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Aims: To systematically explore the clinical supervision (CS) experience for nurses transitioning to advanced practice. Design: A qualitative systematic review using Joanna Briggs Institute meta‐aggregation following an a priori protocol published on PROSPERO (CRD42023426658). Data Sources: Qualitative studies obtained from Medline, CINAHL, PsycINFO, Scopus, Emcare and ERIC databases and ProQuest dissertations and theses for peer‐reviewed, published and unpublished studies from inception to July 2023. Review Methods: Two authors conducted data screening and abstraction. Quality was appraised using the Critical Appraisal Skills Programme tool and reporting followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist for systematic reviews. Results: Sixteen studies contributed to five synthesized findings: CS that is beneficial requires structure and commitment, trusting relationships are foundational for learning, lifting burdens and preventing burnout, learning through reflection, critical thinking and feedback and barriers to CS. Conclusions: This review provides a meaningful exploration of CS to support nurses transitioning to advanced practice. Well‐structured supervision offers a safe space to share work‐related concerns and develop an advanced practitioner identity. Sharing experiences helps alleviate work‐related burdens and reduce professional isolation and burnout. Implications for the Profession: Peer‐support networks are vital for successful transition to advanced practice. Impact: This review highlighted the impact of effective supervisory relationships in forming professional identity and possible links with nursing retention. Public Contribution: No direct patient contributions are included as it forms part of a research degree. [ABSTRACT FROM AUTHOR]

Aims: To (a) seek examples of nursing caring success stories and (b) identify the common contributors to these successes. By focusing on the successes of nursing care rather than critically examining failures, this research seeks to provide examples of proven and feasible approaches and processes for improving care. Design: This study used a narrative inquiry design. Methods: Data were collected through group interviews. Four interviews were conducted with a total of 20 nurse participants working in inpatient settings in South Australian hospitals. A thematic analysis approach was used to analyse the data. Results: Two dominant themes concerning the contributors to caring success were identified. These contributors were (1) the provision of holistic care and (2) the influence of the caring community, which includes family members and other patients. The findings also indicated that the definition of caring success according to nurses is not aligned with organisational performance indicators but is more closely represented by caring values. Conclusion: Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery. Implications for the Profession and/or Patient Care: Nurses value the caring process while working in an environment that primarily values clinical and systems‐level outcomes. Nurses want patients and their families, allied health professionals and hospital executives to be involved and invested in the process of care. Impact: This study addressed a gap in the current literature to identify commonalities in nursing success stories, the contributors informing these successes and how these contributors can facilitate improved patient care. Understanding nursing definitions of caring success provides an opportunity to expand upon current accepted industry definitions and perspectives such as key performance indicators. Reporting Method: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Patient or Public Contribution: No direct patient or public contribution. [ABSTRACT FROM AUTHOR]

Oral healthcare is one of the most missed aspects of fundamental care. Failure to provide reliable and effective daily oral healthcare for older patients can lead to hospital‐acquired pneumonias, longer hospital stays, increased health costs, and poor patient experience. The objective of this study was to codesign, implement, and evaluate an oral healthcare intervention for older adults in a geriatric unit. This mixed methods implementation project combined the hospital's quality improvement processes with the i‐PARIHS knowledge translation framework. Multilevel facilitation guided the development of multidisciplinary implementation strategies, which were co‐designed, tailored, and implemented at the ward and organizational level, targeting: awareness/engagement; clinical guideline development; building workforce capacity; access to appropriate products; patient awareness and support; utilization of multidisciplinary/dental referral pathways; and systematizing oral healthcare documentation. Gaps between evidence‐based and current oral healthcare practice were identified through audits of practice and interviews with patients. Interviews and surveys with staff evaluated the feasibility and acceptability of the oral healthcare intervention and the success of implementation strategies. At the conclusion of the project, awareness, attitudes, and capacity of staff had increased, however, we could not demonstrate change in multidisciplinary oral healthcare practices or improvements for individual patients. Despite mixed success, the project informed discussions about including oral healthcare as a national healthcare standard for the acute care sector in Australia. Attempts to address oral healthcare may have started locally, but its impact was through policy change, which will empower health practitioners and managers to support practice change more widely. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high‐quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition‐specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition. Design: A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis. Participants: Participants were 35 healthcare recipients and 37 carers (n = 72 total). Results: Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts. Conclusion: The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high‐quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition‐specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high‐quality relationships. Patient or Public Contribution: The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high‐quality professional caregiving relationships. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims and objectives: This paper presents an exploratory account of an innovative methodology to record and evaluate fundamental care. Fundamental care is defined as the care required by everyone for survival, health and welfare. Background: Fundamental care has been informed by the development and testing of the Fundamentals of Care Framework, which describes how fundamental care is complex and multidimensional, and consists of three interrelated dimensions and 38 elements. This accords with a broader re‐examination of care provision as part of a complex adaptive system in which existing linear models of cause and effect are inadequate to describe the totality of activity. Design: Informed by graph theory and complexity science, this paper presents a novel methodological innovation. It uses the Fundamentals of Care Framework to create a Matrix to quantify the relationships between different elements within the Framework. Methods: We use a Matrix methodology to process care recipient narratives to generate three outputs: a heat map, a summary table and a network analysis. Conclusions: The three outputs serve to quantify and evaluate fundamental care in a multidimensional manner. They capture different perspectives (care recipients and their families, direct care providers and care managers) to improve care outcomes. The future aim is to advance this exploration into digitalising and operationalising the Matrix in a user‐friendly manner for it to become a real‐time mechanism to evaluate and potentially predict patterns of fundamental care. [ABSTRACT FROM AUTHOR]

