Development and Preliminary Testing of a Framework to Evaluate Patients' Experiences of the Fundamentals of Care: A Secondary Analysis of Three Stroke Survivor Narratives

Aim. To develop and test a framework describing the interrelationship of three key dimensions (physical, psychosocial, and relational) in the provision of the fundamentals of care to patients. Background. There are few conceptual frameworks to help healthcare staff, particularly nurses, know how to provide direct care around fundamental needs such as eating, drinking, and going to the toilet. Design. Deductive development of a conceptual framework and qualitative analysis of secondary interview data. Method. Framework development followed by a secondary in-depth analysis of primary narrative interview data from three stroke survivors. Results. Using the physical, psychosocial and relational dimensions to develop a conceptual framework, it was possible to identify a number of “archetypes” or scenarios that could explain stroke survivors’ positive experiences of their care. Factors contributing to suboptimal care were also identified. Conclusions. This way of thinking about how the fundamentals of care are experienced by patients may help to elucidate the complex processes involved around providing high quality fundamentals of care. This analysis illustrates the multiple dimensions at play. However, more systematic investigation is required with further refining and testing with wider healthcare user groups. The framework has potential to be used as a predictive, evaluative, and explanatory tool. 1. Introduction Many healthcare systems face challenges related to the way they deliver fundamental aspects of patient care [1–5]. Typically, the literature on activities of daily living (ADL), self-care, and essentials or fundamentals of care presents them as discrete elements (such as elimination, mobility, dressing, comfort), assessed independently and pulled together in an overall assessment. With the rise of the patient/person-centred care (PCC) movement, more attention is being paid to patient involvement and participation, ways to enhance shared decision making and ensuring greater choice [6–8]. In addition to the patient-centred care literature, there is a growing need to provide a much more integrated health experience for both the patient and the practitioner [9, 10]. In particular Dossey [11] has built upon the seminal work of Florence Nightingale who argued that the role of the nurse is to place the patient in the best position for nature to heal him, taking account of the range of personal, physical, psychological and environmental conditions [11]. Dossey’s Theory of Integral Nursing [9] starts with healing as the core ingredient and then builds up