Individualised, or ’person-centred’, care is defined as a delivery of care that respects and responds to the individual needs, preferences, and values of patients (Committee of Health 2001). The Nursing and Midwifery Council (a.k.a. NMC) highlights the importance of understanding a patient’s situation and preferences, regardless of whether a nurse works with children, adults, or individuals with mental health conditions. For example, section one of the NMC Code states that being able to recognise diversity and individual choice allows a nurse to provide care specially tailored to that person that will ensure a positive experience for the patient and family, whilst also maintaining their dignity and individualism (Nursing and Midwifery Council 2015). It is important for nurses to understand what is meant by individualised care, and for them to be able to consider factors that contribute to the individualism of a patient and their family, and how to provide care based on these particular variations of circumstance.
When defining individualised care, one must begin by examining what is required of those providing it. The NMC Code expresses that nurses should prioritise their patients’ interests and needs over all, and acknowledge the diversity and individualism of each person they encounter (2015). Only by identifying the individuality of each person and familiarising themselves with their background, emotions, and feelings can a nurse begin to understand their patient’s experience in order to provide care best tailored for them (Radwin 1997). Draper et al stated that for nurses to provide individualised care, they must treat the person as a person with needs, family, emotions, and values, and not just as a medical patient that requires help; ‘patient-centred care’ as opposed to ‘person-centred care’ can cause nurses to emphasise the medical diagnosis of a patient and may lead them to treat the disease or ailment rather than the person (2013). Therefore, by recognising that each patient is a person with their own needs and concerns, nurses are able to provide care that is dignified and individualised, in accordance with the NMC Code (2015). Furthermore, nurses of each field must understand how to recognise patient individuality and prioritise and plan their care accordingly. For example, a nurse working within the adult field may wish to talk candidly with the patient about any expectations they have surrounding their care, learning to understand them as an individual and listening to and acknowledging any concerns they may so that the nurse can provide a standard of care that works for both the patient and themselves (National Institute of Health and Care Excellence 2013).
One of the ways that a nurse can provide individualised care to a patient is by always considering their ‘nursing process’. The nursing process is a systematic approach to the nursing profession containing four key steps that helps nurses to organise their work with the main aim of improving patient care and outcomes (Rush et al 1996). The nursing process considers the person holistically, rather than just their condition, and therefore leads to the application of individualised care. The nurse must first assess the patient, for example: are they breathing irregularly, are they complaining of pain, are they able to move comfortably? As well as assessing the patient, the nurse should consider how they can assess the patient’s needs. This may be as simple as asking them what they require or want, or may be more complex, involving family members or other care providers such as doctors or physiotherapists. Without an assessment, the nurse may make assumptions based on their patient’s condition and treat them in a way that does not suit their current requirements, not only opposing the idea of individualised care but also contradicts section one of the NMC code, which highlights the importance of treating the individual needs of each patient (2015). Only after the patient has been assessed is the nurse able to create a care plan that is suited to the patient’s needs in that particular instance by using the data they have received. After an assessment has been carried out and a plan has been created the nurse must implement their care strategy, considering who should be involved with the patient, whether the patient’s current conditions are suitable for them as an individual, and continually assessing how the patient is responding to their current care plan (Karimi 2011). For example, when treating a patient with flu symptoms the nurse may decide to move the patient from the main bay into a separate isolated room, or involve an Infectious Diseases team. Finally, the nurse must regularly evaluate the care they are providing, asking themselves if what they are doing for the patient is working for them as an individual, and if not, discussing with the patient or with their family to understand how to improve the situation. It is key for the nurse to always prioritise the patient during the nursing process, keeping them at the centre of care and consistently updating them on any changes to the plan. By using the nursing process, nurses can ensure that patients are being treated as individuals and that they, or their families, are always involved in the discussion about their care.
Individuality is an important part of every person’s identity, and is something that can be very easily lost during hospital visits or health-care environments due to the large number of people that health care professionals encounter everyday and the high pressure scenarios they are often placed in. As their role is one that allows for a vast amount of patient contact, nurses are able to communicate with patients and learn about them as an individual, for example how they prefer to be addressed or any dietary requirements they may have, and relay this information to other professionals where necessary in order to maintain the distinctiveness, dignity, and identity of the patient throughout duration of their hospital stay (Abedi 2011). Patients who feel respected by those providing their care are more likely to trust their nurses or doctors, thus willingly adhering to their medical care plans once discharged (Calnan 2004). Furthermore, patients who receive individualised care often report higher levels of satisfaction with the care provided by their nurses, and believe themselves to have a better quality of life and more autonomy after leaving hospital (Katajisto et al 2007). Therefore, providing individualised care not only helps the patient feel comfortable whilst in hospital, but can also help them to cope once they return home.
Whilst nurses should treat all patients as individuals and provide tailored care to them, it is important for them to consider that some patients are more at risk of losing their individualism than others. For example, young children are often restrained in order for professionals to carry out invasive procedures such as cannulation or blood tests and, as these situations are sometimes stressful and fast-paced, it can be easy for children’s nurses to forget that the child, or indeed their family, may feel as though they are not being treated as a person (Deighton, April 2018). Furthermore, disabled children receiving health care may feel as though they have lost their individuality, as they often know exactly what it is they want whilst, but may not be able to express it due to conditions such as muscular dystrophy or cerebral palsy that may render them immobile or non-verbal (Deighton, February 2018). Therefore, it is the duty of the nurse to understand how to help their patients and maintain their individualism, whether this means communicating with the family about how to recognise if the child becomes uncomfortable or needs to something, or making sure that they talk to the patient whilst interacting with them, saying hello and introducing themselves, regardless of whether or not the patient is able to respond. This ensures that the patient and their family knows that the nurse cares and appreciates their individualism rather than seeing them as just another patient in a list of names.
Other personal factors such as the patient’s religion can also affect and impact how the nurse may choose to plan their patient care. Nurses must be able to communicate with patients about their religious preferences and beliefs without making assumptions. Just because a nurse does not have any knowledge of a certain religion does not mean that they should treat that patient how they would treat any other patient, as this may result in the patient becoming distressed or offended. For example, a male patient practicing Buddhism monasticism may wish to be treated by exclusively male practitioners and nurses, and could possibly become angered or distraught should they be designated a female nurse to care for them for fear of contradicting their beliefs and teachings (Galanti 2008). However, without communicating, a nurse may assume that a male patient would feel comfortable being treated by a female nurse, and runs the risk of seriously upsetting or even disgracing the patient. This distress can be easily prevented by making the effort to learn about a patient’s individualised religious beliefs, desires, and needs, and subsequently accommodate them or care for them in a manner suited to their religion or culture. Furthermore, as something like religion can be a huge part of a patient’s identity outside of a healthcare environment, it is important for a nurse to ask the patient about important daily aspects of their religious life, perhaps how often they pray or if they follow a particular diet, and help to accommodate these practises in the healthcare setting. Abedi et al highlighted that helping a patient to find a time and suitable condition for prayer and religious traditions can also reduce the likeliness of them experiencing a negative emotional outcome (2011). Taking the time to discuss with the patient whether or not they have any religious preferences or beliefs that they’d like to be known by the staff, or bringing to the patient’s attention the opportunity to discuss or request any religious guidance such as chaplaincy during their healthcare provision can help not only the patient but also their family to feel safe, accepted, and dignified, and directly adheres to section 1 of the NMC code (2015).