基础护理的领导力：整体大于各部分之和 | J Adv Nurs

Leadership for Fundamental Care: The whole is greater than the sum of the parts

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This Special Issue celebrates leadership for Fundamental Care with a wide and diverse variety of topics being covered. Healthcare and nursing leaders cannot ignore the impact of the COVID pandemic. Several papers have described how this was undertaken (Amaral et al., 2022; Schroberer et al., 2022; Sugg et al., 2022) and how leadership interventions shaped patients' experiences of fundamental care during the pandemic. Contributions from around the globe have ranged from discursive pieces to descriptive and empirical work. While our work on improving the scientific basis has still some way to go, the effort and desire to create improvements and change in fundamental care delivery are real and palpable.

However, from a leadership perspective many challenges remain. We continue to have a dearth of evidence to help us argue for and embed better fundamental care practices in our acute care systems, whether that is trying to reduce delirium in older people in acute hospital settings (Cahill et al., 2022) or understanding why fundamental care is ‘missed’ (Blackman & Mudd, 2022; Grealish et al., 2022). Unless fundamental care is embedded in our professional practice frameworks and measurement processes (Aspinall et al., 2022; Merkley et al., 2022), then the likelihood of neglecting fundamental care is increased.

Moreover, these realities are compounded by observations that registered nurses are not confident in what they can delegate to assistants in nursing (Crevancore et al., 2022), nor do they demonstrate an understanding of who is responsible for preventing avoidable rehospitalization of patients for constipation or hospital acquired pneumonia (Feo et al., 2022). This brings to light the important leadership role of the nurse to explicate what nursing's contribution to the team is and how to role model this behaviour to nursing and other healthcare colleagues (Mudd et al., 2022). Nursing leaders seem to be conflicted in how to do this.

Despite these ongoing challenges, there are lots of opportunities for future growth and development. Embedding fundamental care into the DNA of our health and care systems must be our goal for the next decade. We have great examples from several health systems internationally where nursing leaders have raised awareness to the value and central importance of fundamental care (Merkley et al., 2022). They have operationalized fundamental care through their professional practice frameworks, routine quality and safety measures and clinical indicators (Aspinall et al., 2022; Mainz et al., 2022; Merkley et al., 2022). These initiatives need to be replicated across all our health and care jurisdictions so that our actions around fundamental care lead to demonstrable improvements in health and care outcomes as well as create greater efficiencies.

But what we cannot ignore is the toll that the pandemic has taken on nurses and carers around the world (Buchan & Catton, 2020; Kitson et al., 2021). We are facing a global shortage of nurses and we know that nurses leave the profession because they cannot deliver the relationship-centred, personalized care that they want to deliver (Kitson, n.d. Oxford statement). This is where our affirmation of our leadership for fundamental care will not only save our patients, but it will also save our profession into the future. The reason why nurses are the most trusted professional group globally is because we care, and we care for individuals and their families at times of greatest distress. This should give us the confidence to know that our job is to challenge every decision, policy and system that does not put the patient's fundamental care needs first and our job is to do it in a way that leads to individual, team and system transformation.

By reminding ourselves of this responsibility, and by virtue of our professional identity that we have pledged to society, we will support each other in our collective efforts to transform our health and care systems. We will make them become places that are great to work in, that are productive and innovative and that value human endeavour, innovation, effort and courage. As leaders, we will then be able to carry the responsibility of producing the next generation of nurses who value and own the central importance of getting fundamental care right. Of course, none of this clinical leadership is possible without collaboration with educational, research, policy and executive leaders who know how to work together to achieve these bold ambitions. Our clinical, executive, educational and research leaders have described the innovations in collaborative practice (Gronkjaer et al., 2022) that will enable such ambitions to come to be realized.

We also need to acknowledge that for a global professional workforce the size of nursing, that we are much too compliant and subservient. We no longer need to accept the status quo. Where is the investment in professional development, talent investment, leadership mentoring and support, internships and sabbaticals that any other profession with equivalent impact would take for granted and be offered? Why are our CEOs and political leaders still feeling confident that they can ignore the mounting body of evidence that shows that fundamental care delivery is central to the wellbeing of our patients and our workforce? Transforming fundamental care must continue to be our unifying call to action as leaders (Kitson et al., 2019). And not only will it transform care, but it will also guarantee a strong and relevant future for our profession and its contribution to health, wellbeing and quality of life.

This special issue has shone a light onto what is happening across our global health and care systems to promote better fundamental care. Let us take this opportunity to unite in our shared goal to ensure that every person that we care for is afforded a level of person-centred, evidence-based fundamental care that at least does them no harm and at best helps them on their road to recovery, health, wellbeing and quality of life (or peaceful and dignified death).

