Dignity In Healthcare Research Articles

Experiences of dignity: Age at onset of serious illness matters.

Preserving persons' dignity is integral to nursing. More research is needed to explore how a diversity of patients, particularly those that experience illness from a young age, experience dignity. Describe the characteristics of dignity for persons living with serious illness. Using a secondary data set of twenty audio-recorded interviews, a thematic content analysis was conducted to identify characteristics of dignity. The research team employed van Gennip et al.'s, 2013 "Model of Dignity in Illness" (1) to create a codebook, which the authors utilized to independently code twenty narrative interview transcripts. Twenty persons living with serious illness of heart failure and/or dialysis-dependent renal failure who were admitted in an acute care hospital. This study was approved on August 26, 2019, by the Colorado Multiple Institutional Review Board (COMIRB) IRB Protocol #19-1874. Early-onset participants expressed markedly different dignity concerns than late-onset participants. In the individual domain, early-onset participants felt that their illness was "normal"; they did not experience the "healthy person to patient" transition described by older onset participants. In the relational domain, early-onset participants expressed that their relationships had already integrated their illness while late-onset participants felt that their illness harmed many of their relationships. In the societal domain, early-onset participants described dignity concerns related to how society impacted their ability to financially support themselves during their illness. Differences in the dignity experience of early-onset and late-onset participants are informed by Erikson's "Model of Development" and by Aranda and Jones feminist critique of dignity in healthcare. Persons with early-onset illness experience dignity differently. Awareness of the importance of work and financial independence to the experience of dignity for seriously ill patients may enhance persons' dignity experience.

Using Photographs to Bring Dignity to Patients and Help Clinicians Find Meaning and Joy in Work.

Background: The importance of dignity in health care is well described, yet limited interventions exist to improve dignity, particularly patient-driven interventions. Objectives: To test the hypothesis that patient-selected photographs at the bedside would impact patients' sense of dignity and clinicians' sense of meaningful work, stimulate conversation between patients and clinicians, and serve as a visual and patient-driven complement to the Patient Dignity Question (PDQ). Methods: Patients admitted to three units at an academic medical center displayed photographs above their head of bed and were interviewed for this study. We used thematic content analysis to compare themes extracted from patient interviews, the PDQ, and clinician surveys. Results: Eight themes emerged from patient interviews (n = 19): conveying goals, joy, capturing the patient's spirit, faith and spirituality, sense of belonging, physical appearance and health, stimulating conversation and meaningful connections, and humanizing the patient. The same themes emerged from the PDQ, with the exception of physical appearance and health. Notably, analysis of the clinician surveys (n = 40) yielded six similar themes: conveying goals, joy, stimulating conversation and meaningful connections, humanizing the patient, meaningful work, and compassion and empathy. Conclusions: Patient-selected photographs at the bedside impact both patients and clinicians by stimulating conversation and meaningful connections, humanizing patients, and fostering meaning and joy in work. Photographs and the PDQ provide a similar window into personhood, thereby supporting the use of a photograph as a visual and patient-driven complement to the PDQ.

Health inequalities among homeless adolescents.

highlight health inequalities of homeless adolescents based on the conceptual framework of social determinants of health. this is a convergent parallel mixed-methods study. The population consisted of adolescents who are homeless, with purposeful sampling and data saturation. Quantitative data were obtained with a questionnaire and qualitative data through semi-structured interviews. 19 homeless adolescents participated in the study, 13 (68.4%) aged 16 to 19 years; 11 (57.9%) were male, 3 (15.8%) were female, and 5 (26.3%) were transgender adolescents. Participants experienced different levels of exposure and vulnerabilities to conditions that affect health and were directly related to intermediate determinants of health. this study provides an understanding of the inequalities related to the health of homeless adolescents and shows evidence that supports strategies to promote equity and dignity in health care. (1) Contribute with strategies towards equal access to health services and dignity in adolescent care. (2) Understand the health needs of homeless adolescents. (3) Reflect on adolescent health care. (4) Support the health system and reduce health inequities.

