AimThis scoping review investigated and descriptively summarised previous research about fundamental nursing, its focus (what care needs are described, how is it described and by whom is it described), continuity of care (is it described in relation to fundamental nursing) and possible nursing interventions or activities targeting older people's fundamentals of care needs in home- or facility-based care.MethodsThis scoping review was carried out following the steps of Arksey and O'Malley's methodology and PRISMA-ScR reporting guidelines. Searches were conducted in PubMed via NIH, CINAHL via EBSCO and PsycInfo via ProQuest for the time period between January 2002 and May 2023.ResultsForty-two studies were included where the majority had been conducted in a facility-based care context. Nutrition-or rather nutritional care activities targeting eating and drinking-was the most frequently described fundamental care needs addressed. After this came personal care such as cleansing, dressing, oral care, skin, and foot care. Few studies addressed more than one fundamental care need at the time. The nursing staff described fundamental nursing as complex, comprehensive, and demanding. Older people and relatives described a gap between the fundamental nursing provided and their perceived need for support. Less attention was given to older peoples relational and psychosocial needs. Identified nursing interventions mainly targeted physical care needs. Our findings also implied that interventions focusing on fundamental nursing were described as feasible in practice with favourable or moderate results, while long-term effects were difficult to detect. No studies were identified focusing on fundamental nursing in relation to outcomes such as continuity of care.ConclusionFundamental nursing was mainly described in relation to physical care needs, which were essentially conducted within facility-based care contexts. Interventions and activities primarily focused on one fundamental need at the time, mainly within the physical domain. No nursing interventions were identified focusing on relational and psychosocial needs where continuity of care can be viewed as a relevant outcome. Such limited focus are especially concerning as research has highlighted the importance of that older people with complex care needs can benefit from a holistic and person-centred approach i.e. fundamental nursing.

Background: Nursing practice addressing the physical, psychosocial, and relational needs of older people – the three core dimensions of the fundamentals of care framework along with its overarching dimension, commitment to care – is a complex yet vital aspect of nurses’ scope of practice. However, it is underrepresented in the clinical context of facility-based care, such as nursing homes. Consequently, there is limited understanding of to what extent nurses engage in activities targeting older people’s fundamentals of care needs, the applicability of the framework in practice, and what acts as contextual modulators. Furthermore, contextual modulators of practice require greater attention, especially within increasingly complex healthcare systems, where nursing practice should be studied as a part of a larger system. Objective: To explore nursing practice, its contextual modulators, and the clinical decision-making processes, as aligned with the nursing process of nurses targeting older people’s fundamentals of care needs in nursing homes. Design: An exploratory study. Setting: Four nursing homes across three Norwegian municipalities. Methods: Structured direct observations were conducted. Thus, observations was supported by a protocol developed from established theoretical frameworks and concepts identified in the nursing literature as relevant to practice or as modulators of practice. Data analysis incorporated both textual and numerical analyses in a multimethod approach. Results: A total of 4351 framework activities were observed during 411 sessions (189 hours). On average, nurses engaged in 10.58 activities per observation, often addressing multiple dimensions of the framework simultaneously. Activities related to the dimension commitment to care were less frequently observed than those in the other three dimensions. We found that most observations showed nurses initiating care with activities targeting physical needs, which often expanded to include psychosocial and relational dimensions. Registered nurses primarily focused on the assessment phase of the nursing process. Nursing practice was found to be influenced by a lack of risk management, an unsupportive working environment, and unclear leadership and management of care. Conclusion and implications: This is one of the first studies exploring nursing practice targeting the fundamentals of care framework in this context. We have highlighted the intricate nature of nursing practice, its relationship with clinical decision-making processes, and the functional and performance levels of nursing activities. Contextual modulators were found to negatively influence nursing practice, suggesting the need for improved risk management, a supportive work environment, and clear nursing leadership.

Background

A nurse’s scope of practice includes the full range of roles, functions, responsibilities, and decision-making authority. However, how this scope—particularly in relation to the fundamentals of care—is experienced by registered nurses and non-registered nurses in nursing homes remains underexplored. This study aimed to explore the experiences of nurses regarding their mutual general scope of practice, the differences in their individual scope of practice, and their respective scopes in relation to the fundamentals of care in the context of nursing homes.

Methods

This qualitative study included eight nursing dyads (n = 16) from four nursing homes in south-east Norway. Data were collected through individual, focused interviews, i.e., non-dyadic data, and analysed using the framework method for dyadic analysis. The study followed the Standards for Reporting Qualitative Research (SRQR).

Results

Registered nurses described emotional strain due to a gap between professional ideals and the realities of high-pressure, understaffed environments. The contrast between being perceived as “too posh to wash” and “too busy” highlighted how systemic factors, rather than personal attitudes, shaped role perceptions. These constraints influenced care delivery and undermined their professional identity. Registered nurses tended to focus on indirect care and physical needs, while non-registered nurses took on more direct care, particularly the fundamentals of care—physical, relational, and psychosocial. Although the registered nurses valued holistic care, frequent delegation to the non-registered nurses raised concerns about care quality and role clarity.

Conclusion

Registered nurses’ scope of practice was shaped more by workload demands than by reluctance to engage in the fundamentals of care. The dyadic approach provided new insights into how professional responsibilities and activities are co-constructed in complex care settings. Findings highlight the need for organisational and clinical strategies to clarify role boundaries, strengthen registered nurses’ professional identity, reinforce the delivery of the fundamentals of care, and support effective and safe delegation practices.