Patients' Dignity and Its Relationship with Contextual Variables: A Cross-Sectional Study

Dignified care and associated factors among mothers who gave birth at public hospitals, in Sidama Regional State, southern Ethiopia, 2023

BACKGROUND

Dignified care is an important priority for childbearing mothers. Threats to this deteriorate the therapeutic relationship between healthcare providers and clients, which leads to a negative effect on the quality of care. However, little evidence is identified about dignified care and associated factors in the Ethiopian context. Therefore, this study aimed to assess dignified care and associated factors among mothers who gave birth at public hospitals in Sidama Regional States, southern Ethiopia, 2023.

METHOD

An institution-based cross-sectional study was conducted among 418 mothers who gave birth at public hospitals in Sidama Regional States from July 30 to August 30, 2023. A systematic random sampling technique was employed to select study participants. An interviewer-administered structured questionnaire was used, and the data was collected by Kobotool and analyzed using SPSS Version 25. Bivariable and multivariable logistic regression analyses were conducted, and the crude and adjusted odds ratios, together with their corresponding 95% confidence, were computed. A P value < 0.05 was considered a level of statistical significance in this study.

RESULTS

In this study, the overall study participants' magnitude of dignified care was found to be 44.1%. Secondary education (AOR: 3.91, 95% CI: 1.56, 9.82), spontaneous vaginal delivery (AOR: 2.68, 95% CI: 1.31, 5.46), the presence of a companion during labor and delivery (AOR: 12.35, 95% CI : 7.08, 21.53), and less than two days hospital stay (AOR: 3.26, 95% CI: 1.37, 7.75), and midwife attendance of labour and delivery (AOR = 4.47 (1.40-14.25) were significantly associated with dignified care.

CONCLUSIONS

The findings of this study showed that the dignified care of mothers who gave birth at public hospitals in Sidama Regional State was relatively low to the pooled prevalence of respectful maternity care in Ethiopia. In light of these results, it is recommended to prioritize midwife attendance during labor and delivery, promote the presence of companions, facilitate a shorter hospital stay, and enhance educational opportunities.

Effect of logotherapy counseling program on chronic sorrow, dignity, and meaning in life of palliative care patients: a randomized controlled trial

PURPOSE

Palliative care patients experience chronic sorrow with loss in dignity and meaning in life. Logotherapy is an effective way to cope with loss. This study aimed to evaluate the effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients.

METHODS

This study was conducted with 58 adults hospitalized due to advanced cancer and assigned to either intervention or control group by simple randomization. Data were collected with descriptive information form, Palliative Performance Scale, Patient Dignity Inventory (PDI), Prolonged Grief Disorder Scale-Patient Form (PGDS-PF), and Meaning in Life Questionnaire (MIL) on admission, at the 4th and 8th weeks. The intervention group received eight sessions of logotherapy. The control group received routine care.

RESULTS

The mean scores of PGDS-PF (p = 0.01), PDI (p = 0.01), and searched meaning subdimension of MIL (MIL-SM) (p = 0.11) decreased in the intervention group compared to controls, both at the 4th and 8th week evaluation. The mean score of the present meaning subdimension of MIL (MIL-PM) (p = 0.02) increased at the 4th week evaluation but decreased at a non-statistically significant level at the 8th week. The mean scores of PGDS-PF and PDI increased in the control group while MIL-PM and MIL-SM decreased, both at the 4th and 8th week evaluation.

CONCLUSIONS

Logotherapy was found effective in decreasing the sorrow and dignity-related distress of palliative care patients, while increasing finding meaning in life. Logotherapy is recommended to be used by palliative care professionals to empower patients.

TRIAL REGISTRATION

Clinicaltrials registration number and date: NCT05129059, 19/01/2021.

Exploring COVID-19 patient's dignity and satisfaction: A cross-sectional study

AIM

With the outbreak of COVID-19 and associated challenges such as increased workload for health providers and shortage of equipment, it became more challenging to maintain patients' dignity and satisfaction. This study evaluated the patients' dignity and satisfaction with COVID-19 in Kashan, Iran, in 2021.