103 - A global perspective on dignity-based psychogeriatric care: An urgent call for a Convention on rights for older people

AbstractThe world is ageing fast with a renewed emphasis on comprehensive healthcare for older people. This has created a paradigm shift towards rights and social justice-based approach to augment the medical model of mental healthcare. Dignity is one such construct embedded into the human-rights approach. It comprises of self-respect and worthiness of an individual as well as social acceptance of his/her identity. Dignity is a multi-faceted concept and consists of privacy, independence, inclusion, autonomy, etc. It includes community participation, functional abilities, rights to sexuality and oral healthcare, outcomes which are often neglected in conventional psychogeriatric care. Ageism and fear of ageing can exacerbate social stereotypes thereby compromising dignity in older people and risk of elder abuse.Geriatric psychiatry is uniquely positioned to equip mental healthcare with a ‘dignity-based’ approach promoting social connectedness and health equality. This further needs integration into all levels of public health for better access and holistic psychosocial management.With this background and on the backdrop on the unique psychosocial challenges posed by the COVID- 19 pandemic, this symposium glances at various dimensions of dignity-based psychogeriatric care: –Practical approach towards dignity promotion in healthcare using an attributional model–Perspectives, healthcare challenges and research from LMIC like Brazil and India related to dignity among older people and its impact on ageism and human rights–Rights-based geriatric mental healthcare in the developed nations–Finally, an urgent call for Convention on human rights of older persons for promoting dignity in healthcare and combatting ageism

Making the mundane remarkable: an ethnography of the ‘dignity encounter’ in community district nursing

AbstractThe concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted ‘behind closed doors’, largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the ‘dignity encounter’ through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home.

Eigen regie en waardigheid in de zorg: een kwestie van persoonsgerichte praktijkvoering

Eigen regie en waardigheid in de zorg: een kwestie van persoonsgerichte praktijkvoering

Dignity in healthcare for people with learning disabilities

Dignity in healthcare for people with learning disabilities

Dignity in healthcare for people with learning disabilities

Dignity in healthcare for people with learning disabilities

RCN guidance on dignity in healthcare for people with learning disabilities

Essential factsAccording to the British Institute of Learning Disabilities, an estimated 2% of the population in England has a learning disability. The charity Mencap defines learning disability as reduced intellectual ability and difficulty with everyday activities. Learning disabilities may be mild, moderate or severe, but, given the right level of support, most people with them are able to lead an independent life. However, they are likely to have worse physical and mental health than those without, says Mencap.

Educating student midwives around dignity and respect.

There is currently limited information available on how midwifery students learn to provide care that promotes dignity and respect. In recent years the importance of dignity in healthcare and treating people with respect has received considerable emphasis in both a national and international context. The aim of this discussion paper is to describe an educational workshop that enables learning to promote dignity and respect in maternity care. An interactive workshop, using different creative methods as triggers for learning will be described. Provision of learning opportunities for students around dignity and respect is important to ensure appropriate care is provided in practice. The use of creative methods to inspire has contributed to deep learning within participants. An evaluation of the workshop illustrated how learning impacted on participants practice. Data to support this is presented in this paper. The use of creative teaching approaches in a workshop setting appears to provide an effective learning opportunity around dignified and respectful care. These workshops have evoked a deep emotional response for some participants, and facilitators must be prepared for this outcome to ensure a safe space for learning.

Author’s response to ‘From the struggle of defining to the understanding of dignity: A commentary on Barclay (2016) “In sickness and in dignity: A philosophical account of the meaning of dignity in health care”’

Author’s response to ‘From the struggle of defining to the understanding of dignity: A commentary on Barclay (2016) “In sickness and in dignity: A philosophical account of the meaning of dignity in health care”’

From the struggle of defining to the understanding of dignity: A commentary on Barclay (2016) “In sickness and in dignity: A philosophical account of the meaning of dignity in health care”

We were pleased to see that Barclay (2016) very recently addressed the important issue of dignity in health care. In the paper entitled “In sickness and in dignity: A philosophical account of the meaning of dignity in health care”, the author (Barclay, 2016:136) promotes an understanding and sensitivity for patients’ dignity as ‘core’ outlining critical responsibilities of health care practitioners. This enticing title left us very curious to know more about the philosophical perspective of dignity in health care that the paper purports to offer

In sickness and in dignity: A philosophical account of the meaning of dignity in health care

The meaning of dignity in health care has been primarily explored using interviews and surveys with various patient groups, as well as with health care practitioners. Philosophical analysis of dignity is largely avoided, as the existing philosophical literature is complex, multifaceted and of unclear relevance to health care settings. The aim of this paper is to develop a straightforward philosophical concept of dignity which is then applied to existing qualitative research. In health care settings, a patient has dignity when he or she is able to live in accordance with his or her standards and values. Accordingly, health care practitioners respect a patient's dignity when they refrain from transgressing the patient's standards and values, or refrain from forcing the patient to transgress his or her standards and values. This concept is shown to explain and illuminate most of the key qualitative findings. It therefore provides a more coherent and synthesised concept of dignity in health care.

