Abstract
BackgroundMaintaining dignity is an important element of end-of-life care and also of the care given in nursing homes. Factors influencing personal dignity have been studied from both nursing home residents’ and staff’s perspective. Little is however known about the way nursing home staff perceive and promote the personal dignity of individual residents in daily practice, or about staff’s experiences with preserving dignity within the nursing home. The aim of this study is to gain more insight in this.MethodsA qualitative descriptive interview study was designed, in which in-depth interviews were performed with 13 physicians and 15 nurses. They expressed their views on the personal dignity of 30 recently admitted nursing home residents on the general medical wards of four nursing homes in The Netherlands. Interviews were transcribed and analyzed following the principles of thematic analysis.ResultsAccording to both physicians and nurses, physical impairment and being dependent on others threatened the residents’ dignity. Whether or not this led to a violation of an individual resident’s dignity, depended - in staff’s opinion - on the resident’s ability to show resilience and to keep his/her individuality. Staff mentioned treating residents with respect and taking care of their privacy as most important elements of dignity-conserving care and strived to treat the residents as they would like to be treated themselves. They could often mention aspects that were important for a particular resident’s dignity. But, when asked what they could contribute to a particular resident’s dignity, they often mentioned general aspects of dignity-conserving care, which could apply to most nursing home residents. By attempting to give dignity-conserving care, physicians and nurses often experienced conflicting values in daily care and barriers caused by the lack of resources.ConclusionsTailoring dignity-conserving care to an individual nursing home resident appears hard to bring about in daily practice. Both attention to solve contextual barriers within the nursing home as well as more awareness of staff members for their own values, which they take as a reference point in treating residents, is needed to promote personal dignity in the nursing home setting.
Highlights
Maintaining dignity is an important element of end-of-life care and of the care given in nursing homes
Study population and recruitment The recruitment of physicians and nurses followed on the participation of nursing home residents in an earlier phase of this study, in which 30 recently admitted nursing home residents on the general medical wards of four nursing homes in The Netherlands were interviewed about factors that influenced their personal dignity, either in a positive or negative way
When they were asked about their view on residents’ dignity, it appeared that many nursing home staff members considered someone’s level of dignity to be interwoven with his/her character and attitude to life
Summary
Maintaining dignity is an important element of end-of-life care and of the care given in nursing homes. Factors influencing personal dignity have been studied from both nursing home residents’ and staff’s perspective. Within the context of care given at the end of life, the concept of dignity generally refers to personal dignity, a form of dignity which is individualistic and tied to personal goals and social circumstances. Factors influencing personal dignity in the nursing home have been explored in some studies; both from the residents’ perspective [14,15,16,17] as well as from the perspective of nursing home staff [18,19]. The two last-mentioned studies mainly focussed on staff’s perceptions on their own dignity while working in the nursing home and revealed threats to dignity caused by ethically difficult situations and moral conflicts created by lack of time and resources in the nursing home
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