DESIGN

A cross-sectional descriptive study.

METHODS

In total, 385 patients recovered from COVID-19 were selected through sequential sampling method. Data were collected using demographic, patient dignity inventory, and patient satisfaction questionnaires. Data were analysed using descriptive analysis, independent t-test, ANOVA, and Spearman-Brown coefficient.

RESULTS

The mean age of patients was 50.57. The mean scores of patients' dignity and satisfaction were 1.622 ± 0.653 and 3.851 ± 0.548 (out of 5), respectively. The dignity rating was associated with age, gender, education, underlying disease, and length of hospital stay (p < 0.05); but patient satisfaction was only associated with education (p = 0.002). The results indicated that dignity and satisfaction have a significant direct correlation (r = -0.23, p < 0.001).

PATIENT OR PUBLIC CONTRIBUTION

This study was designed based on the research priorities and needs in the field of clinical research and patients were involved in conducting the study via participating in data collection.

Healthcare Professionals' Perspectives on Dignity in Dementia: A Qualitative Analysis

In dementia care, the concept of dignity has garnered substantial attention from both researchers and policymakers. However, the concept often remains vague and open to interpretation, potentially leading to misunderstandings and suboptimal care for people with dementia. As healthcare professionals occupy a critical role in upholding dignity, exploring their viewpoints on this complex concept is paramount. In this study, we explore Danish healthcare professionals' views on the dignity of people with dementia and discuss these perspectives against existing theoretical accounts. We employed thematic analysis of data collected during facilitated discussions with a total of 99 healthcare professionals, including nurses and healthcare workers, during which we posed the question, "What is dignity to you?" and documented their perspectives. Through a systematic process of data coding and interpretation, we identified recurring patterns in their responses. This approach allowed us to uncover the depth and complexity of their viewpoints, providing valuable insights into the multifaceted nature of dignity as perceived by healthcare professionals. Our findings revealed that healthcare professionals possessed a nuanced understanding of dignity, recognizing both a subjective element and a universal aspect applicable to all individuals, aligning with theoretical interpretations. However, conceptual ambiguity remained a challenge.

Self-reported dignity and factors that influence dignity in hospitalised older adults: A cross-sectional survey

OBJECTIVE

This study examined levels of self-reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana.

BACKGROUND

Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self-reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa.

SETTING

A large teaching hospital in the northern region of Ghana.

PARTICIPANTS

Hospitalised older adults.

METHODS

A cross-sectional survey was used to gather data from a convenience sample of 270 older inpatients, using the Hospitalized Older Adults' Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist.

RESULTS

More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations.

CONCLUSION

Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times.

RELEVANCE TO CLINICAL PRACTICE

The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender-sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions.

PATIENT OR PUBLIC CONTRIBUTION

Survey questionnaires were completed by hospitalised older adults at the study setting.

A holistic approach to assessing an individual with urinary incontinence

Urinary incontinence can have an overwhelmingly negative impact on an individual's quality of life. The personal, physical, psychosocial and sexual implications of urinary incontinence can affect health and well-being. This can increase the risk of falls, depression, anxiety, social isolation alongside a greater need for long-term care from a individual's own home. Statically, the prevalence rates of urinary incontinence increases with age; however, incontinence is not an inevitable or acceptable part of ageing-symptoms can be improved and managed effectively for suffers of this common condition. Urinary incontinence can be challenging to assess, address and overcome for individuals. However health professionals need to have the expertise and experience to undertake a comprehensive continence assessment. When assessment is completed evidence-based interventions can be recommended, implemented and subsequently evaluated.

Dignity and time perspective: A pilot explorative study in cancer patients

OBJECTIVES

This study investigated the possible correlation between emotional distress linked to dignity and dysfunctional temporal orientations in the oncological context.

