Integration of the fundamental of care framework into the clinic (the CONFORM study): A quasi-experimental pre-post implementation study protocol

Introduction. Fundamental care addresses the essential physical and psychosocial needs of patients and is critical for safe, highquality nursing practice. Despite growing awareness of its value, it remains one of the most neglected areas in clinical care. The Fundamentals of Care (FoC) Framework provides a structured approach to support its delivery, yet its practical implementation remains limited and underexplored. This study aims to evaluate the effectiveness of integrating the FoC Framework into nursing practice to reduce patient length of stay in medical and surgical wards. Methods. A quasi-experimental pre-post implementation study will be conducted over 15 months in one medical and two surgical wards. The FoC Framework will guide interventions targeting key needs (nutrition, elimination, mobility, and education) identified through focus groups with nurses, patients, and caregivers. Fol lowing framework introduction, a six-month phase of individualised care will be implemented. Data on interventions and outcomes will be collected daily via the Electronic Health Record, both before and after implementation. The primary outcome is length of stay; secondary outcomes include adverse events, readmissions, patient and nurse satisfaction, turnover intentions, complaints, discharge rates, needs assessments, frequency of interventions, and goal achievement. Analyses will use t-tests or Mann-Whitney tests. Multivariable regression models will be considered for adjusting for confounding factors. Conclusion. This is the first protocol that will assess the implementation of the FoC Framework in clinical practice. Findings will contribute robust evidence on its potential to improve care quality, meet essential patient needs, enhance satisfaction among patients and staff, and reduce adverse outcomes.