Oral care is essential to support the health and rehabilitation of stroke survivors but is often performed poorly in the inpatient setting. This article examines the current practices, barriers and facilitators to oral care on an Australian stroke unit to inform future knowledge translation interventions within this setting. Qualitative semi-structured interviews were conducted with nursing staff members and speech-language pathologists with experience delivering oral care to stroke survivors. Reflexive thematic analysis was used to analyse the data. Three themes were developed from the data. In the first theme, participants described current oral care practices within their stroke unit and acknowledged that there is room for improvement. In the second theme, participants identified the multiple overlapping barriers to oral care delivery on the ward. Finally, the third theme explored participants' suggestions for improving oral care, including both local and organisational change. This study illustrates the complexities of oral care in the inpatient stroke setting and gives voice to the perspectives of nursing and speech-language pathology staff. It is clear that future oral health interventions in this setting require a comprehensive approach to addressing barriers and should prioritise the concerns of staff delivering the care. The delivery of good oral care post-stroke is essential, but in practice is difficult due to limited time and supplies, inadequate education, fear of harm to patient and self, and perceived low priority of the care. Speech-language pathologists are often involved in oral care, but their role is not clearly delineated, and they are not provided with formal training in oral care provision. Oral care interventions should be comprehensive, including organisational policies, clear practice guidelines, structured multi-disciplinary education, and appropriate supplies. [ABSTRACT FROM AUTHOR]

Aim: To outline the International Learning Collaborative (ILC) Oxford Statement, explicating our commitment to ensuring health and care systems are equipped to meet patients' fundamental care needs during times of unprecedented crisis. Design/Method: Discussion paper. The content was developed via a co‐design process with participants during the ILC's international conference. Key Arguments: We, the ILC, outline what we do and do not want to see within our health and care systems when faced with the challenges of caring for patients during global pandemics and other crises. Specifically, we want fundamental care delivery to be seen as the minimum standard rather than the exception across our health and care systems. We want nursing leaders to call out and stand up for the importance of building fundamental care into systems, processes and funding priorities. We do not want to see the voices of nursing leaders quashed or minimized in favour of other agendas. In turn, what we want to see is greater recognition of fundamental care work and greater respect for the people who do it. We expect nurses to have a 'seat at the table' where the key health and care decisions that impact patients and staff are made. Conclusion: To achieve our goals we must (1) ensure that fundamental care is embedded in all health and care systems, at all levels; (2) build on and strengthen the leadership skills of the nursing workforce by clearly advocating for person‐centred fundamental care; (3) co‐design systems that care for and support our staff's well‐being and which foster collective resilience rather than overly rely on individual resilience; (4) improve the science and methodologies around reporting and measuring fundamental care to show the positive impact of this care delivery and (5) leverage the COVID pandemic crisis as an opportunity for transformational change in fundamental care delivery. [ABSTRACT FROM AUTHOR]