全文翻译（仅供参考）

本期特刊以广泛多样的主题来庆祝基础护理的领导力。医疗保健和护理领导者不能忽视COVID大流行的影响。几篇论文描述了这是如何进行的（Amaral et al.，2022; Schroberer等人，2022; Sugg等人，2022）以及领导力干预如何塑造了大流行期间患者的基本护理体验。来自地球仪各地的贡献从论述性文章到描述性和实证性工作不等。虽然我们在改善科学基础方面的工作仍有一段路要走，但在基本护理提供方面进行改进和改变的努力和愿望是真实的和明显的。

然而，从领导力的角度来看，仍然存在许多挑战。我们仍然缺乏证据来帮助我们论证并将更好的基础护理实践纳入我们的急诊护理系统，无论是试图减少急诊医院环境中老年人的谵妄（Cahill等人，2022）或理解为什么基本护理被“错过”（Blackman & Mudd，2022; Grealish等人，2022）。除非基本护理被嵌入到我们的专业实践框架和测量过程中（Aspinall等人，2022; Merkley等人，2022），则忽视基本护理的可能性增加。

此外，注册护士对他们可以委派给护理助理的任务没有信心的观察结果使这些现实变得更加复杂（Crevancore等人，2022），他们也没有证明理解谁负责防止患者因便秘或医院获得性肺炎而可避免的再住院（Feo等人，2022）。这揭示了护士的重要领导作用，阐明了护理对团队的贡献，以及如何向护理和其他医疗保健同事树立这种行为的榜样（Mudd等人，2022）。护理领导似乎在如何做到这一点上存在矛盾。

尽管面临这些持续的挑战，但未来仍有许多增长和发展的机会。将基础护理嵌入我们的卫生和护理系统的DNA必须是我们未来十年的目标。我们在国际上的几个卫生系统中有很好的例子，在这些系统中，护理领导者提高了对基础护理的价值和核心重要性的认识（Merkley等人，2022）。他们通过专业实践框架、常规质量和安全措施以及临床指标来实施基本护理（Aspinall等人，2022Mainz等人，2022; Merkley等人，2022）。这些举措需要在我们所有的卫生和保健管辖区推广，以便我们围绕基本保健采取的行动能够明显改善卫生和保健成果，并提高效率。

但我们不能忽视的是这种流行病给全世界的护士和护理人员造成的损失（Buchan & Catton，2020; Kitson等人，2021）。我们正面临全球护士短缺，我们知道护士离开这个职业是因为他们不能提供他们想要提供的以关系为中心的个性化护理（Kitson，未标明 牛津声明）。这就是我们对我们在基础护理方面领导地位的肯定，不仅会保存我们的病人，也会拯救我们的职业走向未来。护士之所以是全球最值得信赖的专业群体，是因为我们关心，我们在最痛苦的时候关心个人和他们的家人。这应该给予我们信心，让我们知道我们的工作是挑战每一个决定，没有把病人的基本护理需要放在首位的政策和制度，而我们的工作是以一种导致个人、团队和制度变革的方式来做到这一点。

我们会紧记这项责任，并凭借我们向社会承诺的专业身份，互相支持，共同努力改革本港的医护制度，使这些制度成为一个理想的工作场所，发挥生产力和创新精神，并重视人的努力、创新精神、努力和勇气。身为领袖，这样，我们就能够承担起培养下一代护士的责任，他们重视并拥有获得正确的基本护理的核心重要性。2当然，没有教育、研究、政策和行政领导人知道如何共同努力实现这些大胆的抱负。我们的临床、行政、教育和研究领导人已经描述了合作实践中的创新（Gronkjaer等，2022），这将使这些雄心得以实现。

我们还需要承认，对于护理规模的全球专业劳动力来说，我们太过顺从和屈从。我们不再需要接受现状。在专业发展、人才投资、领导力辅导和支持方面的投资在哪里，实习和休假，任何其他具有同等影响力的职业都会认为是理所当然的，并提供？为什么我们的首席执行官和政治领导人仍然自信地认为，他们可以忽视越来越多的证据，这些证据表明，基础护理的提供对我们的患者和员工的福祉至关重要？改革基础护理必须继续成为我们作为领导人的统一行动呼吁（Kitson等人，2019）。它不仅将改变护理，还将保证我们的职业及其对健康、福祉和生活质量的贡献有一个强大和相关的未来。

本期特刊揭示了全球卫生和保健系统为促进更好的基本保健而正在发生的事情。让我们借此机会团结起来，实现我们的共同目标，确保我们所护理的每一个人都能获得一定程度的以人为本、循证的基本保健，至少不会对他们造成伤害，充其量能帮助他们走上康复、健康、健康和生活质量（或平静和有尊严的死亡）。

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