Fundamentals of care and person-centred

The Vale of Leven Inquiry identified significant shortcomings in the delivery of the fundamental aspects of nursing care highlighting how critical they were to the delivery of good quality and compassionate care (1). In recognition of the learning and its importance ‘fundamentals of care’ is at the core of EiC.

Caring for our most vulnerable is only done properly if patients, families and staff work together as a team

Michelle McGinty, Patient and Family Representative

EiC supports the ethos of the nursing and midwifery 2030 Vision, that confident, competent andcompassionate practitioners consistently deliver person-centred care. Person-centred practice is therefore a key focus and golden thread through the EiC framework.

Fundamentals of care

In the past several decades, it has become clear that modern healthcare systems have devalued basic aspects of care in favour of cost-efficiency and disease-focused models of care, with reports of patients receiving inadequate nutrition and hygiene care (2, 7). The consequences of these failures to meet basic needs have resulted in poor patient safety, increased lengths of hospital stay, and adverse patient outcomes (7-9). Subjective indicators–such as patient surveys–have reported varying levels of dissatisfaction with the level of care provided by healthcare professionals, with patients expressing a desire to work in partnership with staff and to ‘get the basics right’ (10). In response to the Vale of Leven Inquiry, EiC prioritises the fundamentals of care, referencing the primary levels of care required by all patients that are irrespective of an individual’s particular disease or treatment (8). These have been further conceptualised as actions which address patients’: safety, comfort, communication, dignity, respiration, privacy, eating and drinking, respecting their choices, elimination of bodily waste, mobility, personal cleaning and dressing, expressing sexuality, temperature control, and rest/sleep (11). Through engaging with nurse leaders and developing the CAIR dashboard, EiC stresses the importance of the fundamentals of care, including standard infection prevention and control precautions (SICPs) across Scottish healthcare systems (1, 7, 12).

Person-centred

As healthcare models have shifted from a purely bio-physiological perspective towards a whole-systems approach that recognises how biological, psychological and social factors combine to represent an individual’s wellness, efforts are made to include patients as partners in their care rather than purely recipients of services (13). Person-centred care is grounded in the model of personhood, recognising the patient as a whole person and developing a relationship of equals (14, 15). This healthcare perspective describes a philosophy that: considers patients’ needs, wants, perspectives and individual experiences; offers patients the opportunity to contribute to their care; and enhances the partnership between the patient and carer (16). The World Health Organisation describe people-centred health services as: '…an approach to care that consciously adopts the perspectives of individuals, families and communities, and sees them as participants as well as beneficiaries of trustedhealth systems that respond to their needs and preferences in humane and holistic ways. Person-centred care requires that people have the education and support they need to make decisions and participate in their own care. It is organised around the health needs and expectations of people rather than diseases.' (17)

When delivering person-centred care, the following key factors should be considered: the delivery of care against the identified need; the patient’s confidence in the knowledge and skills of the care provider and their sense of safety during care delivery; the inclusion of the patient in the decision making relating to their care and how their choices/preferences are respected; understanding what is important to the patient; time spent by care providers and care receivers; and the support for patients to self-care where appropriate. (18)