Jenny Parr

This study aimed to understand the inpatient experiences of people accessing healthcare who identify as Indian in an acute care hospital in Aotearoa New Zealand, using the Fundamentals of Care Framework as a point of care theory. Specifically, the study aimed to explore their experiences of communication, respect, personal care, and self-care, four areas identified for improvement in a previous internal organisational review of care. The study used a qualitative descriptive approach which aligns with critical theory aiming to understand how different participants perceive reality within dynamic contexts. The study was conducted with ten participants who identified as Indian and had been patients in an acute care hospital. Directed content analysis was applied to the data from the interviews using the four previously identified categories. These categories included communication, respect, personal, and self-care. Content drawn from within these categories was then analysed using relational caregiver (nurse) actions as described in the Fundamentals of Care Framework. The results demonstrated that nurses’ actions lacked a relational approach in many of the care episodes particularly concerning communication, respect, and self-care. However, this approach aligned with the participant’s expectations of what nurses can deliver due to the busyness of their work; they seemingly picked up this burden of nursing busyness. Participants did not express any perceived differences in care relating to their culture or ethnicity. The diversity of the workforce reflective of themselves, was a welcoming factor, highlighting the benefits of a globally mobile workforce. Te Reo Māori Translation: He rangahau ine kounga o ngā wheako o ngā tūroro Īnia mō te horanga taurima taketake i tētahi hōhipera māuiui tārūrū: Ngā Ariā Matua Ko te aronga o tēnei rangahau he whai kia mārama ki ngā wheako o ngā tāngata e kī nei he Īnia rātou ina urutomo ki ngā tautiakitanga hauora i tētahi hōhipera taurima māuiui tārūrū i Aotearoa, mā te whakamahi i te Anga Tikanga Taurima Taketake hei pūtahi mō ngā ariā taurima. Inarā, ko te whai a te uiuinga kia tūhuratia ō rātou wheako mō te whakawhiti kōrero, mō te whakarangatira i te tangata, te tiaki whaiaro, me te tiaki i a rātou anō, ēnei katoa i tautohutia i tētahi arotake taurima whakaroto o te whakahaere. Ka whakamahia e tēnei rangahau tētahi ara ine kounga whakamārama e hāngai ana ki ngā ariā tātari e whai nei kia mārama he pēhea te kite a tēnā tangata whai wāhi, a tēnā tangata whai wāhi, i ngā horopaki rerekē. I kawea tēnei uiuinga i te taha o ētahi tāngata whai wāhi tekau i kī he Īnia rātou, ā, kua noho hei tūroro i tētahi hōhipera taurima māuiui tārūrū. I hoatu he tātari whakawhāiti aronga ki ngā mōhiotanga i tāpaetia mai i roto i ngā uiui. I tātaritia ngā kitenga mā te whakamahi kāwai i takea mai i tētahi arotake tō mua o ngā wheako o ngā tūroro o te taurima taketake i taua wāhi tonu o te rangahau mā te whakamahi i ngā kāwai e whā kua whakamāmatia ake nei. Ka uru ki tēnei kāwai ko te whakawhiti, ko te whakaute, ko te āhua whaiaro, me te taurima a te tangata i te tangata anō. I tātaritia ngā kai i takea mai i ēnei kāwai nā te whakamahi i ngā mahi a te kaitaurima (tapuhi) tūtata, e ai ki tōna tūtohutanga i roto i te Anga Tikanga Taurima Taketake. Kei ngā hua ka kitea i te ngaro tētahi tatanga tūturu i roto i ngā tūponotanga taurima maha, otirā mō te whakawhiti kōrero, mō te whakaute, me te taurima a te tangata i te tangata anō, i tino kitea. Ahakoa tērā, i hāngai tēnei ara ki ngā tūmanako o ngā tāngata whai wāhi mō ngā mea ka taea te hora e ngā tapuhi nā te waipuke mai o ngā mahi; i rongo rā rātou i te taumahatanga o te waipuke o te mahi tapuhi. Kāore ngā tāngata whai wāhi mai i tino kōrero mō tētahi makihuhunu, nā tō rātou ahurea, tō rātou momo iwi rānei. I mihi anō rātou ki te āhua o te noho mai o ētahi tapuhi nō tō rātou ao anō, me te mihi ki te āhua o te rere noa o ngā tapuhi ki ngā wāhi maha o te ao, mahi ai.

