Individualized care: its conceptualization and practice within a multiethnic society

This paper reports on the selected findings from a larger ethnographic study of the provision of individualized care by district nurses to patients from different ethnic backgrounds. Undertaken in an English community National Health Service (NHS) Trust serving an ethnically diverse population, the study comprised two stages. First, an organizational profile of the Trust was undertaken in order to analyse the local policy context. Data were collected by means of in-depth interviews with managers and a review of policy documentation and caseload profiles. Second, a participant observational study was undertaken focusing on six district nursing teams. Purposive sampling was used to identify four teams with high minority ethnic caseloads and two teams with predominately white ethnic majority caseloads. Interview transcripts and field notes were analysed by drawing upon the principles of dimensional analysis. This paper focuses upon aspects of the second stage, namely how the nurses' conceptualized and practised individualized care. Six principles underpinning the philosophy of individualized care expounded by the nurses were identified: respecting individuality; holistic care; focusing on nursing needs; promoting independence; partnership and negotiation of care; and equity and fairness. Each is examined in turn and consideration given to how they were modified in their transformation into practice. Some implications for patients from minority ethnic backgrounds of the nurses' conceptualization and practice of individualized care are discussed. The lack of internal consistency within the nurses' discourse, the impact of policy directives on care delivery and the influence of factors outside the nurses' control, served to illuminate the complexity whereby the ideals of individualized care were adjusted and reworked in the realities of everyday nursing practice. This in turn raised questions about the appropriateness of the current interpretation and practice of individualized care in a multi-ethnic society.