Vanderbilt nurses gathered in Light Hall and virtually on May 6 for the inaugural Nursing Grand Rounds, the kickoff of Nurses Week celebrations.
The new series began with the presentation, “Fundamental Care: Creating the Value Proposition for Nursing,” by Devin Carr, DNP, RN, ACNS-BC, NEA-BC, SPSS, Chief Nursing Officer of MaineHealth-Southern Region.
Carr is a former Vanderbilt nurse who served for more than 15 years, from a respiratory therapist to nurse to administrative director of the Surgical and Transplant Patient Care Center. His presentation focused on the essential value of fundamental nursing care, connecting and being present with patients, and attending to their basic care needs, such as nutrition, mobility and oral health.
In a world in which nurses are asked to document and quantify more and more data, Carr emphasized the importance of fundamentals to good patient outcomes.
“Fundamental care is probably the most important thing that we do and that we, as nurses delivering the best fundamental care, are going to be the solution to the problem that people in health care just have yet to acknowledge,” Carr said.
Carr premised his discussion on a 2000 Institute of Medicine study that showed that up to 98,000 patients die yearly from medical mistakes, followed by a similar study from CMS.
“This was a wakeup call for us,” Carr said. Medical systems responded with bundles and work to fight patient-acquired infections and falls and initiated major data collection.
Though that work was important, Carr argues that fundamental nursing care is still being systemically missed — such as basic focus on building patient mobility (to prevent falls), basic oral care (to prevent infection), and nutrition. All these areas prevent mortality, but focusing on fundamentals is challenging with a combination of more acute patients, increased documentation requirements for nurses, and systemic staffing challenges.
“We know there are a lot of critical issues facing hospitals; pressure injuries, falls and infections are growing,” Carr said. Hospitals have responded with an instinct for high-tech interventions. But fundamentals matter, he said. “We’ve got to think differently.”
Take delirium, for example. “Hydration, nutrition, sleep, rest, mobility… decrease delirium,” he said. Delirium leads to dementia for many patients, he added.
Or take fall prevention. Many popular interventions — such as restraints, bed alarms and side rails — only delay the problem. “The longer patients stay in the bed, the more likely when they do get up, they’re going to fall,” he said. “The longer they stay in bed, the more likely they’re going to develop in-hospital delirium. So, these things are not just in isolation, and we can’t just look at interventions designed for one of those. We have to think broadly about a fundamental care bundle.”
Carr said the focus on fundamental care is important not just for improving patient outcomes but preventing expensive adverse patient events.
He said improving patient satisfaction will mean turning away from computer screens to document patient data, at least some of the time, to connect with patients in a personal way.
One lifesaving intervention is as simple as brushing patients’ teeth twice a day, preventing possible fatal infections.
Carr said a paradigm shift needs to take place toward fundamental care, which needs to be better studied and quantified, and care standards need to change as a result.
“This model is developing a relationship with patients and families,” he said. “It’s establishing trust. It’s getting to know each other. It’s getting to anticipate what their care needs are. It’s them learning from us, and it is the foundation of what we do.”
