Dignity in Action in the Home Hospice: The Narrative Selection of a Multidisciplinary Staff.

Abstract

Home hospice (HH) is a palliative care framework that is becoming more and more common in Western countries. HH staff face unique challenges, resulting mainly from their multiple clients and the provision of care in a private territory. Despite the recognized role of professionals in preserving end-of-life (EOL) dignity, how HH staff conceive of EOL dignity has remained unexplored. To fill this lacuna, we invited the multidisciplinary staff of an Israeli HH to recount unguided narratives of dignity and indignity in the HH. We analyzed the mechanisms of narrative selection in each story and in the entire dataset, particularly regarding two dimensions of dignity: situation-whether the recounted cases present dignity, indignity, or both; and relations-who provides (in)dignity to whom. The analysis revealed four interconnected end-points: HH is a dignity-providing framework; HH staff provide and promote dignity; HH dignity as relations and communication; and HH dignity as a holistic process whose boundaries are expanded and blurred, both spatially and temporally. The differences between these and other findings on healthcare professionals' perspectives of EOL dignity highlight the uniqueness of HH staff, and possibly the distinctiveness of the Israeli case with its traditional familial values. Importantly, the findings were generated due to the narrative paradigm guiding the study. The unique attributes of the narrative text enabled us to capture the dynamic temporal nature of dignity-in-action, as embedded in the staff's daily practice. Implications for training professionals to preserve EOL dignity in HH and other EOL care frameworks are discussed.