Predictive modeling has advanced healthcare management by informing operational and strategic decisions; however, such models often exclude the fundamental care elements that shape patients' experiences, thereby limiting person-centered, quality-driven decisions. This gap is addressed by piloting a predictive model grounded in the Fundamentals of Care (FoC) Framework, which captures how system-level and policy-level conditions (Context of Care) influence care outcomes (Integration of Care) through the clinician–patient Relationship. A cross-sectional, exploratory design was implemented across Spain (hospital-based care, n = 55) and Australia (community-based care, n = 32). A culturally adapted, 41-item patient-reported experience measure was developed to operationalize the FoC Framework’s three core dimensions. Structural relationships were tested using Consistent Partial Least Squares Structural Equation Modeling to assess model feasibility. Results indicate that the Context of Care significantly predicted Relationship in both countries (Spain: β = 0.33; Australia: β = 0.68), which strongly predicted Integration of Care (Spain: β = 0.84; Australia: β = 0.92), fully mediating the effect of Context, which had no direct influence on Integration. Findings highlight a consistent structural pathway: Context of Care → Relationship → Integration of Care. This pilot demonstrates the feasibility of integrating patient-reported experience data into predictive modeling grounded in fundamental care delivery theory, offering transferable insights into how system- and policy-level conditions shape care quality through the Relationship dimension. The model supports early-stage decision-making tools for quality improvement, workforce planning, and system design, emphasizing the importance of a Context of Care that enables clinician-patient Relationships to achieve effective Integration of Care.

Aim: To explore and validate an end of shift survey with a low response burden, practical application and generated evidence of related associations between workload, quality of work and patient care, missed care and job satisfaction.Design: A retrospective cross‐sectional survey of the experiences of nursing staff.Methods: Data were collected from 265 nurses who responded to a questionnaire at the end of their shift in 2022. Exploratory factor analysis was undertaken using IBM SPSS v.27 and confirmatory factor analysis was undertaken using IBM AMOS v27. Hypotheses testing was undertaken using IBM SPSS v.27 using multiple regression analyses.Results: All of the hypotheses were supported. There was a negative association between workload and quality of work and job satisfaction. Quality of work was negatively associated with workload and missed care and positively associated with job satisfaction. The association between missed care and job satisfaction was negative.Conclusion: The EOSS is a valid and reliable tool with a low response burden. The tool supports previous research which demonstrated there is a negative relationship between level of workload and shift type with satisfaction, quality of work and potentially nurse retention.Implications for the Profession and/or Patient Care: In the context of a global nursing shortage nursing leaders must ensure that care we provide is of the highest quality. We must take every action to address high workload to reduce the risk that fundamental care is not sacrificed, job satisfaction is improved and nurses remain in the profession. The EOSS gives nurse leaders a reliable, practical, consistent, applied tool that will better enable associations to be observed between resource configuration, workload and critical impacts on nursing and patient care.Reporting Method: We have adhered to the relevant EQUATOR guidelines using the STROBE reporting method.Patient or Public Contribution: No Patient or Public Contribution.

