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Fuseini AG, Rawson H, Redley B, Ley L, Mohebbi M, Kerr D. Self-reported dignity and factors that influence dignity in hospitalised older adults: A cross-sectional survey. J Clin Nurs 2023; 32:7791-7801. [PMID: 37604797 DOI: 10.1111/jocn.16850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/09/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Abstract
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.
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Affiliation(s)
- Abdul-Ganiyu Fuseini
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Helen Rawson
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Lenore Ley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
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Fuseini AG, Mohebbi M, Redley B, Rawson H, Ley L, Kerr D. Development and psychometric validation of the hospitalized older adults' dignity scale for measuring dignity during acute hospitalization. J Adv Nurs 2023; 79:4058-4073. [PMID: 37226570 DOI: 10.1111/jan.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/06/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
AIM To develop and validate a culturally appropriate patient-reported outcome measure for measuring dignity for older adults during acute hospitalization. DESIGN A three-phased exploratory sequential mixed-method design was used. METHODS Domains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre-testing were undertaken using standard instrument development techniques. Two-hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test-retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study. RESULTS We established the 15-item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5-factor structure: shared decision-making (3 items); healthcare professional-patient communication (3 items); patient autonomy (4 items); patient privacy (2 items); respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test-retest reliability were demonstrated. CONCLUSION We established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity-related care in the future. IMPACT The development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity-related measures for older adults (i.e. shared decision-making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For example, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.
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Affiliation(s)
- Abdul-Ganiyu Fuseini
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | | | - Bernice Redley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Helen Rawson
- Monash Nursing and Midwifery, Monash University, Clayton, Australia
| | - Lenore Ley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
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Hoseinian M, Majidi Bidgoli A, Sadat Z, Mirbagher Ajorpaz N. Investigating the level of respect for human dignity and its related factors in providing care for the elderly with COVID-19 in shahid Beheshti Hospital, Kashan, 2021. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:280. [PMID: 37849855 PMCID: PMC10578528 DOI: 10.4103/jehp.jehp_1219_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/09/2022] [Indexed: 10/19/2023]
Abstract
BACKGROUND Patients' dignity includes the feelings of being valuable, maintaining their respect, and respecting their physical and spiritual privacy. Coronavirus disease of 2019 (COVID-19) is one of the life-threatening diseases that affect the dignity of the elderly. Therefore, the aim of this study was to investigate the level of respect for human dignity and its related factors in providing care for the elderly with COVID-19 in Shahid Beheshti Hospital in Kashan, 2021. MATERIALS AND METHODS This cross-sectional study investigated 250 nurses caring for the elderly with COVID-19 and 300 elderly with COVID-19 in Shahid Beheshti Hospital of Kashan in 2021. A sampling of the elderly with COVID-19 was performed continuously based on the inclusion criteria and sampling of nurses by census method. The research tools included the questionnaire on background variables of nurses and the elderly, the questionnaire on respect for human dignity from the perspective of nurse and patient, and the job stress questionnaire. Then, the results were analyzed using Pearson's correlation coefficient tests, t-tests, and multiple regression in SPSS 21 software. RESULTS Based on the results, the mean and standard deviation of patient dignity was 132.13 ± 71.52 and 129.14 ± 06.44 from the perspective of the nurses and the elderly, respectively. The results revealed that the level of respect for human dignity from the nurses' perspective was significantly related to gender and job stress (P < 0.05). Moreover, a significant relationship was found between the human dignity score from the elderly's perspective and the elderly's marital status and education (P < 0.05). According to the results of regression, the variables of nurses' gender and job stress explained about 8.7% of the variance of the patient's dignity observed by the nurses (Adjusted R-Square = 0.087). Finally, the variables of marriage and education of the elderly explained about 4% of the variance of their dignity observed by the nurses (Adjusted R-Square = 0.040). CONCLUSION The results showed that with the increase of job stress in female nurses, their human dignity toward the patient decreases. Elderly people who are married and have a high school diploma have a better understanding of respect for human dignity. Since respect for human dignity is important from the point of view of nurses and the elderly, it is suggested to teach nurses how to respect patient dignity.
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Affiliation(s)
- Masoumeh Hoseinian
- Trauma Nursing Research Center, Nursing and Midwifery Department, Kashan University of Medical Sciences, Kashan, Iran
| | - Azam Majidi Bidgoli
- Trauma Nursing Research Center, Nursing and Midwifery Department, Kashan University of Medical Sciences, Kashan, Iran
| | - Zohre Sadat
- Trauma Nursing Research Center, Nursing and Midwifery Department, Kashan University of Medical Sciences, Kashan, Iran
| | - Neda Mirbagher Ajorpaz
- Autoimmune Diseases Research Center, Nursing and Midwifery Department, Kashan University of Medical Sciences, Kashan, Iran
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Fuseini AG, Rawson H, Ley L, Kerr D. Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives. J Clin Nurs 2023; 32:1286-1302. [PMID: 35322497 DOI: 10.1111/jocn.16286] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore older adults' perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana. BACKGROUND Maintaining hospitalised older adults' dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults' perspectives of dignified nursing care in the African context. STUDY DESIGN A qualitative descriptive research design. METHODS Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi-structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study. RESULTS The following four themes were identified: Effective nurse-patient communication, Maintaining patients' privacy, Respectful and compassionate care provision and Providing quality and safe care. Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy. CONCLUSIONS Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members' involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making. RELEVANCE TO CLINICAL PRACTICE Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability-accessible ensuite bathrooms for patients' comfort and privacy.