METHODS

We conducted an exploratory study between December 2020 and February 2021, referring to a sample of 107 patients in active treatment for solid tumors belonging to the Oncology Department of the Fondazione Poliambulanza (Brescia, Italy). We administered two self-report questionnaires: the Patient Dignity Inventory (PDI-IT) (Italian version, Grassi L, Costantini A, Caruso R, et al. (2017) Dignity and psychosocial-related variables in advanced and nonadvanced cancer patients by using the patient dignity inventory-Italian version. Journal of Pain and Symptom Management 53(2), 279-287), as a measure of perceived level of dignity, and the Italian version of the Zimbardo Time Perspective Inventory scale (ZTPI) (Zimbardo PG and Boyd JN (2009) Il paradosso del tempo. La nuova psicologia del tempo che cambierà la tua vita. Milano: Mondadori), as a measure of the experiential dimensions of time, such as past, present, and future.

RESULTS

From the PDI-IT emerged that our sample reported high levels of physical and psychological distress. Furthermore, we founded higher distress in patients under 55 years (p = 0.04) and lower distress in retired patients (p = 0.01). The ZTPI showed in our patients prevailing orientations to the past-positive (39.3%) and the future (37.4%). We noticed a gender difference: men were mainly oriented to the future while women to the past-positive. Moreover, married subjects reported a prevalent orientation to past-positive and the future. Finally, data analysis found moderate positive correlation between the "Negative Past" dimension of ZTPI and high levels of physical (r = 0.203, p = 0.03) and psychological distress (r = 236, p = 0.01).

SIGNIFICANCE OF RESULTS

In our experience in oncology, dignity and time perspective play a central role as indicators of the quality of care. Our study shows the importance of a treatment path that integrates the constructs of Dignity and Time Perspective to favor a better psychological adaptation.

Methodological quality of dignity-related patient reported outcome measures used in acute hospital settings: A systematic review using the COSMIN methodology

AIMS AND OBJECTIVE

The aim of this systematic review was to examine the methodological quality of dignity-related patient reported outcome measures (PROMs) used to measure patients' dignity during acute hospitalisation using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of PROMs.

BACKGROUND

Previous scoping review studies on the methodological quality of dignity-related PROMs lack specificity for dignity during acute hospital admission. They included PROMs that were developed to measure constructs of care other than patient dignity or designed to measure dignity in contexts outside of the acute hospital setting.

STUDY DESIGN

A systematic review based on COSMIN methodology.

METHODS

A systematic search was undertaken using five databases (CINAHL Complete, Medline Complete, EMBASE, PsycINFo and AgeLine) for articles published between 2000 and 2022. Relevant papers were identified using strict adherence to eligibility criteria, and studies that included development of dignity-related PROMs for use in acute hospital settings were selected. Two reviewers independently screened the identified papers, extracted data and examined the quality of studies.

RESULTS

Six papers met the inclusion criteria. Two PROMs, the 25-item Patient Dignity Inventory and the 34-item Inpatient Dignity Scale, met the COSMIN quality criteria because of their sufficient quality of evidence for content validity and reliable internal consistency. None of the PROMs met the quality criteria for assessment of measurement error, criterion validity, cross-cultural validity and responsiveness.

CONCLUSION

We recommend the Patient Dignity Inventory and the Inpatient Dignity Scale as the PROMs of choice for evaluating patients' dignity and/or dignified care during acute hospital admissions. These PROMs were developed using robust procedures with sufficient overall quality for content validity, internal consistency reliability and other measurement properties, and with moderate to high quality of evidence for these measurement properties. Researchers and clinicians who wish to use other dignity-related PROMs identified in this review should consider the methodological limitations of these PROMs, as highlighted in the present systematic review.

RELEVANCE TO CLINICAL PRACTICE

The review findings will guide healthcare professionals about their choice of patient reported outcome measures for evaluating patients' dignity or dignified care during acute hospitalisation.

A systematic review of patient-reported dignity and dignified care during acute hospital admission

AIMS

To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients.

DESIGN

A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for reporting systematic reviews.

DATA SOURCES

Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward-forward searching using Web of Science and Scopus databases.

REVIEW METHODS

Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross-Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus.

RESULTS

Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations.

CONCLUSION

Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients.

IMPACT

The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.

