It’s essential, not simple

Even the routine tasks of everyday nursing are a vital part of high-quality care. 

Essential nursing care sits at the very core of what nursing is all about and its importance cannot be overstated or talked about too often.

Essential care, referred to by many as basic nursing care, is at times denoted in such a way as to lead to the perception that the care delivered is of less importance and is easily transferable to less skilled workers. This could not be further from the truth.

In April 2013, I wrote an article for Nursing Review about the importance of essential care after the findings of the Mid Staffordshire NHS Foundation Trust Public Inquiry. This inquiry showed a healthcare system overly concerned with the numbers and financial outcomes of its institutions, as opposed to patient care. Outcomes from this inquiry and similar ones have shown that the loss of focus on patient care ultimately leads to failings in standards and, in the worst-case scenarios, avoidable loss of life. If the core principles of essential nursing care are not being undertaken with due diligence or are delegated to untrained workers, failings such as those identified at Mid Staffordshire will continue to happen.

This is not to say that we cannot have other appropriately trained categories of workers alongside registered and enrolled nurses in some settings but it does mean that in delegating care tasks, we need to be clear what we are doing and ensuring that the delegation is appropriate. We need also to remember that it is a task that is usually delegated and not necessarily the care of the person.

There are many different tenets to maintaining the ethos of essential care but there are three I’d like to focus on in this article – individual responsibility and practice; role modelling; and policies and procedures.

To me, individual responsibility is quite simple: maintain your professional integrity; be influenced by true leaders and not those who may practise lesser standards than those you know are right; listen, really listen, to those in your care and their family; be kind and compassionate; and finally, remember that the care you provide to each and every person can have a positive impact on their health, whether it be simple wound care or end-of-life care. As an individual, the very manner in which you engage with the person receiving care is a critical part of ensuring that you meet the standards expected of a professional nurse.

In my own practice, it was often whilst doing what looked like the simplest of tasks that I was able to take the time to observe and wholly engage with the person in my care. I would note changes to skin integrity, breathing patterns and eating behaviours, or learn something related to their care through simple conversations. To an outside observer, these tasks may appear simple but they were, in-fact, part of a much wider picture – assessing and treating the person as an individual, holistically. The underpinnings of Florence Nightingale’s approach of ensuring that those in our care get good nutrition, have skin integrity maintained, and are kept clean and comfortable are as true today as they were when she wrote them. They are essential to providing a good foundation for other care to build on, so the individual is placed in the best possible position to improve their health.

As we know, leadership plays an important role in shaping culture. If students and newly registered nurses witness their nurse unit manager or director of nursing (DON) consistently role modelling and valuing the delivery of essential care to patients, then this positive behaviour will be upheld. Nurse leaders are key agents in delivering the message that essential care should be an ongoing priority – not only for nursing staff but for the entire multi-disciplinary team.

Over my career, I have had many different roles, from ward nurse to DON, chief nurse to CEO. I’ve spoken to many students, nurses, managers, administrators and patients and their families and friends about the importance of essential nursing care. Virginia Henderson, the influential American 20th- century nurse researcher and author wrote of nursing:

“It is assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (to peaceful death) that he would perform unaided, if he had the necessary strength, will or knowledge, and to do this in such a way as to help him gain independence as rapidly as possible.”

Henderson reminds us all that the essential care we deliver is the core component of compassionate care and I would strongly encourage all nurses in a position of leadership to reflect on how they ensure that they are not only delivering but also valuing essential care and see if their behaviours align with Henderson’s words.

It’s not just the responsibility of nurses to ensure essential care is delivered. The policies and procedures implemented by governments and health organisations – whether they’re hospitals, aged-care facilities or community health centres – play a key role in determining the quality of essential care we deliver. The Australian College of Nursing, in conjunction with feedback from our members, provides a number of submissions to government and non-government agencies on the issue of essential care, to ensure standards in Australia are maintained. One such example is ACN’s recent submission to the Australian Commission on Safety and Quality in Health Care on the National Consensus Statement: Essential Elements for Safe and High-Quality End-Of-Life Care in Acute Hospitals. We were pleased to see the document had a strong, patient-centred focus. All health organisations should have a constant review process to ensure that their policies and procedures are not merely supporting but enabling the delivery of essential care as a key component of the nurses’ role.

It’s important we recognise that the effectiveness of many of the essential elements of care within our health system is highly dependent on the role and presence of nurses. Let’s not forget this dependence brings with it great responsibility, which I know many nurses take seriously as they actively endeavour to deliver quality essential care every day – sometimes despite difficult circumstances. I would argue that, as a minimum, engaging with patients with compassion and kindness as you strive to deliver essential care is critical.

Adjunct professor Debra Thoms is the CEO of the Australian College of Nursing.

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