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To describe the development and refinement of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice through stakeholder feedback. The tool, based on the Fundamentals of Care Framework, supports healthcare leaders and clinicians in assessing fundamental care in a practical and user-friendly manner that embraces rather than minimises the inherent complexity of this care delivery as it occurs in practice.
Multi-method study informed by participatory action principles.
Data collection involved an anonymous online survey and cognitive interviews with key stakeholders internationally to gauge perspectives on the clarity, usability, and acceptability of the tool. Data were collected between October–December 2023. Quantitative, categorical data were analysed using descriptive statistics. Qualitative data were analysed via content analysis.
Participants described the Tool as Comprehensive, Practical, and Useful. Participants liked the visual representation of results in the form of bar and radar diagrams, which aided in interpreting the outcomes. The main suggestions for improvement were: (1) Simplifying items relating to the ‘Context of Care’ dimension of the Fundamentals of Care Framework; (2) Reducing similarity between some items; (3) Separating or simplifying items with multiple components; and (4) Clarifying terminology.
Based on stakeholder feedback, the Flinders Fundamentals of Care Assessment Tool for Clinical Practice is now digitised and includes a comprehensive instruction manual and definitions for each element of the Fundamentals of Care Framework assessed within the tool. The tool supports healthcare leaders and clinicians to assess fundamental care delivery at multiple levels—individual, team, unit/ward, organisational—identifying areas of strength and improvement to inform decision-making, planning, and quality improvement. The tool offers a way of assessing fundamental care holistically as a multi-dimensional construct rather than as a series of disaggregated tasks, better reflecting and capturing the complex reality of fundamental care delivery.
The Flinders Fundamentals of Care Assessment Tool for Clinical Practice supports real-time feedback (i.e., immediate visualisation of results), facilitating its integration in clinical practice to support enhanced fundamental care delivery.
Seeking stakeholder feedback has enhanced the relevance, acceptability, and feasibility of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice, facilitating its use as a decision-making and planning tool to support improved fundamental care delivery across clinical settings.
This study is reported using the CROSS and SRQR guidelines.
No Patient or Public Contribution.
The Fundamentals of Care (FoC) Framework emphasises that care quality depends not only on clinical tasks but also on interpersonal relationships and the organisational context in which care is delivered. Although patient-reported outcome and experience measures (PROMs and PREMs) have gained relevance in capturing these aspects, tools based on the FoC Framework remain limited in non-English-speaking settings.
To psychometrically validate the Spanish version of the FoC Intelligence Modelling Tool (FoC-IMT) and explore predictive relationships among the FoC dimensions: Context, Relationship and Integration of Care.
A cross-sectional study was conducted with 1053 hospitalised patients in southern Spain. Exploratory and confirmatory factor analyses (EFA and CFA) were performed, alongside a mediation analysis using partial least squares structural equation modelling (PLS-SEM) to examine directional relationships among constructs.
EFA and CFA supported a two-factor model—Context and Integration of Care—with excellent internal consistency (Cronbach's α and McDonald's ω = 0.97). CFA showed a moderate correlation between these factors. However, PLS-SEM mediation analysis revealed a directional model in which Context influences Relationship (β = 0.39), which in turn predicts Integration of Care (β = 0.89). Although embedded within Integration under CFA, the Relationship showed independent predictive power in PLS-SEM, validating its conceptual importance. This aligns with the foundational assumption of the FoC Framework: that caregiving quality is shaped not only by tasks or procedures but by the broader environment and interpersonal relationships in which care occurs.
The Spanish FoC-IMT Tool is a valid, reliable instrument for assessing person-centred care. The predictive model highlights the pivotal role of therapeutic relationships in delivering integrated, high-quality care.
Hospitalised patients contributed directly by responding to the FoC-IMT survey, thereby shaping the psychometric validation and predictive model. Patients were not involved in the study design, conduct or manuscript preparation.
To examine the feasibility of using a large language model (LLM) as a screening tool during structured literature reviews to facilitate evidence-based practice.
A proof-of-concept study.
This paper outlines an innovative method of abstract screening using ChatGPT and computer coding for large scale, effective and efficient abstract screening. The authors, new to ChatGPT and computer coding, used online education and ChatGPT to upskill. The method was empirically tested using 400 abstracts relating to public involvement in nursing education from four different databases (CINAHL, Scopus, ERIC and MEDLINE), using four versions of ChatGPT. Results were compared with a human nursing researcher and reported using the CONSORT 2010 extension for pilot and feasibility trials checklist.
ChatGPT-3.5 Turbo was most effective for rapid screening and had a broad inclusionary approach with a false-negative rate lower than the human researcher. More recent versions of ChatGPT-4, 4 Turbo, and 4 omni were less effective and had a higher number of false negatives compared to ChatGPT-3.5 Turbo and the human researcher. These more recent versions of ChatGPT did not appear to appreciate the nuance and complexities of concepts that underpin nursing practice.
LLMs can be useful in reducing the time nurses spend screening research abstracts without compromising on literature review quality, indicating the potential for expedited synthesis of research evidence to bridge the research–practice gap. However, the benefits of using LLMs can only be realised if nurses actively engage with LLMs, explore LLMs' capabilities to address complex nursing issues, and report on their findings.
Nurses need to engage with LLMs to explore their capabilities and suitability for nursing purposes.
No patient or public contribution.
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.
This study used a narrative inquiry design.
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.
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.
Success, according to nurses, is not exclusively defined by patient outcomes but includes the approach to, and process of, care delivery.
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.
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.
Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
No direct patient or public contribution.
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