Aim: To identify and synthesize empirical evidence on the role of healthcare leaders in the development of equitable clinical academic pathways for nurses.Design: Integrative literature review.Data Sources: Literature was searched using CINAHL, PubMed, ProQuest and Google Scholar databases.Review Methods: A total of 114 eligible articles published between 2010 and2022 were screened, 16 papers were selected.Results: Results highlighted the need for consistent national, regional, and organizational policy approaches to developing clinical academic careers for nurses. Government health departments and National Health boards must focus on increasing engagement in research and evidence‐based nursing practice for high‐quality patient care. Discriminatory practices and attitudes were identified as barriers. Discrimination due to gender was evident, while the impact of race, ethnicity, and other social categories of identity are under‐researched. Educational leaders must unravel misconceptions about research, highlighting its relevance to patient care and bedside nurses' work. Academic leaders together with executive nurses, research funders and professional nursing bodies must create appropriately remunerated career structures. Transformative approaches are required to develop the clinical academic nurse role and understand its value in clinical practice.Conclusion: Multiple elements exist within complex systems that healthcare leaders can navigate collaboratively to develop and implement clinical nurse academic roles. This requires vision, acknowledgement of the value of nursing research and the importance of evidence‐based research infrastructures.Impact: Findings highlight the collaborative role of healthcare leaders as critical to the success of critical academic careers for nurses. This review can inform those still to formalize this innovative role for nurses.Reporting Method: The review complies with the PRISMA guidelines for reporting systematic reviews. This paper contributes evidence about the healthcare leader's role in developing clinical academic pathways for nurses to the wider global clinical community.Patient or Public Contribution: No patient or public contribution was included in this review.

Aims: Investigated the experiences of Māori (the Indigenous peoples of Aotearoa, New Zealand) patients and whānau (extended family network) engaging with acute hospital inpatient services and their priorities for a Māori‐centred model of relational care.Design: A qualitative Māori‐centred research design using a Thought Space Wānanga (learning through in‐depth group discussion, deliberation and consideration) approach.Methods: Two wānanga were conducted between May 2022 and June 2022, with 13 Māori patients who had been acutely hospitalized within the past 12 months and their whānau members. The first wānanga utilized storytelling and journey mapping to collect data. The second wānanga refined the initial themes. Wānanga were audio‐recorded and then inductively coded and developed into themes.Results: Thirteen patients and whānau attended the first wānanga, while 10 patients and whānau participated in the second wānanga). Four themes were developed: (1) Whakawhanaungatanga (establishing connections and relationships), (2) Whakamana (uplifting the status and esteem of Māori), (3) Whakawhitiwhiti kōrero (the importance of communicating, discussing and deliberating) and (4) Kotahitanga (working together with purpose) all provide insights into the importance of effectively engaging and connecting with Māori patients and whānau when acutely hospitalized.Conclusions: The experiences and priorities of Māori patients and whānau affirm the international literature, suggesting that Indigenous relational concepts are critical to building relationships, connections and trust. Despite existing healthcare models for working with Indigenous peoples, their poor application contributes to sub‐optimal healthcare experiences at all points of their healthcare journey. A relational mode of practice focused on engagement and forming connections better meets the needs of Indigenous peoples engaging with inpatient health services.Implications for the profession and/or patient care: Despite the existence of Indigenous models of care, Indigenous peoples consistently report a lack of engagement and connection when accessing inpatient health services. Without establishing relationships, applying models of care is challenging.Impact (Addressing): What problem did the study address? Internationally, healthcare systems are consistently ill‐equipped to deliver culturally safe care for Indigenous and marginalized peoples, evident in ongoing health inequities. Like other reports of Indigenous experiences of health services, Māori express dissatisfaction with care delivery in an acute inpatient setting. This study investigated Māori patients and whānau experiences engaging with acute hospital inpatient services and their priorities for a Māori‐centred model of relational care. What were the main findings? Māori patients and whānau recounted negative experiences with healthcare professionals lacking effective relationships and trust. Satisfaction occurred when engagement with health care professionals resembled Indigenous cultural rituals of encounter that considered their holistic, collective and dynamic worldviews. Previous models of relational care, while helpful, are not Indigenous and so do not address their needs, such as engagement as a mode of practice (how) to achieve this. Where and on whom will the research have an impact? This research impacts Indigenous peoples' health outcomes, particularly Māori, and nurses and clinicians working and interacting within acute inpatient and other hospital settings. Indigenous research methods support co‐constructing knowledge for translation into practical outcomes through transformational practices, policies and theory development. Reporting method: We used the Consolidated Criteria for Strengthening the Reporting of Health Research Involving Indigenous Peoples (CONSIDER) statement (see File S2—CONSIDER Checklist) and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (see File S3—COREQ Checklist).Patient or public contribution: Māori patients and their whānau interviewed about their experiences were involved in data interpretation.

