The core of nursing practice, essential to patients’ quality of life

Bathing and dressing patients, helping them eat and drink, communication – these are just a few examples of key nursing care activities. “Surprisingly, however, they were supported by little evidence”, says Professor of Nursing Science Sandra Zwakhalen. “Fortunately, researchers have been paying more attention to basic care in recent years. This type of care is essential to patients’ quality of life, after all. And there’s still so much work to be done.”

“Researchers have traditionally been more interested in technical aspects of nursing, like caring for or preventing pressure sores”, says Sandra. “But basic care shouldn’t be overlooked. Although basic nursing care activities may sometimes be relatively simple, they’re complex because of the context in which they take place. Take the communication between health professionals and patients with dementia, for example.”

The research programme Basic Care Revisited put the topic of basic care on the map. The programme ran for five years (2014-2019) and was a joint effort of three university medical centres in the Netherlands: Maastricht UMC+, Radboudumc and UMC Utrecht. “This was a conscious decision”, explains Sandra. “The fact that the results weren’t achieved in one single location makes the evidence more convincing. We also worked closely with practising nurses and involved older people in our research. Networks such as the Living Lab in Ageing and Long-Term Care South Limburg were invaluable in that. Basic Care Revisited involved ten studies on the most basic nursing care activities in nursing homes, hospitals and home care settings. We focused on communication, eating, bathing and dressing, and mobility. We had to make a selection; basic care also involves activities like toileting assistance and palliative care.”

Person-centred communication

Essentially, basic nursing care activities focus less on the disease and more on the person behind the patient. They also promote empowerment. For example, one of the studies was about improving communication with people with dementia. “Older people with dementia may have difficulty expressing themselves or understanding others. Our researchers observed that many of the conversations between health professionals and patients during nursing care activities are task-oriented and not very personal. This can be improved by getting to know the patient better. If the professional knows what’s important to the patient, they can work this into the conversation. Based on this knowledge, we worked together with practising nurses, caregivers and speech therapists to develop an intervention to coach nurses on the job in order to improve communication and, therefore, care.”

Activities of daily living

Another study focused on preventing deterioration and promoting recovery in activities of daily living (ADL), such as bathing and dressing. As Silke Metzelthin, assistant professor, explains, “We looked at the effects of Function-Focused Care (FFC) in home care settings and hospitals. FFC is a philosophy of care that was developed in the United States to help health professionals and informal carers involve older people in ADL as much as possible. The goal of FFC is to empower older people and help them maintain muscle strength. It also makes people living at home less dependent on home care providers. We worked together with health care institutions to translate this concept into a training programme for home care providers, among other things.” According to Silke, “Health professionals are doers. They were taught to take over tasks from patients, who have become used to that. Now, professionals need to learn how to take a step back. Instead of asking, ‘What can I do for you?’, they now have to ask, ‘What are you going to do and how can I help you with that?’”

The results of the study were so promising that the Netherlands Organisation for Health Research and Development (ZonMw) has provided funding for follow-up studies to Basic Care Revisited. Interventions will be further developed and implemented in a three-year research project. A quality standard for ADL care will also be developed. “This should ultimately lead to guidelines for nurses and caregivers so that they will know better what to do in certain situations when providing basic care”, explains Sandra. “We can already see that the FFC approach is slowly but surely becoming a shared value. It’s also increasingly embedded in training courses and study programmes.”

Washing without water

“The follow-up project also focuses on washing without water”, says Sandra. “This method involves washing patients with a package of specially developed washcloths rather than giving them a bed bath with water and soap. Research has shown that this method is considered equally valuable by both nurses and patients. Although the method is already in widespread use, it’s not always used correctly. For example, not all the washcloths in the package are used, or washcloths are used unheated. We’re going to investigate why this is and how the use of the method can be improved.”

Unique collaboration

The basic care studies at the Living Lab in Ageing and Long-Term Care South Limburg have attracted a lot of international attention. “We’re active in various international networks, working together with colleagues from all over the world, from Australia and New Zealand to the United States”, says Silke. Sandra adds, “It’s wonderful that awareness of the importance of research into basic care is spreading like wildfire. This collaboration between Maastricht, Utrecht and Nijmegen is quite unique. We’re also working closely together with health care institutions and other projects at the Living Lab in Ageing and Long-Term Care South Limburg.” Sandra is also very positive about the involvement of other types of educational institutes in the Netherlands, like universities of applied sciences, in the studies. “This is how we can build a solid foundation for improved basic care in the future.”

Text: Margo van Vlierden 
Translation: Maud Bovelander

More information:
Basic Care revisited
Function-Focused Care