AUTONOMIA EM DEMÊNCIA AVANÇADA E ESTADOS VEGETATIVOS PERMANENTES NA IMINÊNCIA DE MORTE

A autonomia privada existencial, como expressão da dignidade da pessoa humana, representa para o indivíduo a possibilidade de agir em conformidade com valores e significados eleitos essenciais na elaboração do seu projeto de vida. Neste estudo, seus autores, dois terapeutas ocupacionais, dois advogados e uma psicóloga, somam saberes e dialogam com intuito de demarcar a relevância da autonomia privada existencial nas condições de demência avançada, nos estados vegetativos permanentes e na iminência de morte. Na tarefa a que se propõem, os autores ponderam sobre suas experimentações e interlocuções enquanto profissionais de formação acadêmica diversificada, inclinados a ofertar espaços para comunicar vida e acolher dores. São apresentadas e discutidas as bases jurídicas da autonomia privada, assim como os pressupostos da Logoterapia de Viktor Frankl em defesa da liberdade de vontade e da dignidade no final da vida.

Construcción y validación de un cuestionario para evaluar la relación médico-paciente y su asociación con los principios bioéticos

La relación médico-paciente (RMP) es una relación profesional-interpersonal base para la gestión de la salud. Nuestro objetivo fue desarrollar un instrumento que permitiera evaluar la presencia de los principios bioéticos en la atención médica recibida en la consulta externa de una institución hospitalaria. El instrumento quedó constituido por 21 reactivos para evaluar su confiabilidad y consistencia. El coeficiente de correlación intraclase fue de 0,81 (p < 0,05); para el cumplimiento de los principios bioéticos, fue de 0,740 (p < 0,05). El cuestionario mostró que la autonomía fue el principio más reportado (69 %), después la dignidad (67 %) y justicia (60 %). La presencia de los principios de la bioética ampliados hace más llevadera la enfermedad.

Construcción y validación de un cuestionario para evaluar la relación médico-paciente y su asociación con los principios bioéticos

La relación médico-paciente (RMP) es una relación profesional-interpersonal base para la gestión de la salud. Nuestro objetivo fue desarrollar un instrumento que permitiera evaluar la presencia de los principios bioéticos en la atención médica recibida en la consulta externa de una institución hospitalaria. El instrumento quedó constituido por 21 reactivos para evaluar su confiabilidad y consistencia. El coeficiente de correlación intraclase fue de 0,81 (p < 0,05); para el cumplimiento de los principios bioéticos, fue de 0,740 (p < 0,05). El cuestionario mostró que la autonomía fue el principio más reportado (69 %), después la dignidad (67 %) y justicia (60 %). La presencia de los principios de la bioética ampliados hace más llevadera la enfermedad.

Journey less travelled: Female nursing students' experiences in providing intimate care in two nursing education institutions in Gauteng province, South Africa

Background

Intimate care is not facilitated in South African nursing education and training. Nursing students encounter it for the first time in clinical practice, where they see and touch the naked bodies of patients. The societal segregation of gender roles has led to the feminisation of the nursing profession, suggesting that women are more caring and maternal and that intimate care implementation comes more easily to them than to their male counterparts.

Aim

This study explored female nursing students' experiences of intimate care for diverse patients.

Setting

The study was conducted in two nursing education institutions in Gauteng province, South Africa.

Methods

Descriptive phenomenology was used to describe the lived experiences of participants. Seventeen female nursing students were purposively sampled. Data were collected using semi-structured interviews and analysed using Moustakas' (1994) eight steps.

Results

Four themes emerged: intimate care comprehension, preparedness for providing intimate care, reactions in providing intimate care and coping mechanisms when providing intimate care to diverse patients.

Conclusion

Intimate care forms a basis on which nursing students prioritise the physical needs of patients by providing care that exposes their bodies and requires touch. The students were taught to provide care with respect, maintaining patient autonomy and nursing professionalism. Unfortunately, age and gender barriers create feelings of discomfort and embarrassment. More needs to be done to support and empower nursing students in providing intimate care to diverse patients competently, confidently and comfortably.

Contribution

Understanding the experiences of participants in providing intimate care to diverse patients will assist nurse educators in intimate care facilitation and support. The female nursing students will be empowered and trained to execute intimate care in a manner that is culturally, religiously and ethically acceptable.

