Patient Dignity Research Articles

Barriers to maintaining dignity for patients with schizophrenia: A qualitative study.

Since dignity is one of the fundamental rights of each patient, maintaining patients' dignity is essential. Unfortunately, in many cases, particularly among patients with schizophrenia (SCZ), dignity is not fully respected. Nonetheless, there is limited knowledge regarding this matter in Middle Eastern Nations. This study aimed to identify the barriers to maintaining dignity for patients with schizophrenia from the perspective of patients with schizophrenia, their family caregivers, and healthcare personnel. This qualitative study was conducted with patients (n = 16), family caregivers (n = 4), and healthcare personnel (n = 6) who were selected using a purposeful sampling method. The data were collected through semi-structured, in-depth face-to-face interviews until the data reached saturation. Data were analyzed using the Graneheim and Lundman method. The Research Ethics Committee of Urmia University of Medical Sciences (IR.UMSU.REC.1401.099). Analysis of the interviews revealed two main themes and five subthemes as the barriers to maintaining dignity for patients with schizophrenia. The main themes included "Black shadow of stigma" (three subthemes: "Facing the fear and discrimination of others," "Misconceptions in society," and "Social rejection") and "Facing violations" (two subthemes: "Basic human rights violation" and "Negative emotional responses"). Patients' dignity with schizophrenia was at a low level due to the negative attitude of society toward these patients. In this respect, the basic human rights violations, social rejection, and misconceptions were abundant in society and care centers. An in-depth comprehension of the threatening factors affecting dignity can assist policymakers in safeguarding their dignity through effective programs.

Unmet care needs in psychiatric healthcare context: A systematized literature review.

Missed, rationed or unfinished nursing care represents a global problem that jeopardizes the provision of quality and safe care. This phenomenon is frequently observed in adult, paediatric and child healthcare facilities and various care units. The findings of this review contribute valuable information to inform evidence-based practices, foster organizational improvements and ultimately optimize the overall quality of care in psychiatric healthcare settings. In addition, the review illuminates the far-reaching consequences of care on both patient and nurse outcomes, emphasizing the urgent need for tailored strategies to mitigate these effects. Based on the synthesis of the literature, a thorough and continuous assessment of patient care needs in the physical, psychological and social domains is needed, primarily utilizing standardized instruments designed for psychiatric settings to ensure a comprehensive understanding of unmet needs. Based on identified unmet needs, nurses should develop individualized care plans and tailor interventions to address them. In addition, nurse managers must adopt and implement regular monitoring mechanisms to track the prevalence of unmet care needs and at the same time establish reporting systems that capture the proportion of unmet needs, allowing timely interventions and adjustments to care delivery. Lastly, nurse managers must not only emphasize the importance of ethical care practices and dignity-focused interventions but also educate healthcare providers, especially nurses, on the potential threats to patient dignity arising from unmet care needs. INTRODUCTION: Despite frequent observations of unmet care needs in acute care adult settings, there are a limited number of studies that focus on investigating this phenomenon in the psychiatric setting. To synthesize the existing empirical research on unmet care needs in psychiatric healthcare settings. The search was carried out in August 2023 in four scientific databases, PubMed, ProQuest, Web of Science and OVID Nursing, based on their institutional availability. The search produced 1129 studies. The search and retrieval process reflected the recommendations of the Preferred Reporting Items for systematic reviews and meta-analyses. This review included 14 studies investigating unmet care needs in the psychiatric healthcare setting. Unmet care needs included three domains: physical, psychological and social. The analysis of the factors revealed factors related to the characteristics of the organization, nurse and patient. The classification of unmet needs provides a comprehensive understanding of the various challenges facing people in psychiatric healthcare settings. Identified factors that influence the occurrence of unmet care needs will help prevent the occurrence of unmet care needs and timely assessment. The resolution of needs helps to achieve patient and nurse outcomes, increase the quality of care provided and patient satisfaction in a psychiatric healthcare setting.

Poor Concordance Between Intensive Care Unit Patients' and Family Members' Patient Dignity Inventory Scores Despite Communication of Dignity-Related Distress.

Promptly assessing and treating the distress of intensive care unit (ICU) patients may improve long-term psychological outcomes. One holistic approach to reduce patient distress is through dignity-centered care, traditionally used in palliative care. The 25-item Patient Dignity Inventory has construct validity and reliability for measuring dignity-related distress among ICU patients. Because family members often serve as ICU patients' surrogates and play an integral role in patients' dignity, we examined whether family members reliably recognized ICU patients' sources of distress. Two single-center observational studies of adult ICU patients were performed from May to June 2022. Inclusion criteria were ICU length-of-stay >48 hours, awake and alert, intact cognition, and no delirium. Study #1 evaluated concordance between patient and family for dignity-related distress. Both completed the Patient Dignity Inventory independently. The next Study #2 measured how many distressing items that the patient reported discussing with family members. Study #1 of concordance had 33 patient-family dyads complete the Patient Dignity Inventory. The concordance correlation coefficient was small, 0.20 (99% confidence interval -0.21 to 0.55) and less than the inventory's test-retest reliability (r = .85). Study #2 examined sharing of Patient Dignity Inventory-related items between patients and family members. There were 12 of 19 patients who had severe distress based on an average Patient Dignity Inventory item score ≥1.92. The median patient shared multiple items of distress with their family (median 12, 99% 2-sided exact Hodges-Lehmann interval 4.0-17.5). Although ICU patients often report sharing sources of distress with their loved ones, family members cannot accurately or reliably assess the extent to which patients experience psychosocial, existential, and symptom-related distress during critical illness. Treatments of distress should not be delayed by the absence of family members.

Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: A Systematic Review.

Background: The population of older adults across the world continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts which are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age-in-place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged care facilities in the future. Whilst studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020195989) prior to the commencement of the database searches. This review was conducted in accordance with the Joanna Briggs Institute Methodology for Systematic Reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. Results: Several factors affected clinicians' perspectives on their readiness to adopt smart home technology for remote health monitoring including challenges such as patient privacy and dignity, data security, and ethical use of 'invasive' technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusion: Clinicians including nurses reported both challenges and benefits to adopt smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness to Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020195989) prior to the commencement of the database searches.

The ethics of overriding patient refusals during 5150s and other involuntary psychiatric holds.

Involuntary psychiatric holds, such as the 5150 hold in California, allow for an individual to be taken into custody for evaluation and treatment for up to 72 h when they present a risk of danger to themselves. 5150s and other coerced holds present a bioethical tension as patient autonomy is overridden to provide psychiatric care. I discuss two arguments that aim to provide ethical justifications for overriding patient autonomy during 5150 holds: the "clinical benefit" and "lack of capacity" arguments. By demonstrating that these arguments do not always hold, I argue that overriding patient autonomy during 5150 holds is not always ethical and can be harmful. Lastly, I make recommendations for the 5150 and similar involuntary psychiatric holds to minimize harmful breaches of patient dignity: creating consistent field guidelines for assessing prehospital capacity, educating prehospital providers about the potential harms of 5150s, and utilizing existing support structures within the social context of the patient when they have capacity to refuse further prehospital care.

Revitalizing Open-Door Policies in Psychiatric Institutions: A Strategy for Preserving Patient Dignity – A Letter to the Editor-in-Chief

Revitalizing Open-Door Policies in Psychiatric Institutions: A Strategy for Preserving Patient Dignity – A Letter to the Editor-in-Chief

Experiences of restrictive interventions in psychiatric health care from the perspectives of patients and health care professionals: Meta-synthesis of qualitative evidence.

Following their experience, patients with physical restraints often experienced traumatic sensations. The experiences of healthcare professionals' (HCPs') are primarily concerned with moral distress or conflicts between loyalty to the treatment and oppression of the patient's freedom when implementing RIs. Improving the competency of HCPs can help establish therapeutic relationships rooted in compassionate care and facilitate appropriate assessments to determine whether and how often RIs are necessary. Furthermore, fostering an environment that guarantees patient safety and dignity, assuring a sufficient staffing ratio, and providing opportunities to share RI experiences can help improve the quality of care and build safe environments for RIs. Effective interaction between HCPs and patients, thorough patient assessment, and compassionate patient care may improve competency of HCPs intervene RIs procedures. Creating a safe therapeutic environment, including improvements to structural environments, increasing the staff-to-patient ratio, establishing organizational policies that guarantee staff debriefing, provide emotional support, provide appropriate training programs to HCPs to their coping skills during RIs also reduce the use of RIs and improve the quality of mental health care. INTRODUCTION: Restrictive interventions (RIs) are used in psychiatric inpatient units for ensuring safety. However, few studies have comprehensively reviewed physical restraint and seclusion experiences from the perspectives of both patients and healthcare professionals' (HCPs'). This study aims to gain an in-depth understanding of the RI experiences of mental health inpatients and HCPs. A meta-synthesis was undertaken of qualitative studies exploring the RI experiences. Five electronic databases were searched and additional manual searches were performed for studies published within the last decade. Twelve articles were included, and a thematic analysis was conducted. The Critical Appraisal Skills Program (CASP) checklist was used to assess data quality. Two main subthemes were identified: 'Competency of HCPs' (three subthemes: interaction between patients and HCPs, assessment methods, and care) and 'systems' (three subthemes: environment, protocols with training, and debriefing), including both positive and negative experiences. The Competency of HCPs and the ward environment are critical factors related to patients' unmet needs. Effective interactions between HCPs and patients, thorough patient assessments, and compassionate patient care are important elements of RI implementation. An environment that guarantees safety and care with dignity, sufficient staffing ratios, and opportunities to share RI experiences may improve quality of care and create safe environments for RIs.

