Exploring person-centred fundamental nursing care in hospital wards: A multi-site ethnography.
Elise van Belle, Jeltje Giesen, Tiffany Conroy and 4 others
PMID 31408557WHAT IT FOUND
Hospital morning care was dominated by physical tasks and safety checks.
Nurses often asked standard questions but did not follow up on cues, and colleagues frequently interrupted bedside care. Some nurses did integrate conversation, privacy and encouragement into washing and dressing.
Key findings
01Morning care was dominated by physical tasks, especially safety checks, washing and dressing, and medication management, while psychosocial and relational elements were less frequent.
02Nurses often asked standard questions about pain, sleep, nutrition and vital signs but did not consistently follow up on answers or incorporate them into care planning.
03Patient participation was mostly one-sided, with nurses explaining actions and offering limited choices, while goals, discharge information, family involvement and patient questions were seldom observed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only morning care was observed, so the findings may not represent the rest of the day. Observations were made in three wards in two hospitals in the Netherlands, so they may not transfer to other settings. The observers were nurses, so their own professional views could have influenced what they noticed and recorded. Patients were observed, but their experiences were not collected, and some patients were excluded because nurses judged them unsuitable for observation. The study did not test whether changing these behaviours improves patient outcomes.
Declared interests
The authors declared no conflict of interest. Funding was from the Netherlands Organisation for Health Research and Development (ZonMw).
The easy way to misread this
Do not conclude that nurses cannot provide person-centred care or that psychosocial care takes extra time. Some nurses integrated it into routine physical care, and the authors observed ample opportunity. This was a qualitative observation study, so it describes practice in three wards during mornings; it does not show that changing communication improves patient outcomes.