Perceived Capability, Opportunity and Motivation to Deliver Fundamental Nursing Care: A Cross-Sectional Survey in Neurological Settings

BACKGROUND: Delivering nursing care to patients' fundamental needs in neurological settings is challenging due to complex needs such as long-term care, physical disability and cognitive or communicative impairment.

AIM: To examine how registered nurses and nurse assistants perceive their capability, opportunity and motivation to deliver fundamental nursing care and use this insight to inform implementation strategies based on the Fundamentals of Care framework.

DESIGN: Cross-sectional survey.

METHODS: The questionnaire, grounded in the Capability-Opportunity-Motivation (COM-B) model and the Fundamentals of Care framework, was distributed to all nursing staff (n = 404) in four neurological departments at a university hospital in Denmark. Level of agreement was calculated as the proportion of responses in the top two Likert categories ('to some extent agree' and 'completely agree') and categorised as low (< 60%), medium (60%-85%) or high (> 85%). Quantitative results were analysed descriptively and inferentially; open-text answers were examined using deductive content analysis.

RESULTS: The response rate was 63%. Agreement was high for capability (90.6%), motivation (89.2%) and addressing physical needs (85.2%), while opportunity (75.3%) and relational care (69.1%) were lower. The relational domain scored notably high for taking time to listen (95.8%) and low for evaluating the nurse-patient relationship (43.5%). Nurse assistants showed significantly higher agreement in the physical care domain than registered nurses. Variation across departments highlighted higher agreement in spinal cord injury and neurology compared to anaesthesia, pain, respiratory and traumatic brain injury units.

CONCLUSION: Nursing staff show strong internal drive and perceived competence-particularly in physical care-but face structural barriers in relational nursing and continuity. Implementation strategies should leverage high motivation, strengthen leadership engagement, ensure resource allocation and systematically integrate relational care into practice.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

TRIAL REGISTRATION: Danish Data Protection Agency (P20231246).