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Affiliation(s)
| | - Helen Rawson
- Monash Nursing and Midwifery, Monash University, Melbourne, Vic., Australia
| | - Lenore Ley
- School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia.,Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia
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Ozdinc A, Aydin Z, Calim M, Ozkan AS, Bakir H, Akbas S. Privacy awareness among healthcare professionals in intensive care unit: A multicenter, cross-sectional study. Medicine (Baltimore) 2023; 102:e32930. [PMID: 36820550 PMCID: PMC9907926 DOI: 10.1097/md.0000000000032930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
This multicenter, cross-sectional study aimed to determine and examine the privacy awareness and patient rights education of healthcare professionals working in intensive care units (ICUs). The primary purpose of this study was to determine the privacy awareness of healthcare professionals working in the ICU. In addition, the secondary aim was to examine the relationship between patient rights education and awareness scores, as well as to question the need for privacy awareness education. The study population consisted of ICU physicians, nurses, and allied health personnel working in university hospitals, training and research hospitals, state hospitals, and private hospitals in Turkey. The data were collected through a questionnaire prepared by the researchers, including a question set about sociodemographics, a question about patient rights education, and the privacy awareness scale (PAS) scores using online Google Forms. In the results of the study conducted among 569 participants, the mean total PAS score was 38.31 ± 2.54. The PAS score was significantly different according to the occupation. The PAS scores of the nurses were higher than physicians and allied health personnel. The PAS scores differed according to whether the participants had received patient rights education. This study found that nurses were the group with the highest PAS scores among healthcare professionals. In addition, the PAS scores of nurses working in private and training and research hospitals were higher than those of other hospital employees. On the other hand, the lowest scores belonged to university hospitals and receiving patient rights education increased the PAS score of the nurses. This study showed that all enrolled healthcare professionals required in-service training to gain privacy awareness.
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Affiliation(s)
- Ahmet Ozdinc
- Department of Medical History and Ethics, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
- * Correspondence: Ahmet Ozdinc, Department of Medical History and Ethics, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, 34098, Istanbul, Turkey (e-mail: )
| | - Zuleyha Aydin
- Department of Biostatistics and Medical Informatics, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Muhittin Calim
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Ahmet Selim Ozkan
- Department of Anesthesiology and Reanimation, Inonu University School of Medicine, Malatya, Turkey
| | - Huseyin Bakir
- Clinic of Surgical Oncology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Sedat Akbas
- Department of Anesthesiology and Reanimation, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Fuseini AG, Redley B, Rawson H, Ley L, Kerr D. Methodological quality of dignity-related patient reported outcome measures used in acute hospital settings: A systematic review using the COSMIN methodology. J Clin Nurs 2023. [PMID: 36604845 DOI: 10.1111/jocn.16598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/26/2022] [Accepted: 11/23/2022] [Indexed: 01/07/2023]
Abstract
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.
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Affiliation(s)
- Abdul-Ganiyu Fuseini
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Helen Rawson
- Monash Nursing and Midwifery, Monash University, Victoria, Melbourne, Australia
| | - Lenore Ley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
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Nazari F, Chegeni M, Shahrbabaki PM. The relationship between futile medical care and respect for patient dignity: a cross-sectional study. BMC Nurs 2022; 21:373. [PMID: 36577980 PMCID: PMC9795617 DOI: 10.1186/s12912-022-01144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Various technologies and interventions at intensive care units can lead to futile medical care for critically ill patients. Futile medical care increases patients' suffering and costs, reduces nurses' attention to patients, and thus affects patients' dignity. This study aimed to investigate the relationship between futile medical care and respect for patient dignity from the perspective of nurses working in intensive care units of medical centers. METHODS We conducted this cross-sectional study on 160 nurses working in intensive care units in Kerman. We measured nurses' perceptions of futile care and respect for patient dignity using futile care and patients' dignity questionnaire. We used linear regression model to investigate the effect of futile care on the patient dignity. RESULTS The mean severity and frequency of futile care in the intensive care unit were 57.2 ± 14.3 and 54.1 ± 19, respectively. Respect for patient privacy and respectful communication were desirable, while patients' autonomy was not desirable. We found a significant direct relationship (p = 0.006) between the severity of futile care and respect for patient dignity, with every unit increase in futile care, a 0.01 unit increase was available in patient dignity. We observed no significant association between frequency of futile care and dignity. CONCLUSION Our results indicated the effect of futile care on nurses' respect for patient dignity. Nurses must raise their awareness through participating in training classes and specialized workshops to improve the level of care, the quality of care, and respect for patient dignity.
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Affiliation(s)
- Faezeh Nazari
- grid.412105.30000 0001 2092 9755MSc in Nursing, Afzalipour Hospital, Kerman University of Medical Science, Kerman, Iran
| | - Maryam Chegeni
- Department of Public Health, Khomein University of Medical Sciences, Khomein, Iran, Molecular and Medicine Research Center, Khomein University of Medical Sciences, Khomein, Iran
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Fuseini A, Ley L, Rawson H, Redley B, Kerr D. A systematic review of patient-reported dignity and dignified care during acute hospital admission. J Adv Nurs 2022; 78:3540-3558. [PMID: 35841334 PMCID: PMC9795980 DOI: 10.1111/jan.15370] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
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.
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Affiliation(s)
- Abdul‐Ganiyu Fuseini
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
| | - Lenore Ley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
| | - Helen Rawson
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Bernice Redley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
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