Aims: Identify the experiences of Māori nurses and priorities for a Māori model of relational care working with Māori patients and their whānau (extended family network) in acute hospital services.Background: Māori, the Indigenous peoples of Aotearoa (New Zealand), have a relational and holistic worldview fundamental to establishing relationships with Māori patients and their whānau. Increasing the Indigenous Māori nursing workforce can improve Māori patient experiences but is challenged by ongoing recruitment and retention issues.Design: A qualitative Māori‐centred research methodology with 12 Māori nurses.Methods: Data were collected using wānanga (learning through discussion, deliberation and consideration) using he aha ō hikoi (journey mapping) and kōrero mai (storytelling). Inductive thematic analysis was undertaken using a mahi a roopū (group process) approach. This study was conducted between May 2022 and June 2022.Results: Three key themes: (1) Māori first, nurse second, (2) Cultural loading and (3) Compromised realities were identified. Māori nurses' praxis used their complex cultural and clinical intelligence to engage in a mana‐enhancing way (strengths‐based) to improve the care delivery for whānau Māori during their hospitalization journey. Cultural loading meant Māori nurses were often burdened with unrecognized workloads as they provided care for Māori patients and whānau, which often compromised their cultural integrity.Conclusion: Nurses' commitment to care for whānau and their assigned patient load created extra burdens and threatened their cultural integrity. Their experiences highlighted modes of practice rather than models of care required to improve healthcare delivery for Māori entering the hospital. These findings signal issues and areas nursing leaders need to heed, necessary for addressing the retention of Māori in nursing and improving workload equity.Patient or Public Contribution: Māori nurses and service users were involved in the interpretation of the data.

Aim: To outline the International Learning Collaborative (ILC) Oxford Statement, explicating our commitment to ensuring health and care systems are equipped to meet patients' fundamental care needs during times of unprecedented crisis.Design/Method: Discussion paper. The content was developed via a co‐design process with participants during the ILC's international conference.Key Arguments: We, the ILC, outline what we do and do not want to see within our health and care systems when faced with the challenges of caring for patients during global pandemics and other crises. Specifically, we want fundamental care delivery to be seen as the minimum standard rather than the exception across our health and care systems. We want nursing leaders to call out and stand up for the importance of building fundamental care into systems, processes and funding priorities. We do not want to see the voices of nursing leaders quashed or minimized in favour of other agendas. In turn, what we want to see is greater recognition of fundamental care work and greater respect for the people who do it. We expect nurses to have a ‘seat at the table’ where the key health and care decisions that impact patients and staff are made.Conclusion: To achieve our goals we must (1) ensure that fundamental care is embedded in all health and care systems, at all levels; (2) build on and strengthen the leadership skills of the nursing workforce by clearly advocating for person‐centred fundamental care; (3) co‐design systems that care for and support our staff's well‐being and which foster collective resilience rather than overly rely on individual resilience; (4) improve the science and methodologies around reporting and measuring fundamental care to show the positive impact of this care delivery and (5) leverage the COVID pandemic crisis as an opportunity for transformational change in fundamental care delivery.

