By Maura MacPhee

• New emphasis on the importance of dignity in practice, compassion, patient-centered care (PCC)
• Curriculum challenges; systems challenges
  • What should we teach in our curriculum? What should healthcare organizations be doing?
    • The UK Francis Inquiry: worrying accounts of nurse failures to meet basic care standards + uphold ethical codes

“The reasons for these systems failures are many and complex, one potential problem area may be that nursing lacks the consistency of language and conceptual frameworks to synthesis nursing actions in practice…” (p.335).

• Nursing needs a systematic approach/an integrated way of thinking about nursing fundamentals
• International Learning Collaborative (http://intlearningcollab.org/)
• Theories, conceptual frameworks versus pragmatics

“The argument for the need for a more pragmatic and practical framework is to ensure that the basic physical and psychosocial needs of patients are embedded both in the practice and the thinking, reflection and assessment processes of the nurse” (p.393)

• Fundamentals of Care Template
  • The foundation for PCC
    • For education
    • How stroke survivors experienced care during acute/recovery phases
  • Systems Framework
    • The nurse makes a moral commitment to care: the patient-nurse relationship
    • Assessment→practical actions related to fundamentals of care
    • The nurse-patient interacting with the broader healthcare system
  • What do we know?
    • Nurses focus on tasks versus relationships
      • There is choice

“Therefore, we argue that for each encounter with a patient, the nurse can choose either to engage in a way that reflects this ‘commitment to care’ or operate in a way that executes a series of tasks” (p. 336).

• Being present in the moment
  • Choosing to “be for the other” or “not be for the other.” (p. 336)
  • Focus on the patient versus self
    • Know how to establish a therapeutic relationship- “whether it be for 30 seconds or for 15 minutes or longer” (p. 336).
  • Effectiveness of the encounter=the patients’ experience
• Nurse sensitive outcomes
  • Positive outcomes versus negative outcomes
    • Self-esteem, comfort, dignity versus pressure ulcers, falls with injuries
  • Researchable questions
    • One research domain: identifying and testing how “nurses acquire skills around the fundamentals of care” ( 337).
  • Next brownbag will discuss current innovations in curriculum design and delivery