Individualized care: its conceptualization and practice within a multiethnic society

This paper reports on the selected findings from a larger ethnographic stud y of the provision of individualized care by district nurses to patients fr om different ethnic backgrounds. Undertaken in an English community Nationa l Health Service (NHS) Trust serving an ethnically diverse population, the study comprised two stages. First, an organizational profile of the Trust w as undertaken in order to analyse the local policy context. Data were colle cted by means of in-depth interviews with managers and a review of policy d ocumentation and caseload profiles. Second, a participant observational stu dy was undertaken focusing on six district nursing teams. Purposive samplin g was used to identify four teams with high minority ethnic caseloads and t wo teams with predominately white ethnic majority caseloads. Interview tran scripts and field notes were analysed by drawing upon the principles of dim ensional analysis. This paper focuses upon aspects of the second stage, nam ely how the nurses' conceptualized and practised individualized care. Six p rinciples underpinning the philosophy of individualized care expounded by t he nurses were identified: respecting individuality; holistic care; focusin g on nursing needs; promoting independence; partnership and negotiation of care; and equity and fairness. Each is examined in turn and consideration g iven to how they were modified in their transformation into practice. Some implications for patients from minority ethnic backgrounds of the nurses' c onceptualization and practice of individualized care are discussed. The lac k of internal consistency within the nurses' discourse, the impact of polic y directives on care delivery and the influence of factors outside the nurs es' control, served to illuminate the complexity whereby the ideals of indi vidualized care were adjusted and reworked in the realities of everyday nur sing practice. This in turn raised questions about the appropriateness of t he current interpretation and practice of individualized care in a multi-et hnic society.