Aim: To demonstrate how implementing a system‐wide measurement and improvement programme can make the delivery of the Fundamentals of Care visible in practice.Design: Discussion paper.Data Sources: A retrospective evaluation of the experience of implementing a system‐wide peer review programme using the Promoting Action on Research Implementation in Health Services framework.Implications for Nursing: Implementing this programme engages nursing leaders at all levels in fundamental care delivery, evaluation and improvement. It positions nursing leaders as accountable for and champions of fundamental care.Conclusion: The peer review programme offers a solution to the complex challenge of measuring the fundamentals of care in practice. Successful implementations of this programme at two New Zealand inpatient sites have shown positive results in improved care and patient experience. This makes it worthy of consideration for other health organizations. Nursing leadership has proven to be critical to success. The Promoting Action on Research Implementation in Health Services framework highlights the components that assist with successful implementation and assists in presenting a case for change.Impact: This paper addressed the problem of the lack of action and dearth of quality, integrated data, visibility of the patient experience and the contribution of nursing leadership in an inpatient setting. Findings indicate that the peer review programme is translatable, modifiable and sensitive to ethnicity and disability. Using the implementation framework to evaluate the process has provided a guide for future implementations.

Aim and Objectives This study aimed to explore inpatient healthcare delivery experiences of Māori (New Zealand's Indigenous people) patients and their whānau (extended family network) at a large tertiary hospital in New Zealand to (a) determine why Māori are less satisfied with the relational and psychosocial aspects of fundamental care delivery compared to other ethnic groups; (b) identify what aspects of care delivery are most important to them; and (c) contribute to the refinement of the Fundamentals of Care framework to have a deeper application of Indigenous concepts that support health and well-being. Background Bi-annual Fundamentals of Care audits at the study site have shown that Māori are more dissatisfied with aspects of fundamental care delivery than other ethnic groups. Design Retrospective analysis of narrative feedback from survey data using an exploratory descriptive qualitative approach. Methods Three hundred and fifty-four questionnaires containing narrative patient experience feedback were collected from the study site's patient experience survey reporting system. Content analysis was used to analyse the data in relation to the Fundamentals of Care framework and Māori concepts of health and well-being. The research complies with the SRQR guidelines for reporting qualitative research. Results Four themes were identified: being treated with kindness and respect; communication and partnership; family is the fundamental support structure; and inclusion of culture in the delivery of care. Conclusion The current iteration of the Fundamentals of Care framework does not reflect in depth how indigenous groups view health and healthcare delivery. The inclusion of an Indigenous paradigm in the framework could improve healthcare delivery experiences of Indigenous peoples. Relevance to clinical practice Research around the application and relevance of the Fundamentals of Care framework to Indigenous groups provides an opportunity to refine the framework to improve health equity, and healthcare delivery for Indigenous people.

Aims and objectives: Identify the key concepts, principles and values embedded within Indigenous Māori models of health and wellbeing; and determine how these could inform the development of a Māori‐centred relational model of care.Background: Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners’ engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing.Design and methods: A qualitative literature review on Māori models of health and wellbeing yielded nine models to inform a Māori‐centred relational model of care. We followed the PRISMA guidelines for reporting literature reviews.Results: Four overarching themes were identified that included dimensions of health and wellbeing; whanaungatanga (connectedness); whakawhanaungatanga (building relationships); and socio‐political health context (colonisation, urbanisation, racism, and marginalisation). Health and wellbeing for Māori is a holistic and relational concept. Building relationships that include whānau (extended family) is a cultural imperative.Conclusions: This study highlights the importance and relevance of relational approaches to engaging Māori and their whānau accessing health services. It signals the necessary foundations for health practitioners to build trust‐based relationships with Māori. Key elements for a Māori‐centred model of relational care include whakawhanaungatanga (the process of building relationships) using tikanga (cultural protocols and processes) informed by cultural values of aroha (compassion and empathy), manaakitanga (kindness and hospitality), mauri (binding energy), wairua (importance of spiritual wellbeing).Relevance to clinical practice: Culturally‐based models of health and wellbeing provide indicators of important cultural values, concepts and practices and processes. These can then inform the development of a Māori‐centred relational model of care to address inequity.