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

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