Antecedents to providing individualized care: How nurses come to know their patients
Individualized care is considered an important indicator of quality nursing care. Knowing the patient has been described as the process by which nurses come to understand their patient's experiences, behaviors, feelings and perceptions to individualize their care (Radwin, 1993). Research has documented the ways that knowing is used to provide individualized care. However, little research has examined the various strategies nurses use to come to know their patients. The purpose of this study is to develop a better understanding of nurse's ways of knowing. A 32 bed orthopedic unit of an urban teaching hospital was site of this 10 month ethnographic study. The research was conducted using participant observation, interviewing, and document review. Contextual factors within the patient care unit and the hospital as well as the nurse's worldview were analyzed to understand the ways in which they influence the processes through which nurses come to know their patients. The study found that coming to know the patient involved a number of strategies that differ according to the ways in which nurses classify patients. At the most basic level, patients on this unit are classified according to 6 trajectories of care. Nurses organize care and assessment practices according to normative expectations about the needs of the patients within each trajectory. Differences between patients based on characteristics such as age or physical size may signify the need for predictably specialized forms of care. Patients who, for various idiosyncratic reasons deviate from the norm and hence require additional forms of care and ongoing assessment are identified as difficult patients. This study highlights several strategies nurses use to come to know patients who respond to care in both normative and idiosyncratic ways. The primary strategies enacted by nurses on this unit involve social interaction with patients, families, interdisciplinary colleagues and other nurses. Implications for nursing education and practice are discussed and suggestions for further nursing research are offered.
Rockett, Joan L, "Antecedents to providing individualized care: How nurses come to know their patients" (2001). Dissertations available from ProQuest. AAI3015361.