Treating the Unvaccinated COVID-19 Patient with Compassion

Delivering high-quality care services is essential in the support and treatment of the unvaccinated coronavirus disease (COVID-19) patient. The need to show compassion to the patient has been preserved within the codes of conduct for health and social care professionals and a fundamental value in the National Health Service (NHS) constitution. This article highlights the place and necessity of compassion when health and social care workers are caring for the unvaccinated COVID-19 patient.

Dressings and dignity in community nursing

Although dignity has been widely explored in the context of healthcare, it has rarely been the subject of empirical exploration when care is delivered by community district nursing teams. This paper demonstrates how a commonplace community nursing task (changing dressings) can constitute a clinical lens through which to explore the ways in which community nurses can influence patients' dignity. This ethnographic study involved two research methods: interviews with patients and nurses (n=22) and observations of clinical interactions (n=62). Dignity can manifest during routine interactions between community nurses and patients. Patient-participants identified malodour from their ill-bodies as a particular threat to dignity. Nurses can reinforce the dignity of their patients through relational aspects of care and the successful concealment of 'leaky' bodies.

Effects of free maternal policies on quality and cost of care and outcomes: an integrative review

AIM

We conducted an integrative review of the global-free maternity (FM) policies and evaluated the quality of care (QoC) and cost and cost implications to provide lessons for universal health coverage (UHC).

METHODOLOGY

Using integrative review methods proposed by Whittemore and Knafl (2005), we searched through EBSCO Host, ArticleFirst, Cochrane Central Registry of Controlled Trials, Emerald Insight, JSTOR, PubMed, Springer Link, Electronic collections online, and Google Scholar databases guided by the preferred reporting item for systematic review and meta-analysis protocol (PRISMA) guideline. Only empirical studies that described FM policies with components of quality and cost were included. There were 43 papers included, and the data were analysed thematically.

RESULTS

Forty-three studies that met the criteria were all from developing countries and had implemented different approaches of FM policy. Review findings demonstrated that some of the quality issues hindering the policies were poor management of complications, worsened referral systems, overburdening of staff because of increased utilisation, lack of transport, and low supply of stock. There were some quality improvements on monitoring vital signs by nurses and some procedures met the recommended standards. Equally, mothers still bear the burden of some costs such as the purchase of drugs, transport, informal payments despite policies being 'free'.

CONCLUSIONS

FM policies can reduce the financial burden on the households if well implemented and sustainably funded. Besides, they may also contribute to a decline in inequity between the rich and poor though not independently. In order to achieve the SDG goal of UHC by 2030, there is a need to promote awareness of the policy to the poor and disadvantaged women in rural areas to help narrow the inequality gap on utilisation and provide a sustainable form of transport through collaboration with partners to help reduce impoverishment of households. Also, there is a need to address elements such as cultural barriers and the role of traditional birth attendants which hinder women from seeking skilled care even when they are freely available.

Dignity and Predictors of Its Change Among Inpatients in Long-Term Care

The purpose of this study was to identify any differences in the dignity evaluation of geriatric inpatients after 1 month of hospitalization in a long-term care wards (LTC) and predictors of this change. This follow-up study included 125 geriatric inpatients who filled the Patient Dignity Inventory (PDI-CZ), Geriatric Depression Scale, Barthel Index, and Mini-Mental State Examination. In the initial measurement, the patients rated of PDI-CZ item “Not able to perform tasks of daily living” the worst. One month after, the items “Not able to perform tasks of daily living,” “Not able to attend to bodily functions,” and “Not feeling worthwhile or valued” were improved. Patients with higher education, for whom self-sufficiency improved and depression decreased, rated their dignity more positively 1 month after the hospitalization in LTC. Our findings suggest that these factors are important for the maintenance of the dignity of older adults hospitalized in LTC.

Effects of meaning in life and individual characteristics on dignity in patients with advanced cancer in China: a cross-sectional study

PURPOSE

This study was conducted to evaluate the effects of meaning in life and individual characteristics on dignity in patients with advanced cancer.

