Provision Of Individualized Care Research Articles

The meaning of spirituality: a literature review

This paper presents a literature review in relation to the meaning of spirituality. It is proposed that meeting the spiritual needs of patients is a fundamental part of providing holistic nursing care, but that the assessment and meeting of those needs is impeded by inadequate definitions and conceptual frameworks. It should not be assumed that spirituality is either synonymous, or coterminous, with religion, and it is suggested that to adopt this restrictive view is unhelpful in the provision of individualized care. Reflection on the literature reveals that the self, others and 'God' provide the key elements within a definition of spirituality, and that other emerging themes namely meaning, hope, relatedness/connectedness, beliefs/belief systems and expressions of spirituality, can be articulated in the context of those three key elements. In particular, it is proposed that the nature of 'God' may take many forms and, essentially, is whatever an individual takes to be of highest value in his/her life. It is suggested that the themes emerging from the literature can be utilized as a framework to give practitioners and researchers a direction for future exploration of the concept of spirituality.

Knowing the patient: the route to individualized care.

Provision of individualized care is dependent on knowing the patient as a person. Three factors contributed to individualized care: congruent societal and health care values; commonalities of patient needs in all settings; and primacy of caring through knowing the patient. Role modeling by mature nurses appears to have been of prime importance in the transmission of this way of nursing.

Care dependence and individual care provision.

For policy purposes as well as for the provision of individual care, it is relevant to known which individual characteristics have impact upon the level of care dependence. For purposes of individual care provision, characteristics which can be influenced and which also have an important impact upon the care dependence are of interest. This study showed that the profoundly mentally handicapped are almost all totally dependent upon care, and therefore additional information about individual characteristics is superfluous. The results of logistic regression analyses showed a statistically significant and important impact of ADL-functions. Exactly which other characteristics are relevant to consider depends upon the level of care dependence and the level of mental handicap.

Care dependence and services planning

For policy purposes as well as for the provision of individual care, it is relevant to know which individual characteristics have an impact upon the level of care dependence. For policy purposes, it is preferable to predict the level of care dependence as efficiently as possible. This study of residents of institutions and group homes for people with mental handicap showed that profoundly mentally handicapped residents are almost all totally dependent upon care: additional information about the individual characteristics of this group is superfluous. The results of logistic regression analyses for residents with severe or mild mental handicap showed that age, gender and aetiological diagnosis (Down's syndrome or other) do not have significant predictive power. For the level of care dependence, adding the score on Activities of Daily Life (ADL) to the various models improved the predictive power. It depends on the level of mental handicap and on the level of care dependence which one wants to predict which other individual characteristics have to be included in order to improve predictive power.

The work of community psychiatric nursing.

The findings of this study provide an explanation of how community psychiatric nurses make community psychiatric nursing work. The work of community psychiatric nursing can be usefully compared to that involved in making a theatre production. In the theatre there is a play with a plot which is conveyed through the parts played by characters. In the face of production limitations (size of theatre, costs and time constraints, for example) and the demands of sponsors, audience, theatre critics and others in the Company, the characters make use of the stage props and get the show on the road. The community psychiatric nurses can be likened to the characters in a play, whose title is 'the provision of a community psychiatric nursing service'; the plot being the provision of individualized care. Similar to the production limitations in the theatre, the community psychiatric nurses have limited care options and resources and are faced with the varied demands of patients, carers and situations, other specialists and the bureaucracy. Yet the nurses have to produce the best match of needs to resources. Maintaining a theatrical analogy, the nurses have to use what props they have on the stage, not to 'get the show on the road', but to make the community psychiatric nursing service work. Unlike a theatrical production, however, community psychiatric nurses do not appear to have an overall director controlling the work; neither are there guidelines which limit or define practice. This results in individual community psychiatric nurses establishing their own modus operandi and defining their own work practices. Two major themes pervade this account of the work of community psychiatric nurses.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychological reactions to a coronary care unit

203 consecutive male patients who had received initial treatment in the Coronary Care Unit, Royal Infirmary, Edinburgh were interviewed in the medical ward of transfer on the day following discharge from the unit. The patients' attitudes to their treatment in the CCU (6 beds in separate sound-damped rooms) were ascertained and ans assessment of their psychological state, including a measurement of anxiety (Cattell 8-Parallel Form A), was carried out. 129 (63·5 per cent) had a proven myocardial infarction. 179 (88 per cent) were reassured by the unit, 15 (7 per cent) were indifferent and 9 (5 per cent) had been upset by their stay in the unit. Therapeutic procedures in the unit did not upset the patients and the physical severity of illness bore no relation to the psychological reactions evoked by the unit. Factors which contributed and the explanation of its use, and the provision of individual care and attention. Indifference and lack of reassurance occured predominantly in patients with long standing psycho-social problems. In addition, the patients' current psychological state influenced their attitudes to the unit.