Nursing studies

Why students must value and prioritise fundamental nursing care

University of Exeter’s course teaches that ‘basic care’ involves complex interventions

University of Exeter’s course teaches that ‘basic care’ involves complex interventions

Washing a patient is part of fundamental nursing care. Picture: Paul Stuart

When the University of Exeter launched its first-ever adult nursing programme in September 2019, we decided to prioritise the teaching of fundamental nursing care.

Fundamental care concerns the core nursing activities that address people’s essential needs, such as personal hygiene, nutrition and hydration, mobility, elimination, sleep, safety, comfort, sense of self, mood and level of anxiety.

Evidence of unmet fundamental care needs

In recent years, reports have suggested that, in some cases, nurses have not focused enough attention on patients’ fundamental care needs.

Most notable was the 2013 Francis Report – documenting the public inquiry into poor care at Mid Staffordshire NHS Foundation Trust, chaired by Sir Robert Francis QC – which revealed that some patients were left in soiled bed clothes, assistance was not provided with feeding, and water was often left out of reach.

Most of us take it for granted that we will meet our own essential care needs through everyday activities and interactions. It is only when we are no longer able to do this that we even think about them.

Fundamental care addresses our basic humanity

When we hear about astronauts, for example, or people who do extreme sports, we wonder how they go to the toilet. What do they eat and drink? How do they cope psychologically? We are interested in the answers because they concern our basic humanity.

As nurses, we meet people whose ability to undertake these actions is compromised by their physical, psychological or social condition. Asking the above questions of these people is integral to the core business of nursing.

‘Basic care’ involves high level of expertise

There is a widespread perception that meeting people’s fundamental needs is synonymous with ‘common sense’ and undertaking ‘basic’ task-focused activities. At Exeter, we reject this notion and teach students that these activities are in fact complex interventions requiring a high level of knowledge and expertise.

Washing someone, for example, could be considered simple; you fill a bowl with water, pick up a wash cloth and soap, and wash them.

But washing can be an incredibly intimate activity, which is also deeply subjective. There are many issues to consider, such as preserving independence, dignity and respect, using a person’s favourite toiletries, and timing the wash to accommodate a patient’s visitors. The significant differences between the people we are washing also need to be recognised.

Suddenly, it doesn’t sound like a basic task at all.

The way personal hygiene needs are met is often one of the things people remember and value most when they have been unwell, so ensuring that the person has a positive and individualised experience is paramount.

The structure of our university course

Fundamental nursing care is fully integrated into the curriculum as one of the six ‘pillars’ of our adult nursing course. All of our pillars work together, each with a lecturer who acts as the ‘pillar guardian’. This guardian also ensures that fundamental nursing care is embedded within the other five pillars.

The six pillars of our adult nursing degree programme  

  • No health without mental health
  • Fundamental nursing care
  • Evidence for practice
  • Patient and public involvement
  • Global health
  • Leadership and management

The most important thing students learn is to value fundamental nursing care interventions as highly as other more technical nursing proficiencies. They learn that patients’ experience of nursing is often synonymous with the experience of receiving fundamental care.

Monitoring patients’ physical, psychosocial and relational well-being

Learning about fundamental care is structured around a specific framework, developed by the International Learning Collaborative (ILC). This is a network of nurse leaders and academics who work together to improve the evidence base for, and delivery of, fundamental nursing care in health systems.

The ILC framework includes nurses paying attention to people’s physical, psychosocial and relational well-being. Students learn the importance of establishing a positive relationship between nurse and patient to ensure fundamental care needs can be met effectively.

Despite fundamental care being part of core nursing business, the evidence base to support such complex interventions is sparse. Exeter nursing students are therefore taught how to work as ‘scientist practitioners’ – finding, using and generating evidence for their care – and learn to be constantly curious.

Prioritising fundamental care

As fundamental care is often undervalued and delegated to less well-qualified practitioners, a key challenge for students is to reconcile patient need with available resources, and to shape and influence the setting where care is given. They act to ensure that fundamental care is prioritised within their practice placements.

Nurses are starting to re-value the fundamental business of nursing care, becoming proud once again of its unique contribution to health and well-being. The Exeter course puts meeting people’s basic human needs firmly back at the core of nursing education.

Susannah Tooze is senior lecturer and practice lead for the MSci Nursing programme at the University of Exeter Academy of Nursing



David Richards is professor of mental health services research and head of nursing at the University of Exeter Academy of Nursing



This is the second in a series of articles about the six pillars of Exeter’s adult nursing programme. Read the first one here:  

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