Integrating fundamentals of care - moving from strategic intent to clinical practice: An organizational case study

To describe the integration of the Fundamentals of Care framework into clinical quality development in a large hospital department and explore how it contributed to shared understanding, implications for nursing leadership, and operationalization.

The study was a descriptive organizational case study combining top-down policy direction with bottom-up operationalization of a nursing framework in routine clinical settings. The study was conducted in a Danish regional university hospital department encompassing four medical specialties. Methods for integration included a professional governance structure with steering group meetings and inter-ward networks. Data on integration outcomes included the products developed under this governance structure as well as surveys of hospital-wide opinions about framework implementation.

Integration outcomes included reflective tools, shared quality improvement themes, use of appreciative inquiry-guided engagement processes, and quarterly improvement cycles that addressed fundamental care topics across diverse clinical contexts. Furthermore, hospital-wide surveys indicated that the framework provided a shared language and values base for quality improvement but required operationalization to achieve clinical relevance. Integration was supported by the professional governance attributes accountability, professional obligation, collateral relationships, and decentralized decision-making. While direct impacts on patient outcomes were difficult to isolate, the Fundamentals of Care framework fostered reflective practice and alignment with core nursing values.

Integrating a theoretical framework like Fundamentals of Care into clinical quality development is feasible but requires deliberate translation, leadership support, and organizational structures that prioritize professional autonomy and cross-level collaboration.

The Fundamentals of Care framework can serve as catalyst for cultural transformation when integrated through professional governance structures. Local adaptation, reflective tools, and relationship-based approaches support sustainability and clinical anchoring.