clinical practice and in leadership roles to be able to speak up for the need to integrate all dimensions of care to achieve person-centred fundamental care. Various activities for reflection, person-centred care and leadership to apply the framework in clinical practice were presented, together with minor suggestions for development of the framework. TWEETABLE ABSTRACT:Bedside nurses recognise their clinical practice within the Fundamentals of Care framework, showing the core of modern nursing.

COVID-19 restrictions prevented relatives from visiting and accompanying patients to hospital and required that nurses wore personal protective equipment. These changes affected patients’ relationships with relatives and challenged their ability to connect with nurses. Individual, semi-structured interviews with 15 patients were carried out to explore patients’ experiences of their relationships with relatives and their collaboration with nurses during in- and outpatient contacts in non-COVID-19 hospital wards. The analysis of data was guided by phenomenological hermeneutic frame of reference and the study was reported according to the COREQ checklist. The findings illustrated that patients felt lonely and insecure when separated from relatives, caught between relatives and professionals during information exchange, and experienced the absence of relatives as both beneficial and burdening. Visitor restrictions provided patients with time to heal but prevented provision of informal care. Patients had to take responsibility for maintaining contact with relatives independent of their health condition. COVID-19 restrictions created distance with nurses, which potentially led to insufficient physical and psychosocial care.

This study aims to explore how a changed COVID-19 work environment influences nurses' clinical decision-making. Data were collected via three focus groups totaling 14 nurses working in COVID-19 pandemic wards at a Danish university hospital. The factors influencing decision-making are described in three themes; navigating in a COVID-19 dominated context, recognizing the importance of collegial fellowship, and the complexities of feeling competent. A strong joint commitment among the nurses to manage critical situations fostered a culture of knowledge-sharing and drawing on colleagues' competencies in clinical decision-making. It is important for nurse leaders to consider multiple factors when preparing nurses not only to work in changing work environments, but also when nurses are asked to work in environments and specialties that deviate from their usual routines.

Aim The aim was to describe and discuss the process of establishing and leading a cross-institutional partnership to regain focus on and reconceptualize fundamental nursing care in clinical practice, nursing education and research in one region in Denmark. Design A discursive paper. The case study method is used as an adapted frame for describing and discussing the establishment and strategic decisions of a cross-institutional partnership. Data sources This discursive paper draws on the authors' experiences with establishing a cross-institutional partnership and related literature. Implications for nursing The paper addresses the challenges surrounding fundamental care. Establishing cross-institutional partnerships can contribute to a reconceptualization of fundamental care and initiate discussions on what nursing care is and requires. The paper provides an example of how a cross-institutional partnership can be established and describes and discusses the opportunities and challenges in doing so. Conclusion A key step in the process of establishing a partnership is to actively involve key stakeholders and stimulate their commitment to investing time and resources in the partnership. This requires commitment, clear strategic direction and leadership. Another key step is engaging and informing executive management leaders, and continuously nurture their interest. Impact The paper aims to inform clinicians, educators, nursing leaders, researchers and policy makers on how to organize a formal partnership structured around a strategic research, development and implementation programme where the focal point of the collaboration is improving nursing care by integrating the conceptual FoC framework. No patient or public contribution Patients, service users, caregivers or members of the public were not involved in this study as it is a discursive paper based on the authors' experiences and relevant literature.