METHODS

One hundred sixty-seven patients with advanced cancer participated in this study. Dignity was assessed with the Patient Dignity Inventory (PDI), meaning in life was assessed with the Meaning in Life Scale (MiLS), and performance status was defined as the Karnofsky Performance Status (KPS). Sociodemographic and clinical variables were also measured. Independent T tests and one-way ANOVA were performed for the PDI scores and sociodemographic and clinical variables. Relationships among the PDI, MiLS, and KPS scores were evaluated with bivariate analyses (Spearman rank correlation). A multiple linear regression analysis was conducted to determine the predictors the of PDI score.

RESULTS

Patients reported a mean of 4.2 (SD 4.9) problems affecting their sense of dignity; 21.6% reported moderate to severe loss of their sense of dignity. Multivariable regression analyses revealed that a lower MiLS score, younger age, inpatient status, and a lower KPS score predicted the loss of dignity. Stepwise regression showed that 49.8% of dignity-related distress could be explained by the MiLS score, age, inpatient status, and the KPS score.

CONCLUSION

Self-perceived dignity is significantly negatively associated with meaning in life, age, inpatient status, and performance status. The early recognition of risk factors for the loss of dignity and interventions to enhance meaning in life may prevent the loss of dignity in patients with advanced cancer.

Patient's Dignity: Viewpoints of Patients and Nurses in Hospitals

Much of the available research on perceptions of patient dignity either is qualitative in type or explores them in specific patient groups, such as elderly patients, cancer patients, terminally-ill patients, and adolescent patients. The present study addresses nurses' and adult patients' views on patient dignity. A total of 400 individuals (200 nurses and 200 patients) from 39 internal and surgical units from four hospitals affiliated to Shiraz University of Medical Sciences participated in the study. The collected data were analyzed using descriptive, t-test, one-way ANOVA, and Pearson's correlation coefficient using SPSS v. 23.0. A significant difference between nurses' and patients' points of view was identified in relation to four domains: the importance of privacy (p < 0.001); attention to patient autonomy (p < 0.001); respect for patients (p < 0.001); and communication between nurses and patients (p < 0.001). In order to maintain patients' dignity in practice, nurses must become better acquainted with patients' expectations. The questionnaire assessing respect for patient's dignity developed in the present study is a reliable and valid instrument for this purpose.

Nurses' perceptions about the dignity of intubated patients

BACKGROUND

The intensive and critical care units are high-dependency areas, with patients requiring complex care. The intubated status of the intensive and critical care patients makes them dependent on healthcare providers not only for acute care, but also for intimate care, imposing a threat to their dignity. Nurses, being the central care providers, become the stakeholders for dignity promotion. The incorporation of dignity in patient care improves the quality of care, and promotes the health and well-being of intubated patients.

OBJECTIVE

The purpose of the study was to explore nurses' perceptions about the dignity of intubated patients in the intensive and critical care units.

RESEARCH DESIGN

A qualitative descriptive exploratory study design was used to explore the nurses' perceptions about the dignity of intubated patients.

PARTICIPANTS AND RESEARCH CONTEXT

The intensive and critical care nurses of a tertiary care hospital were recruited using the purposive sampling technique. The data were collected through in-depth individual interviews, using a semi-structured interview guide. The findings were manually analyzed into themes and categories through content analysis.

ETHICAL CONSIDERATION

The study was conducted after the approval from the Ethical Review Committee of the Aga Khan University.

FINDINGS

Four major themes emerged from the data analysis: (1) two sides of the contemporary nursing practice; (2) benefits of dignified nursing care; (3) challenges to the dignity of intubated patients; and (4) strategies for promoting the dignity of intubated patients.

DISCUSSION

Dignity incorporates both the science and the art of nursing. The provision of dignified care is the core component of the quality nursing care and patient well-being in the high-dependency units.

CONCLUSION

This is the first exploratory and descriptive study conducted in Pakistan that explored the nurses' perceptions about the dignity of intubated patients, and also generated contextual understanding about the phenomenon.

