Individualized care: is it possible to plan and carry out?

The purpose of the study reported in this paper was to assess the reality of attempting to deliver individualized nursing care. An ethnographic case study research design was used on a nursing development ward. The organizational framework was a mixture of primary nursing and team nursing. Activities of three patients were observed over 4 days each, covering 16 hours of the 24-hour period for each patient. The observations were unstructured, but attempted to relate activities to the nursing care plan. Informal, semi-structured, tape-recorded interviews were undertaken with 12 of the ward staff, qualified and unqualified. The interviews asked questions relating to aspects of planning care, delivering care and ensuring continuity of care. In addition, two nurses kept diaries of significant events for 5 days. Field notes of observations were coded for analysis, interviews were transcribed and coded and diaries were coded. The findings suggest that whereas the patient is offered choice on some occasions, at other times the patients fit into the routine. Supervision of meals and the use of the care plan were issues raised. Communication between nurses was reported to be well-developed and helped to ensure continuity of care. Difficulties in delivering individualized care were related to issues of skill mix and lack of support staff.