Aim: To investigate the strategies used by nurse leaders to facilitate fundamental care delivery in their clinical area. Design: An interpretative qualitative design study reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Methods: Twenty‐four self‐identified nurse leaders from across Australia were interviewed between November 2020 and April 2021 to discuss their strategies for facilitating fundamental care. Data was analysed using inductive thematic analysis. Results: Nurse leaders' experience of facilitating fundamental care produced two major themes, delivery of fundamental care (comprising three sub‐themes: valuing fundamental care, understanding and developing staff capacity and supportive relationships), and monitoring of fundamental care (including three sub‐themes: visibility in the clinical area, embedding fundamental care in the practice setting and specific direct actions). Conclusion: Facilitating fundamental care delivery is complex. This study highlighted the importance of nurse leaders' individual characteristics, and nurse leaders' ability to establish and maintain relationships alongside the role of informal and formal monitoring of fundamental care delivery. Impact Findings from this study build on existing research into fundamental care and contribute to our understanding of the role, characteristics and actions of nurse leaders to facilitate fundamental care. The results demonstrate the complexity and intricacy of nursing leadership to facilitate fundamental care, and that a dynamic 'thinking and linking' approach is required. The results show individualized practice which may create challenges for new nurse leaders seeking guidance, and for monitoring nurse leader activity. Further research is advocated to explore insights and tools to optimize nurse leaders' endeavours in facilitating fundamental care. Patient or Public Contribution: This study was designed using insights generated from patient and public involvement in nursing leadership and fundamental care. [ABSTRACT FROM AUTHOR]

Aim: To explore undergraduate nursing students' understanding of fundamental care and identify educational leadership opportunities to deepen students' understanding of fundamental care concepts. Design: Sequential‐explanatory mixed methods study. Methods: We conducted a cross sectional survey (n = 202) and focus groups (n = 24) to explore undergraduate nursing students' ability to identify fundamental care needs. All data were collected between November 2020 and April 2021. Survey data were analysed using descriptive and inferential statistics and focus group data were thematically analysed. Results: Year One students scored significantly lower in their ability to identify fundamental care needs compared with students in other years, even after controlling for route, gender and age. Post‐degree students scored significantly higher than direct entry or transfer students. Students ≤19 years of age had significantly lower scores compared with students ≥25 years of age. Our focus group findings highlighted that students were often unable to define fundamental care, but they identified learning about various components of fundamental care in a variety of ways. While students understood that fundamental care was required in all settings, they were challenged in providing this care in acute and virtual settings. Students shared several suggestions to support fundamental care skills development across the curriculum. Conclusions: There is a need for a clear definition and description of the fundamentals of care that is used consistently by faculty, students and curriculum documents. It is important to encourage and support educators to share real‐world nursing stories, offer students time to share their personal experiences, develop creative learning opportunities and foster student reflection to deepen students' understanding of the fundamentals of care. Impact Educators need support to meaningfully incorporate fundamentals of care learning opportunities across multiple care settings. Educational leaders can use these findings to develop or adapt their curricula to support fundamental care skill development. [ABSTRACT FROM AUTHOR]

Aims: To investigate nursing and allied health professional perceptions of the interrelationship between avoidable hospital readmissions and fundamental care delivery. Design: A qualitative, exploratory study using a critical realist approach. Method: One‐to‐one semi‐structured interviews with 14 nursing and allied health professionals conducted between May and September 2019. Results: Several tensions and contradictions were identified in the data, which demonstrated clinicians' perceptions about the priority of both fundamental care and two avoidable readmission conditions (aspiration pneumonia and constipation). These tensions are illustrated in two major themes: Avoidable versus inevitable; and everyone versus no one. The first theme demonstrates clinicians' perceptions that readmissions for aspiration pneumonia and constipation are not common, despite acknowledging that they generally lacked knowledge on readmission rates; and that these conditions may not be preventable in acute settings. The second theme demonstrates clinicians' perception that preventing readmissions is everyone's responsibility, however, this was coupled with a lack of articulation around how this multidisciplinary approach could be achieved, leading to a distinct lack of agency for care delivery. Conclusion: Articulating the tensions described in the results provides vital knowledge for understanding how clinicians may respond to initiatives designed to reduce avoidable readmissions. Avoidable hospital readmissions may be usefully understood as a wicked problem: one that is complex and requires adaptive, not linear, solutions. Wicked problems pose a challenge for leaders and managers in healthcare because top‐down, hierarchical strategies are unlikely to be successful. Effective prevention of avoidable readmissions requires leaders to enable facilitator‐led change through relational leadership strategies. Impact Avoidable hospital readmissions are a global problem increasingly addressed via funding changes and the introduction of penalties to hospitals. This study provides insights on clinicians' perspectives of avoidable hospital readmissions and their prevention, demonstrating the complexity of this challenge and the need for healthcare leaders to enable individual and organizational readiness for change. [ABSTRACT FROM AUTHOR]

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; andRecognizing 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. [ABSTRACT FROM AUTHOR]