The driving and restraining forces that promote and impede the implementation of individualised nursing care: A literature review

Background: Despite substantial attention devoted to the development of individualised care in recent years, there is a lack of coherent information and empirical research assessing the driving and restraining forces that promote and impede its implementation. Objectives: The aim of this integrative literature review is to describe the driving and restraining forces for the implementation of individualised nursing care from the nurse's point of view, This information is useful for the development of clinical nursing care and in identifying areas for future research. Design: An integrative literature review. Data sources: An integrative analysis of empirical studies and reviews derived from the MEDLINE, CINAHL databases and EMB Reviews - The Cochrane Database of Systematic Reviews (individual* care & nurse, from earliest through April 2008) was conducted focusing on studies which used nurses as informants. The final sample of 43 articles published in English focusing on the individualised care of adult patients from the nurse's point of view was retrieved after a two-stage process. Review methods: The integrative analysis of the studies included three steps. Firstly, the full texts of the final eligible studies were read. Secondly, the driving and restraining forces, that respectively promote or impede the delivery of individualised care were identified and listed in a working sheet. A total of nine categories were identified. Thirdly, a working sheet was completed summarising the information found in the studies reviewed and listing the authors. Results: Nine categories describing both driving and restraining forces for individualised nursing care were identified: (1) nurse's personal characteristics, (2) skills enhancement, (3) ethical issues, (4) nursing care delivery and interventions, (5) patient characteristics, (6) organisation of work, (7) staffing, (8) team work and group dynamics, and (9) leadership and management. Conclusions: A body of knowledge was identified for future research. The results inform both clinical practice and education and promote better use of the nursing work force in order to provide individualised care for patients and maximise good patient outcomes. (C) 2009 Elsevier Ltd. All rights reserved.