Hospitalised cancer patients' perceptions of individualised nursing care in four European countries.

The aim of this study was to describe hospitalised cancer patients' perceptions of individualised care in four European countries and compare these perceptions using the patients' socio-demographic characteristics and the Individualized Care Scale. The patients' socio-demographic characteristics used were: education, age, gender, type of hospital admission, previous hospitalisation and hospital length of stay. The Individualized Care Scale has two parts (1) nurses' support of individuality and (2) patients' receipt of individuality. Data (n = 599) were collected in Cyprus (n = 150), Finland (n = 158), Greece (n = 150) and Sweden (n = 141). Multivariate analysis of variance models were constructed and differences in perceptions of individualised care were analysed using the patients' socio-demographic characteristics as covariates. The level of support for individuality and receipt of individualised care was reported as moderate and good respectively. Generally, the highest assessments were made by the Swedish respondents and the lowest by those in Greece. This study revealed some between-country differences in patients' perceptions of care individualisation. These differences, for example, conceptual, educational, based in clinical practice or in the health organisation, require further research. Enquiry into the individualised care perceptions of health care providers and the families of cancer patients would also be useful.

The clinical nurse specialist in the faculty role.

Often, contributions by the clinical nurse specialist (CNS) are seen as exclusive to CNSs employed in the service setting. Yet, this may be too narrow a view of the possibilities of the specialist role. This paper examines how a faculty member in a school of nursing who does not hold a joint appointment can fulfill the mission and intent of the CNS role. Citations from the literature and examples from practice describe how the CNS who is a faculty member can enhance nursing as a direct care provider, consultant, researcher and educator.

Knowing the patient: a process model for individualized interventions.

A grounded theory method was used to study nurses' clinical decision making. Field notes, in-depth interviews, and documents were analyzed. The beginning process model contained the core concept, knowing the patient, a purposeful action whereby the nurse uses understanding of the patient's experiences, behaviors, feelings, and/or perceptions to select individualized interventions. Familiarity and intimacy were the properties of the core process; the patient-nurse interaction was the context. Three conditions included time, the nurse's experience, and other nurses' input. Four strategies facilitated the core process: empathizing, matching a pattern, developing a bigger picture, and balancing preferences with difficulties. Different strategies were used, as time and familiarity with the patient varied.

Empirically generated attributes of experience in nursing.

Researchers examining clinical decision-making often explored the role of the nurse's experience. In these studies, experience was conceptualized as either the time spent in nursing or the knowledge which came from practice. This paper reports on the conceptualization of the nurse's experience emerging from a grounded theory study describing one decision-making process: 'knowing the patient'. Data included in-depth interview text, participant observation fieldnotes, and documents. Data were analysed using the constant comparative method and open, axial and selective coding techniques. In the analysis, the nurse's experience was conceptually defined as 'the application of that learned from previous practice situations'. Three attributes of the nurse's experience emerged. These included a focus on the patient, confidence in practice, and knowledge of antecedents and consequences of similar patient situations. Each aspect enhanced the individualization of nursing interventions. The findings are related to other investigations in nursing and insights for practice are offered.

Research on diagnostic reasoning in nursing.

NANDA has traditionally complemented its work on the development and clinical testing of nursing diagnoses with concurrent interest in nurses' diagnostic reasoning processes. This literature review describes studies in diagnostic reasoning, including research based on the information processing model, research examining the role of intuition, and research using grounded theory to study the diagnosis of specific patient conditions. The review presents a synthesis of the research to date, and common themes in these diverse studies are identified. This review emphasizes research in nursing, although pertinent findings from cognitive psychology and medicine are included. Suggestions for future work in diagnostic reasoning are offered.

'Knowing the patient': a review of research on an emerging concept.

Knowing the patient is an important concept emerging from recent studies of nursing practice. The concept is relevant to therapeutic decision-making. Also, knowing the patient actualizes a cherished value in nursing: the treatment of persons as unique individuals. Investigators described that knowing the patient comprises two components: the nurse's understanding of the patient and the selection of individualized interventions. In addition, the nurse's experience with caring for patients, chronological time and a sense of closeness between the patient and nurse, are three factors consistently related to knowing the patient. The concept has implications for practice, including that knowing the patient may result in positive patient outcomes. Also, expert nurse decision-making may be characterized by knowing the patient. Recommendations for further research in this area include the clarification and refinement of the concept, as well as the examination of relationships between knowing the patient and outcomes of care.

Conceptualizations of decision making in nursing: analytic models and "knowing the patient".

Most studies of clinical decision making in nursing have been guided by analytic theories, such as information-processing and decision-analysis theories. Recently, some investigators have used naturalistic methods and have identified "knowing the patient" as relevant to clinical judgment. The author discusses two lines of inquiry and offers possible explanations for differences between the two conceptualizations of clinical decision making. Insights for future research are proposed.

Individualized nursing care: an empirically generated definition.

Individualization is considered a particularly important feature of nursing care by nurses, patients and their families, and by health care administrators. Descriptions in the literature suggest that individualized care requires some background knowledge of the patient, which nurses use to devise care plans that treat each patient as unique. However, few research-based descriptions of individualized care exist. The purpose of this article was to offer a definition of individualized nursing care synthesized from research findings. Descriptions of nursing care individualization emerged from two previously conducted grounded theory studies of nursing practice. Data relevant to the concept were retrieved from each study. These data were compared and contrasted in order to identify and describe individualized care from the perspectives of nurses and patients. The analysis resulted in a definition of individualized nursing care that makes explicit the characteristics of such care, thus providing a framework for designing and evaluating nursing care that recognizes patients as unique persons.