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Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework

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  • Eva Jangland
  • Therese Teodorsson
  • Karin Molander
  • Åsa Muntlin Athlin

Abstract

Aims and objectives To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. Background The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high‐quality, person‐centred care, it is important to understand how these factors affect patients' experiences and care needs. Design A focused ethnographic approach. Method A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. Results The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high‐tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Conclusion Patients with acute abdominal pain were cared for in the high‐tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. Relevance to Clinical Practice Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well‐being and recovery.

Suggested Citation

  • Eva Jangland & Therese Teodorsson & Karin Molander & Åsa Muntlin Athlin, 2018. "Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(11-12), pages 2311-2321, June.
  • Handle: RePEc:wly:jocnur:v:27:y:2018:i:11-12:p:2311-2321
    DOI: 10.1111/jocn.14095
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    References listed on IDEAS

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    1. Helen Schultz & Niels Qvist & Christian B Mogensen & Birthe D Pedersen, 2014. "Discharge from an emergency department observation unit and a surgical assessment unit: experiences of patients with acute abdominal pain," Journal of Clinical Nursing, John Wiley & Sons, vol. 23(19-20), pages 2779-2789, October.
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    Cited by:

    1. Debra Jackson & Olga Kozlowska, 2018. "Fundamental care—the quest for evidence," Journal of Clinical Nursing, John Wiley & Sons, vol. 27(11-12), pages 2177-2178, June.
    2. Alexander Tegelberg & Eva Jangland & Claes Juhlin & Åsa Muntlin Athlin, 2019. "Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(19-20), pages 3641-3650, October.

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    1. Alexander Tegelberg & Eva Jangland & Claes Juhlin & Åsa Muntlin Athlin, 2019. "Who is in charge of the care of patients with acute abdominal pain? An interview study with managers across the acute care chain," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(19-20), pages 3641-3650, October.

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