AIMS To explore the role of ward-based nurse managers in supporting nurses to undertake high-quality fundamental care. DESIGN A qualitative study guided by the principles of interpretive description. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ). METHODS Nurse managers in three urban, publicly funded hospitals in Australia, Denmark and New Zealand, were invited to participate in group interviews to discuss how they support fundamental care in their clinical areas. Six group interviews were conducted between February 2017 and March 2020 involving 31 participants. RESULTS Six interrelated themes were identified: Difficulty expressing how to support the nurse-patient relationship; Establishing expectations for care delivery without clear strategies for how this can be achieved; Role modelling desired behaviours; Significance of being present to support care quality; The importance of engaging and supporting staff in their work; and Recognizing the challenges of prioritizing care needs. CONCLUSION This study indicates that nurse managers are not universally clear in explaining how they support their staff to provide fundamental care. If fundamental care is not clearly understood and communicated in the nursing team, then there are risks that fundamental care will not be prioritized, with potential negative consequences for patient care. Nurse managers may benefit from additional resources and guidance to help them to support fundamental care delivery in their clinical areas. IMPACT Previous research exploring fundamental care and missed care highlights the importance of the role of the nurse manager in influencing nursing care. This study demonstrates that though nurse managers have a passion for supporting their staff to deliver fundamental care, clear strategies to achieve this are not always evident. This study suggests that scholarship around leadership to promote and facilitate fundamental care is crucial to improving nursing practice and patient outcomes.

AIM:To explore clinical supervisors' perceptions and use of the Fundamentals of Care framework in supervising nursing students in clinical placement in hospital settings. DESIGN:A qualitative study using focus group interviews. Reported in accordance with Consolidated Criteria for Reporting Qualitative Research. METHODS:Twelve clinical nurse supervisors working in medical, surgical or psychiatric wards in hospitals in Denmark participated in four focus groups conducted from September to November 2020. Data were analysed using thematic analysis. RESULTS:Clinical supervisor's perceptions and use of the framework are described in three themes: structuring students' clinical learning, supporting tool for learning what nursing care is and developing own supervision practice. CONCLUSION:Supervisors perceive the Fundamentals of Care framework positively and use it as a supporting tool to structure and facilitate students' reflection on what nursing is and requires. They perceive that having a shared framework across school and clinical setting contributes to a safe and positive learning environment. Furthermore, using the framework develops their own practice as clinical supervisors.

Aim To summarize existing research syntheses reporting newly graduated registered nurses' experiences of providing direct care in hospital settings. Design Umbrella review. Data Sources An extensive search of all relevant databases was conducted for research syntheses. Initial key terms included "new* nurse", "nursing care" and "hospital setting" in combination with index terms to find relevant literature. Methods Critical appraisal, data extraction and summary were performed independently by two reviewers according to the Joanna Briggs Institute guidelines for undertaking umbrella reviews. Results Nine research syntheses published between 2010 and 2019 and representing 173 studies were included following critical appraisal. The evidence was summarized in narrative form with supporting tables. Twenty-six sub-branches and seven main-branches were organized in a coding tree showing the structure of three overlapping themes: "Feeling a lack of competency", "Sense of emotional distress" and "In need of support". Conclusions Evidence demonstrates that newly graduated registered nurses' experiences of a lack of competency, emotional distress and need for support emerged as essential requirements for the provision of competent and safe direct care for the patient. Impact Newly graduated registered nurses face multiple challenges in the transition from student nurse to practicing nurse. Unmet expectations of being a newly graduated nurse might lead to low levels of job satisfaction, high attrition rates or missed nursing care. Nurse educators, leaders and policy makers should be mindful that newly graduated registered nurses' perceptions of professional and personal identity and degree of support influences newly graduated registered nurses' direct care provision.

The maintenance of physical distance, the absence of relatives and the relocation of registered nurses to COVID-19 units presumably affects nursing care at non-COVID-19 units. Using a qualitative design, this study explored registered nurses' experiences of how COVID-19 influenced nursing care in non-COVID-19 units at a Danish university hospital during the first wave of the virus. The study is reported using the COREQ checklist. The analysis offered two findings: (1) the challenge of an increased workload for registered nurses remaining in non-COVID-19 units and (2) the difficulty of navigating the contradictory needs for both closeness to and distance from patients. The study concluded that several factors challenged nursing care in non-COVID-19 units during the COVID-19 pandemic. These may have decreased the amount of contact between patients and registered nurses, which may have contributed to a task-oriented approach to nursing care, leading to missed nursing care.