Supporting Individualised Nursing Care by Nursing Interventions
17.2 Individualised Interventions and Patient Outcomes
In the review by Suhonen, Välimäki and Leino-Kilpi [9], there was some support, albeit limited, for the assertion that individualised or tailored interactions have a greater impact on patient care than non-individualised or non-tailored interventions [9]. Most of the studies in the review included individualised educational interven- tions. There is previous evidence especially about the effect of individualised educa- tional interventions on patient outcomes. This review focused on intervention studies conducted up to 2005. Later, Rebelo Botelho et al. [10] reviewed similar literature from 2005 to 2013. An update to literature published since 2013 was conducted to highlight the changes in the foci of individualised interventions on patient outcomes.
In the review by Suhonen, Välimäki and Leino-Kilpi [9], the effects of individu- alised interventions were categorised into four areas: (1) help-seeking behaviours or
utilisation of special type of healthcare services, (2) clinical health status indicators, (3) adherence to the recommended care regimen promoting self-care, and (4) patient perceptions of care quality, such as satisfaction.
17.2.1 Help-Seeking Behaviours or Utilisation of Special Type of Healthcare Services
Individualised or tailored nursing interventions were likely to be effective in health promotion (e.g. [11].), supporting health behaviours through health information [12, 13]. Recent research on the utilisation of care and services suggests the poten- tial benefits of individualised, tailored interventions on service use and thereby, on reduced costs. However, the evidence is still scarce. In addition to the effects of individualised interventions on patient outcomes, the interventions also bring ben- efits to costs of care by reducing unplanned clinical visits to physicians and to the emergency room and promoting self-care [14]. Olsson et al. [15] found that the recovery trajectory for hip fracture surgery may be shortened if nurses pay more attention to the individual patient’s resources and motivation for rehabilitation. The application of an integrated care pathway with individualised care appears to enhance both rehabilitation outcomes and cost-effectiveness. Hamar et al. [16] also pointed out that the effect of individualised support programme participation resulted in significant reductions in hospital admissions (−11.4%, P < 0.0001), readmissions (−36.7%, P < 0.0001) and bed days (−17.2%, P < 0.0001) in patients with chronic diseases. Durfee et al. [17] studied tailored intervention designed to improve care and reduce costs for patients with the highest rates of hospital utilisa- tion. The use of tailored services, including a dedicated intensive outpatient clinic, for super-utilisers within a larger primary care practice transformation reduced mor- tality and provided significant savings even as total hospitalisations increased.
17.2.2 Clinical Health Status Indicators
Some studies have identified the effects of individualised interventions on patients’
clinical outcomes, such as activities of daily living, functional ability or capacity (e.g. [18–20]) and memory functioning [21]. Some intervention studies have been conducted in samples of older people. These showed the effectiveness of individu- alised or tailored interventions on decreased incontinence (e.g. [22–24].), decreased complications or risks [18], and obtaining balance in chronic conditions [25]. Also shortened recovery after hip fractures [15, 26] was found. Recently, individualised interventions provided by physical therapists were found to have the potential to significantly improve symptom severity and health-related quality of life in women over 65 years of age with different types of urinary incontinence [23]. Individualised patient education interventions were found to be effective in promoting significant changes in the quality of life of cancer patients [27] and heart surgery patients [28].
Individualised interventions were also effective in reducing depression and anxiety in patients undergoing heart surgery [28].
Some studies have been conducted on the effects of individualised interventions on outcomes for people with dementia or who are otherwise in vulnerable condi- tion. Individualised activities for nursing home residents with dementia were more effective in resulting in pleasure, alertness, engagement, positive touch and positive verbal behaviour compared with usual standard activities [29]. Fox et al. [30] sug- gest that specific acute care for older people interventions including medical review, early rehabilitation and individualised care appears to be optimal for overall out- come achievement and for reducing iatrogenic complications and functional decline in older adults admitted to the hospital for an acute event. Individualised nursing education intervention was also effective in preventing diabetic foot ulceration among diabetic patients with high-risk foot [31].
17.2.3 Adherence to the Recommended Care Regimen Promoting Self-Care
Most of the studies on self-care or self-management and adherence or compliance with care included individualised educational interventions. In recent studies, interventions have been targeted especially on health promotion, supporting health behaviour and changes in health behaviour [28, 32] and prevention [32].
O’Brien and colleagues [33] showed that patient education using motivational interviewing techniques and an individualised approach was successful in altering knowledge, attitudes and beliefs about acute coronary syndrome among a high- risk population. Adherence to recommended care is important for recovery and for returning to a normal way of life after hospitalisation. Such interventions are important as the number of days spent in hospital has decreased significantly thanks to advanced care technology, mini-invasive care options and the change in patients’ role. Patients’ knowledge of specific issues such as medication [34, 35]
and smoking cessation [36, 37] is successfully increased by individualised interventions.
Recent intervention studies have focused on rehabilitation, recovery and self- care. For example, Cossette et al. [38] aimed to determine whether a nursing inter- vention focusing on patients with acute coronary symptoms and their perceptions of their disease and treatment would increase rehabilitation enrolment after discharge.
They found that progressive, individualised interventions by nurses resulted in greater rehabilitation enrolment, thereby potentially improving long-term outcome.
Other studies have revealed positive outcomes of individualised interventions on exercise compliance in older people for managing fatigue [39]. Individualised inter- ventions may help support independence, self-management or self-efficacy [16], enhancing patients’ active role in self-care [40–42]. A recent review on stroke self- management programmes by Warner et al. [43] concluded that the most prominent strategies identified were goal setting and follow-up and an individualised approach using structured information and professional support. Tailored education imple- mented by visiting nurses can improve diabetic patients’ knowledge of diabetes and foot self-care in particular [44].
17.2.4 Patient Perceptions of Care Quality, Such as Satisfaction Earlier studies have focused on clinical outcomes in different clinical and commu- nity settings. However, other types of patient outcomes are rarely studied. Earlier, only few studies focused on the softer patient outcomes, such as care satisfaction as a result of individualised interventions [13]. Recently, in their review, Rebelo Botelho et al. [10] identified the increase in the number of studies focusing on per- ceived patient outcomes, such as felt accepted (e.g. [45]), felt respected [46] and felt supported [47, 48].