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The Fundamentals of Care Framework as a Point-of-Care Nursing Theory

Kitson, Alison L.

doi: 10.1097/NNR.0000000000000271

Background Nursing theories have attempted to shape the everyday practice of clinical nurses and patient care. However, many theories—because of their level of abstraction and distance from everyday caring activity—have failed to help nurses undertake the routine practical aspects of nursing care in a theoretically informed way.

Objective The purpose of the paper is to present a point-of-care theoretical framework, called the fundamentals of care (FOC) framework, which explains, guides, and potentially predicts the quality of care nurses provide to patients, their carers, and family members.

Discussion The theoretical framework is presented: person-centered fundamental care (PCFC)—the outcome for the patient and the nurse and the goal of the FOC framework are achieved through the active management of the practice process, which involves the nurse and the patient working together to integrate three core dimensions: establishing the nurse–patient relationship, integrating the FOC into the patient’s care plan, and ensuring that the setting or context where care is transacted and coordinated is conducive to achieving PCFC outcomes. Each dimension has multiple elements and subelements, which require unique assessment for each nurse–patient encounter.

Implications The FOC framework is presented along with two scenarios to demonstrate its usefulness. The dimensions, elements, and subelements are described, and next steps in the development are articulated.

Alison L. Kitson, BSc(Hons), PhD, RN, FRCN, FAAN, FAHMS, is Vice President and Executive Dean, College of Nursing & Health Sciences, Flinders University, Adelaide, Australia.

Accepted for publication September 12, 2017.

This paper was accepted under the Editorship of Susan J. Henly.

The author would like to acknowledge colleagues (Rebecca Feo, Post Doctoral Research Fellow; Tiff Conroy and Jan Alderman, Lecturers in Nursing; Rick Wiechula and Philippa Rasmussen, Senior Lecturers; and all members of the Adelaide Nursing School Fundamentals of Care Research Program) who have worked tirelessly with me on developing and refining the concepts that have shaped the fundamentals of care framework. The author would also like to acknowledge members of the International Learning Collaborative who have contributed significantly to the ideas around fundamental care, in particular to Yvonne Wengstrom, Professor of Nursing at the Karolinska Institute, Sweden; Jack Needleman, Fred W. & Pamela Wasserman Professor, UCLA Fielding School of Public Health, California; Asa Muntlin Athlin, Head of Research, Department of Emergency Care and Internal Medicine, Uppsala University Hospital, Sweden; Eva Jangland, Senior Lecturer, Department of Surgical Sciences, Uppsala University, Sweden; and Erik Sorensen, Professor in Clinical Nursing, Alborg University, Denmark.

The author has no conflicts of interest to report.

Corresponding author: Alison L. Kitson, BSc(Hons), PhD, RN, FRCN, FAAN, FAHMS, College of Nursing & Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia 5042, GPO Box 2100 Adelaide 5001 (e-mail:

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