The Concept of Individualised Care
4.3 Defining Individualised Care in Nursing Science
4.3.2 Defining Elements and Empirical Referents
In the Individualised Care Project (ICP), the term “individualised nursing care”
was defined from the patients’ point of view [10] as a perception of the patient or healthcare service user. Thus, the definition includes subject matters which patients can experience, see or recognise while being cared for (nursing activities performed at the bedside). Patients’ perceptions and assessment of individuality on their care become possible when individualised care is set in the frame of patient-care provider interaction. Thus, the elements are set in the form that this
Table 4.1 (continued)
Definition Context and viewpoint Author
“Individualised care results when the nurse:
Knows the patient as a unique individual, and Tailors nursing care to patient’s experiences (including events associated with illness, home, work and leisure); behaviours (including physical indicators and preferred coping strategies); feelings; and perceptions (including meaning ascribed to experiences and
interpretations of events)”
Framework for crafting and evaluating individualised care, whether nurses consider components of the definition as interventions are implemented Patient care, nurses’
assessments
Radwin and Alster [7] (p. 62)
“Respecting individuality; Holistic care;
Focusing on nursing needs; Promoting independence; Partnership and negotiation of care; and Equity and fairness”
Principles underpinning the philosophy of individualised care How nurses conceptualised and practiced individualised care
Gerrish [60]
(p. 93)
The “Seeing the individual patient” category represents the individualised nature of nursing care experience”… “to be known as more than their diagnoses”…
…“expected the nurses to treat them as a person”. “patients’ needs to be treated as unique individuals”
Hospitalised patients’
perceptions of their nursing care
Sub-concept for patients’
perceptions of hospital care
Schmidt [61]
(p. 395)
interaction assumes. This meant the presence of nursing activities. Individualisation of care can be supported through specific nursing activities. While cared for with individualised activities, the patient can experience individuality in his/her care.
Originally, individualised care was defined in terms of patients’ views on how individuality was supported through specific nursing activities and how they expe- rienced individuality in their own care [1, 42]. This definition was based on the deductive reasoning of the uses and definitions of the concept found in the litera- ture (see Table 4.1) and also in qualitative research literature. As the literature at that time concentrated mainly on nurses’ point of view or patients’ perceptions of care in general, dictionary definitions were used to reveal the patient viewpoint.
This definition includes two interpretations: the perception of how nurses support patient individuality by their activities and the perception (experience) of how their individuality is taken into account in care provision (maintenance of actual care). Both of these interpretations were included in the operationalisation of the concept for empirical research. The developed Individualised Care Scale com- prised two parts:
Individualised care is a type of nursing care delivery which takes into account patients’
personal characteristics in their clinical situation (=condition), personal life situation and preferences and promoting patient participation and decision-making in his/her care (=deci- sional control) [1, 42].
Common themes in the individualised care literature have included the recognition of patients’ individual clinical situation, personal life situation and decisional control over care (e.g. [5, 7, 13]). The criterion for identifying these themes (domains) was the frequency of the characteristics. Finally, the elements of the concept of individualised care were extracted through the selection of key statements by identifying and clustering similarities from mainly qualitative studies examining patients’ perceptions (Table 4.2).
Table 4.2 Domains and elements of individualised nursing care Patient’s clinical situation
Patient’s personal life
situation Patient’s decisional control Physical and psychological
care needs, fears and anxieties
Life situation in general (employment, etc.)
Knowledge about illness and treatment/care
Abilities, capacities or resources
Cultural background, traditions
Making choices, having alternatives
Health condition Daily activities, habits and preferences
Decision-making Meaning of illness Family involvement Expressing own views,
opinions, wishes and making proposals
Reactions or responses to illness
Earlier experiences of hospitalisation Feelings, affective states
Conclusion
Over time, the concept of individualised care has triggered discussion and misunderstandings as to what it entails. Indeed, the context of healthcare, where the concept has mainly been championed, is a complex one that requires extensive study of the concept’s antecedents, defining elements and empirical referents.
However, one should acknowledge the limitations in any attempt to comprehen- sively attribute a conceptual definition to any given concept. Concepts are like ice cubes; just when you think you have grasped them, a lack of clarity results in their slipping beyond your grasp [27].
While the definitions of individualised care, tailored care and patient-centred care are not the same, they do share an important common attribute: their theo- retical basis rests on the principles of holism which acknowledges that the human being, composed of a mind, body and soul integrated into an inseparable whole that is greater than the sum of the parts, is in constant interaction with the uni- verse and all that it contains.
The complexity in seeking a comprehensive understanding of individualised care also lies on the varying viewpoints from where one can experience individu- ality. Primarily, there are two paramount viewpoints, that of the patient and the nurse. Bringing the concept of individualised nursing care from the patients’
point of view was the main target of the initiatives taken by researchers in the Individualised Care Project and later continued by a wide network of nurse sci- entists throughout the world. However, individuality in patient care may also be assessed from other viewpoints, such as nurses’ perceptions of the individuality of patient care. This enabled the development of the concept and especially the empirical research on the topic from different viewpoints.
Over the years, the model of care has moved to a more multidisciplinary and interdisciplinary approach, and future attempts to conceptualise and research the topic of individualised care need to accommodate this multi-professional land- scape of care. Within this context the needs, preferences and expectations of the person need to be acknowledged by all the disciplines involved in the delivery of the care without the interventions of one’s discipline neutralising those of another discipline. Tensions between the varying perspectives of individualised care can go beyond the conceptualisation of the concept to include differences in the reali- sation of the interventions that guide implementation practice. Primarily, the aim should be for these interventions to complement one another. Interventions need to be jointly developed to comprehensively capture the multidimensional aspects of the person and allowing the person to play an active role where decisions need to be made when aspiring to attain a shared-decision model.
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© Springer International Publishing AG, part of Springer Nature 2019 R. Suhonen et al. (eds.), Individualized Care,
https://doi.org/10.1007/978-3-319-89899-5_5 A. Gallagher (*)
International Care Ethics Observatory, University of Surrey, Guildford, Surrey, UK e-mail: [email protected]
R. C. Warren
National Center for Bioethics in Research and Health Care, Tuskegee University, Tuskegee, AL, USA