Observation of Patients' Privacy by Physicians and Nurses and Its Relationship with Patient Satisfaction

The present study was conducted to determine the extent of observation of patients' privacy by physicians and nurses and its relationship with patient satisfaction. This descriptive correlational study was conducted on 600 patients selected by convenience sampling. Based on the patients' points of view, the level of observation of patients' privacy and its dimensions, especially the psychosocial dimension, were reported to be higher in nurses than in physicians. Pearson's correlation coefficient showed a direct and significant relationship between the observation of privacy by the nurses and physicians and different dimensions of patient satisfaction.

Addressing and acting on individual ideas on continence care

Continence care should be individually delivered with dignity, decorum, distinction in all diverse contexts and circumstances. From the dependency of childhood to ultimately the end of life, continence care is essential for all, no matter what the setting is: at home, sheltered structures, community care, residential settings and nursing homes. Person-centred care is central to healthcare policies, procedures to the provision of personalised consultation, developing a collaborative partnership approach to continence assessment, promotion, and management.

Dignity and loss of dignity: Experiences of older women living with incurable cancer at home

In this study, we explored and identified crucial experiences that constitute dignity and loss of dignity among older women living with incurable cancer at home. In-depth interviews with 13 women, and participant observations of five of these women, were performed. Hermeneutical interpretations of interview texts and field notes were conducted. Crucial experiences that preserved the women's dignity included having a sense of control, making one's own decisions, experiencing hope and meaningfulness, feeling valued as a human being and having the opportunity to be in a treasured and nurturing environment. Dignity loss was related to losing the opportunity for self-determination, sensing hopelessness and worthlessness in a shroud of illness, experiencing violation of their personal life and being situated in surroundings that enhanced their sense of disconnection and alienation. Quality of care was experienced as more important than the physical place in which to spend their final stage of life. The findings suggest that dignity preservation should be a core dimension in care for older women living with incurable cancer at home. Future research should investigate how dignity-preserving care can be organized and practiced within municipal palliative care services.

Dojemanje dostojanstva pacientov z vidika zdravstvenih delavcev

Uvod: Človeško dostojanstvo je neodtujljiva pravica vsakega posameznika, njegovo ohranjanje pa temeljna naloga zdravstvenih delavcev. Namen raziskave je bil ugotoviti, v kolikšni meri se med hospitalizacijo pacientom zagotavlja dostojanstvo ter kako to dojemajo zaposleni v zdravstvu.Metode: Raziskava temelji na eksplorativni kvantitativni raziskovalni metodi. Podatki so bili pridobljeni s strukturiranim vprašalnikom. V raziskavi je sodelovalo 267 priložnostno izbranih zdravstvenih delavcev iz petih slovenskih splošnih bolnišnic. Pridobljeni podatki so bili obdelani z bivariatno in multivariatno analizo.Rezultati: Splošno mnenje anketirancev o sodelavcih in njihovem zagotavljanju zasebnosti je dobro (x = 3,79, s = 0,70). Dojemanje dostojanstva se lahko pojasni v 52,18 % z osebno odgovornostjo zaposlenih (23,82 %), informiranostjo pacientov (16,62 %) in pacientovim sodelovanjem pri odločitvah (11,74 %). Poklicne skupine imajo različno stališče do informiranosti pacientov (F = 5,44, p = 0,001). Med vključenimi bolnišnicami so razlike v izvajanju aktivnosti: zapiranje vrat bolniške sobe (F = 9,07, p < 0,001), uporaba paravana ali zavese (F = 25,65, p < 0,001), nameščanje opozorila na vrata bolniške sobe (F = 28,16, p < 0,001) ter obveščanje pacientov o tem, kaj se bo dogajalo med intervencijami (F = 5,91, p = 0,001), aktivnosti pogosteje izvajajo zaposleni v zdravstveni negi s srednješolsko izobrazbo.Diskusija in zaključek: Med hospitalizacijo se dostojanstvo pacientom ne zagotavlja popolnoma, zato bodo rezultati lahko uporabni za načrtovanje izboljšanja strokovnega znanja, razumevanja področja dostojanstva ter infrastrukturnih in materialnih pogojev.