Struggling to care: A discursive-material analysis of negotiating agency among HIV-positive MSM.

A discursive-materialist framework of agency asserts the mutual constitution of agency within cultural discursive, economic, and embodied material structures. Understanding how HIV-positive men who have sex with men in the Philippines negotiate agency vis-a-vis wider social structures, we utilized Foucault's care of the self to locate agency in relationships with the self, others, and the broader world. Using data from narratives of 20 Filipino HIV-positive men who have sex with men, we analyzed the negotiation of agency as HIV-positive as embedded in the unique discursive terrain of Roman Catholicism and the economic materiality of a developing country. Three main processes of negotiating agency are elaborated: (1) questioning the spiritual self and the sexual body in the relationship with the self, (2) navigating interpersonal limits to care giving in the relationship with others, and (3) reclaiming human dignity in health care in the relationship with the broader world. Theoretical insights on the discursive and material constitution of healing in light of discursive and material challenges are discussed.

BATHE: An Interprofessional Educational Approach to Promoting Patient-Centered Care

The promotion of patient dignity is an important aspect of healthcare provision. However, there is evidence to suggest that patient dignity is not being promoted as expected and a number of attributing factors have been suggested in the literature. This article proposes that healthcare educators should incorporate the subject of dignity in its own right within the curriculum. Attempts in teaching the concept of dignity have tended to adopt an uni-professional approach: this paper proposes that inter-professional education (IPE) is the most suitable approach in teaching the issues relating to dignity in healthcare.

Human Dignity in Healthcare: A Virtue Ethics Approach

The term ‘dignity’ is used in a variety of ways but always to attribute or recognize some status in the person. The present paper concerns not the status itself but the virtue of acknowledging that status. This virtue, which Thomas Aquinas calls ‘observantia’, concerns how dignity is honoured, respected, or observed. By analogy with justice (of which it is a part) observantia can be thought of both as a general virtue and as a special virtue. As a general virtue observantia refers to that respect for human dignity that is implicit in all acts of justice. As a special virtue it concerns the specific way we show esteem for people. Healthcare represents a challenge to observantia because those in need of healthcare are doubly restricted in expressing their dignity in action: in the first place by their ill health, and in the second place by the conditions required by healthcare (hence the sick are termed ‘patients’ rather than ‘agents’). To be understood properly, especially in the context of healthcare, the virtue of observantia needs both to qualify and to be qualified by the virtue of misericordia, empathy, or compassion for affliction. The unity of the virtues requires a simultaneous recognition of the common dignity and common neediness of human existence.

Learning to promote patient dignity: An inter-professional approach

The promotion of patient dignity is an important aspect of healthcare provision. However, there is evidence to suggest that patient dignity is not being promoted as expected and a number of attributing factors have been suggested in the literature. This article proposes that healthcare educators should incorporate the subject of dignity in its own right within the curriculum. Attempts in teaching the concept of dignity have tended to adopt an uni-professional approach: this paper proposes that inter-professional education (IPE) is the most suitable approach in teaching the issues relating to dignity in healthcare.

Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey.

