Integrating the Fundamentals of Care Framework Into Clinical Practice: An Exploratory Pre-Post Study of Nurses' Perceived Capability, Opportunity, and Motivation.

Introduction: Missed Nursing Care is a persistent global problem associated with adverse patient outcomes. The Fundamentals of Care Framework provides a conceptual structure for delivering person-centred, high-quality nursing care. However, limited empirical evidence exists on how the Framework can be systematically integrated into routine clinical practice through structured implementation strategies. Objective: To evaluate the effect of an implementation strategy for integrating the Fundamentals of Care Framework into clinical practice on staff perceptions of capability, opportunity, and motivation to deliver fundamental nursing care. Methods: An exploratory single-group pre-post study was conducted using paired questionnaire data collected before and after implementation of a structured, theory-informed implementation strategy designed to support integration of the Fundamentals of Care Framework into daily nursing practice. Nurses' perceived behavioural determinants were assessed using a questionnaire informed by the Capability, Opportunity, Motivation-Behaviour model. Analyses focused on within-person change and estimation of directional trends. Given the exploratory nature and limited sample size, emphasis was placed on descriptive statistics and confidence intervals rather than hypothesis testing. Results: Pre- and post-implementation data from the same individuals (paired data) suggested small and variable changes across behavioural domains following implementation. Directional trends indicated increases in perceived capability and opportunity, while motivation appeared relatively stable over time. Confidence intervals were wide, reflecting limited statistical power and uncertainty around effect estimates. Conclusion: This pre-post evaluation provides early insights into the integration of the Fundamentals of Care Framework using a structured implementation strategy. While definitive conclusions regarding effectiveness cannot be drawn, the findings illustrate how behavioural determinants may respond differently during integration processes and highlight the challenges of evaluating complex nursing interventions in real-world clinical settings.