IP 2 0 2 1 R EVIEW


understanding and managing the dynamics of the nurse-patient relationship or encounter (termed a “thinking and linking” approach).


l The need for a systematic approach to the fundamentals or basics of care that combines the physical, psychosocial, and relational dimensions of the care encounter within the wider context of the care environment.


The discussion has been focused on three key dimensions: relationships, integration of care and the context of care. While a focus on safety is crucial, the social context, in which care and illness are experienced, is also important and this has become particularly evident during the pandemic – COVID-19 impacted hardest on those who experienced deprivation, lived in poverty, who were unable to feed themselves properly, and were elderly. “We know that in deprived areas, people were twice as likely to die from COVID…In February 2020, Health Equity in England: The Marmot Review 10 Years On2


that if we put invasive devices in without thinking about when we will take them out, infection continues.” One approach put forward in the US has been the strategy of ‘interventional patient hygiene’ (IPH) – a comprehensive evidence-based intervention for reducing the bioburden of both the patient and healthcare worker, combined with mobility strategies, to proactively prevent hospital- acquired infections and skin injuries. Components include hand hygiene, oral care, skin care/antisepsis, and catheter site care.5-7 “If you take care of the fundamentals, you can have an impact,” Prof. Loveday asserted. She went on to explain that she is engaged in research looking at the fundamentals of care in relation to the prevention of UTIs – working in collaboration with chief investigator, Dr. Jacqui Prieto, from the University of Southampton, and other colleagues (including Prof. Wilson). Funded by the NIHR, ‘Stop UTI’:


highlighted


the fact that life expectancy had stalled for the first time since the 1900s, and that health inequalities are now a major public health issue,” commented Prof. Loveday. Highlighting papers by Jangland et al3 and Recio-Saucedo et al4


she added that


missed aspects of fundamental care lead to poor outcomes for patients. “If we miss hand hygiene or don’t handle invasive devices appropriately, infection results,” she commented. “We also know


STrategies for Older People living in care homes to prevent Urinary Tract Infection: a realist synthesis of the evidence is currently looking at ‘what works, for whom, why and in what circumstances?’8


Systems that support


early recognition of UTI by care home staff are critical to driving improvements in UTI prevention, while over-diagnosis of UTI is also recognised as a problem in this setting. “Halfway through the project, we are finding there are lots of things we can do that can make a difference. Over the past 10 years, there has been a lot of work undertaken to make catheters less


acceptable and their removal more frequent, but we know ‘we are not there yet’,” she commented. Another aspect of ‘fundamental care’ than can make a difference is oral hygiene. A paper highlighted by Prof. Loveday revealed how the University Hospitals Birmingham NHS Foundation Trust (UHB), using a dental nurse, reduced the prevalence of non-ventilated-hospital- acquired pneumonia (NV-HAP) on several wards by delivering basic mouth care education to healthcare workers and following the fundamentals of care.9 Ultimately, she highlighted the need for IP&C teams to be perceived as ‘facilitators for care’ and not as ‘barriers to care’. This will require a cultural shift and effective leadership will be key. “Every one of us is a leader in some shape or form. It is your actions that will inspire people to dream more, to learn more, to do more and become more. I want you to think about how we can move forward the fundamental aspects of care to ensure our patients and their carers do not worry about infection,” she concluded.


References 1 Kitson, A, et al, Anything but Basic: Nursing’s Challenge in Meeting Patients’ Fundamental Care Needs, Journal of Nursing Scholarship, 23 April 2014 https://doi.org/10.1111/jnu.12081


2 Marmot, M, Health Equity in England: The Marmot Review 10 Years On, February 2020, accessed at: https://www.health.org.uk/publications/reports/the- marmot-review-10-years-on


3 Jangland, E, 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, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 11-12, p. 2311-2321


4 Recio-Saucedo, A, et al, What impact does nursing care left undone have on patient outcomes? Review of the literature. J Clin Nurs. 2018 Jun;27(11- 12):2248-2259. doi: 10.1111/jocn.14058. Epub 2017 Oct 16.


5 McGuckin, M, Interventional patient hygiene model: Infection control and nursing share responsibility for patient safety, Am J Infect Control. 2008 Feb;36(1):59-62. doi: 10.1016/j.ajic.2007.01.010. Accessed at: https://www.sciencedirect.com/ science/article/pii/S0196655307004592)


6 Vollman, K, Interventional patient hygiene: Discussion of the issues and a proposed model for implementation of the nursing care basics, Intensive and Critical Care Nursing (2013) 29, 250—255


7 Vollman K. Back to the fundamentals of care: why now, why us! Aust Crit Care. 2009 Nov;22(4):152-4. doi: 10.1016/j.aucc.2009.09.001. PMID: 19836967.


8 Accessed at: https://fundingawards.nihr.ac.uk/ award/NIHR130396


9 Garvey, M, et al, Mouth care matters – A HAP prevention strategy, Journal of Infection, 29 May 2021, DOI:https://doi.org/10.1016/j. jinf.2021.05.032


12 l WWW.CLINICALSERVICESJOURNAL.COM DECEMBER 2021


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