Although qualitative studies have raised attention to humiliating treatment of women during labour and delivery, there are no reliable estimates of the prevalence of disrespectful and abusive treatment in health facilities. We measured the frequency of reported abusive experiences during facility childbirth in eight health facilities in Tanzania and examined associated factors. The study was conducted in rural northeastern Tanzania. Using a structured questionnaire, we interviewed women who had delivered in health facilities upon discharge and re-interviewed a randomly selected subset 5-10 weeks later in the community. We calculated frequencies of 14 abusive experiences and the prevalence of any disrespect/abuse. We performed logistic regression to analyse associations between abusive treatment and individual and birth experience characteristics. A total of 1779 women participated in the exit survey (70.6% response rate) and 593 were re-interviewed at home (75.8% response rate). The frequency of any abusive or disrespectful treatment during childbirth was 343 (19.48%) in the exit sample and 167 (28.21%) in the follow-up sample; the difference may be due to courtesy bias in exit interviews. The most common events reported on follow-up were being ignored (N = 84, 14.24%), being shouted at (N = 78, 13.18%) and receiving negative or threatening comments (N = 68, 11.54%). Thirty women (5.1%) were slapped or pinched and 31 women (5.31%) delivered alone. In the follow-up sample women with secondary education were more likely to report abusive treatment (odds ratio (OR) 1.48, confidence interval (CI): 1.10-1.98), as were poor women (OR 1.80, CI: 1.31-2.47) and women with self-reported depression in the previous year (OR 1.62, CI: 1.23-2.14). Between 19% and 28% of women in eight facilities in northeastern Tanzania experienced disrespectful and/or abusive treatment from health providers during childbirth. This is a health system crisis that requires urgent solutions both to ensure women's right to dignity in health care and to improve effective utilization of facilities for childbirth in order to reduce maternal mortality.

Attaining human dignity for people with birth defects: A historical perspective

People with birth defects have been stigmatised, marginalised and discriminated against for millennia, diminishing their human dignity and abrogating their human rights. Beginning with the United Nations Universal Declaration of Human Rights, promulgated in 1947, the circumstances in which human dignity in healthcare for people with birth defects could be achieved arose, and this was accomplished over the next 65 years through the insight, hard work and dedication of a select group of people and organisations. In 2010 the World Health Organization prioritised services for the care and prevention of birth defects, particularly in middle- and low-income countries. Translating what has been achieved into human rights in healthcare for people with birth defects is the next objective.

In pursuit of human dignity

Philosophy publications and in particular healthcare philosophy papers which include the term dignity as a major discussion point are numerous. Indeed, dignity has become something of an evergreen topic, seemingly a perpetual theme in writings on human rights and health care, offering an opportunity for philosophers and others to exercise ingenuity. Yet, it is not unreasonable to ask whether any of these texts significantly advances our understanding of the concept of human dignity itself or crucially, influences its practical application. In the United States, the President’s Council on Bioethics, an eminent body of 17 experts in the field deliberated on dignity over many years, spurred on by rapid developments in the fields of genetics, bioethics and medical innovation. The associated publication Essays Commissioned by the President’s Council on Bioethics (2008), some 550 pages long and containing 20 essays written by members of the commission and by others, provides a comprehensive summary of many key aspects though it is clear that there is not an overwhelming consensus regarding the concept itself or indeed its relevance. It seems that if complete agreement or at least substantial accord is what is required, then the search may prove rather futile. At the same time, the irony is that many if not most members of the general public possess an immediate and clear intuitive understanding of what they perceive to be flagrant infringements of respect for human dignity in health care. Similarly, press reports on aspects of manipulation of fundamental human genetic material, for instance those questioning the use of stem cells or whether ‘‘three-parent IVF’’ should be permitted, tend to stimulate real public concern on either religious grounds or for not being natural. Whilst the term dignity itself might not always feature, it appears at least implicitly to be the nature of the unease. Such concerns as there are indicate that a respect for human dignity is acquired by most of us, like many other fundamental moral attitudes, as part of the process of growing up and living in a cultural community in which certain standards of behaviour are apparent and imbued. Hence, although there may not be significant public awareness of the theoretical concept of dignity nor relevant underlying principles this might not be a serious problem if intuition is all that is required or could be expected. And indeed educating the public could prove to be both difficult and unnecessary other than clearly setting out relevant factual details. So, against this background, just who needs a theoretical concept of human dignity and why? It would seem that the importance of maintaining and enhancing academic scholarship in this field is most applicable in assisting healthcare professionals and administrators to fully appreciate the nature and relevance of human dignity in their practice and in particular to identify contexts where failure D. Badcott (&) Centre for Applied Ethics, Cardiff University, Humanities Building, Colum Drive, Cardiff CF10 3EU, UK e-mail: badcottd@cf.ac.uk