FUNDAMENTAL CARE

Every nurse knows that patients, regardless of their clinical condition, requires a standard of care.

The care that patient’s receive from nurses is multifaceted.

It encompasses the physical, psychical and relational aspects of care.

And it is almost invisible in the drama that can occur in any setting but in particular –  especially in acute hospitals.

Feo and Kitson write that fundamental care provided by nurses is rendered invisible and devalued for three reasons.

The biomedical model continues to dominate over more patient-centred biopyschosocial models.
Healthcare systems do not value the delivery of fundamental care.
Nurses themselves do not (or cannot) value fundamental care.

So what are the fundamentals of care that nurses do not or cannot value?

Firstly, the physical fundamentals of care are safety, comfort (including warmth and rest), nutrition and hydration, mobility, hygiene and personal dressing, elimination and continence.

Secondly, the aspects of care that are psychosocial are that patients are calm, able to cope, hopeful, respected, involved and informed, and treated with dignity.

Finally, the fundamental relational aspects of care that patients should expect is that the nurses are empathic, respectful, compassionate, consistent, set goals, and provide continuity.

Each element of these fundamentals of care are important in providing person-centred nursing.

Yet nurses, as Feo and Kitson, identifies 

“ appear to afford fundamental care relatively little priority and value in comparison to other care tasks… Highly specialised and technical forms of nursing are often seen by nurses as more prestigious than basic nursing care, with nurses who practice in highly specialised fields afforded higher level status”

They cite nutrition that is considered as an elementary tasks that does not receive a lot of recognition about its importance.

This basic of nursing care is left to the less skilled nurse despite the dangers that can occur with patients at mealtimes and that the dignity of patients can be compromised, particularly if patients are unable to feed themselves.

Assisting with food intake only becomes valued when patients need assistance because they are having difficulty swallowing and/or have a high risk of choking.

Then the act of assisting becomes highly technical and is deemed of value.

The so-called simpler act of supervising patients at mealtimes to ensure they receive adequate nutrition is rendered invisible.

“ This devaluing of fundamental care has created a division in care delivery, with more educated and experienced nurses carrying out technical, cure-directed acts such as administering complex medications and surgical wound care, while less skilled nurses are focusing on fundamental care.” Feo and Kitson. 

Nursing assistants, healthcare assistants, vocational nurses, nursing auxiliaries are some of the names given to staff who now deliver fundamental care in stead of registered nurses.

In fact, there seems to be a fundamental belief among registered nurses that delivering fundamental care is not part of their work.

The flow on  of this view extends to student nurses who having observed registered nurses undertake their work. 

The relegation of fundamental tasks to assistants devalues this aspect of care in nursing students.

Nursing students perceive tasks in a hierarchy – basic nursing care is at the bottom relative to complex technical nursing skills.

There is a failure to consider the whole needs of the patients, not just those that are easily measured.

It is easy to record the administration of medication – it is harder to record the quality of the nurse interaction with patient when assisting with hygiene.

There is very little research activity about fundamental care.

So it means that nursing care that is fundamental is devalued.

As Feo and Kitson say

“Routinely engaging in work that is not valued or being able to provide quality fundamental care … can be morally distressing. As such, whilst many nurses might initially value caring and enter the profession with the desire to provide high-quality fundamental care, working in a task-based environment can lead to disengagement from patients and the devaluing of fundamental care as a means of coping and self-preservation.”

To learn more about fundamental care:

Feo, Rebecca, and Alison Kitson. “Promoting patient-centred fundamental care in acute healthcare systems.” International journal of nursing studies 57 (2016): 1-11.