Dignity enhanced through faith & family support in palliative care: a qualitative study

BackgroundDignity is integral to palliative care. Illness can diminish it, causing hopelessness and the wish to hasten death. Yet, dignity is a complex multidimensional phenomenon, influenced by values and context. Understanding its varying interpretations can inform practice and policy. The aim of the study is to explore the understanding of dignity in adult patients with palliative care needs from a Lebanese perspective and how it is preserved during illness and while receiving health services.DesignQualitative interview study underpinned with a social constructionist lens. Fourteen patients recruited from home-based hospice and outpatient clinics in Lebanon. Data analysed using reflexive thematic analysis.ResultsFour themes were developed across all the interviews: (a) Dignity anchored through faith in God and religious practices; (b) Family support in maintaining physical, psychological wellbeing, and social connectedness; (c) Physical fitness, mental acuity, and healthy appearance through which patients may escape the stigma of disease, (d) accessible, equitable, and compassionate healthcare.DiscussionDignity is elusive and difficult to define but faith and religious beliefs play a significant contribution in this study. For the participants, illness is seen as a natural part of life that does not necessarily diminish dignity, but it is the illness related changes that potentially affect dignity. Findings show the importance of family and children in preserving dignity during illness and how their active presence provide a sense of pride and identity. Participants aspired to restore physical, social, and mental well-being to reclaim their dignity and normalize their lives. Challenges related to physical appearance, memory loss, vitality, and social stigma associated with illness diminished dignity. Accessible, equitable and compassionate healthcare services are also crucial in preserving dignity. Participants valued clear communication, respect, and empathy from healthcare providers and identified affordability of care essential for maintaining dignity.ConclusionFaith in God, and strong family ties are dominant elements to maintaining dignity in the Lebanese context. Relational connectedness with family, children or God is also a need in maintaining dignity in other communal countries with variations in emphasis. The study indicates that religious and cultural context shapes the needs and perceptions of dignity during illness. These findings are likely to be transferable to many Middle Eastern countries but also countries with strong religious and family ties globally.

생애말기 의학적 돌봄 향상을 위한 연명의료결정법의 개정방안

The Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life (ELDA) was passed by the Korean National Assembly in 2016 and came into effect in 2018. Although the stated purpose of the act is to uphold patient autonomy and dignity in the context of end-of-life (EOL) care, its utilization remains low, with only some 40% of EOL decisions reflecting patients’ direct opinions. This study aims to pinpoint areas for enhancing ELDA by comparing it with similar systems in other countries and gathering expert opinions. To achieve this, we reviewed ELDA, compared it with EOL care systems in Taiwan, Japan, the UK, the US, and Germany, and surveyed Korean medical experts to collect their thoughts on how ELDA might be improved. On this basis, we make several recommendations, including broadening the scope of ELDA, bolstering the role of advance directives, and providing education for healthcare professionals. These recommendations are expected to increase the utilization rate of ELDA and enhance the quality of EOL care in South Korea.

Towards understanding and improving medication safety for patients with mental illness in primary care: A multimethod study.

Medication safety incidents have been identified as an important target to improve patient safety in mental healthcare. Despite this, the causes of preventable medication safety incidents affecting patients with mental illness have historically been poorly understood, with research now addressing this knowledge gap through a healthcare professional lens. However, patients and carers can also provide complimentary insight into safety issues, and as key stakeholders in healthcare, it is vital to consider their needs when designing effective interventions. A two-stage approach was adopted by (i) conducting three focus groups (FG) comprising 13 patients with mental illness and their carers to develop a holistic picture of medication safety in primary care with extraction of themes guided by the P-MEDS framework; (ii) conducting two separate nominal group consensus workshops with seven patients with mental illness/carers and seven healthcare professionals to identify priority areas for targeted interventions. Seven themes were identified in the FGs: communication; trust, involvement and respect; continuity and support; access; the healthcare professional; the patient and carer;and the organisation. Priority areas identified for intervention by key stakeholders included improving communication within and between clinical services, enhancing patient support with holistic continuity of care, maximising shared decision-making and empowerment, ensuring timely access to medicines and services, strengthening healthcare professional knowledge regarding mental illnesses and associated medications,and increasing patient dignity and respect. This study has developed a holistic picture of contributors to medication safety incidents affecting patients with mental illness in primary care. This theory was then used by key stakeholders to inform and generate priority recommendations for targeted interventions. These findings can be used to inform future intervention research, as they consider the needs of those who access or work within primary care services. An advisory group consisting of three expert patients with lived experience of mental illness was consulted on the design of both stages of this study. Patients with mental illness and/or their carers were recruited and participated in both stages of this study. Patients/carers aided with data analysis and interpretation during the patient/carer nominal group consensus workshop.

Critical care nurses' experiences of ethical challenges in end-of-life care.

In Swedish intensive care units, nine percent of patients do not survive despite receiving advanced life-sustaining treatments. As these patients transition to end-of-life care, ethical considerations may become paramount. To explore the ethical challenges that critical care nurses encounter when caring for patients at the end of life in an intensive care context. The study used a qualitative approach with an interpretive descriptive design. Twenty critical care nurses from eight intensive care units in an urban region in Sweden were interviewed, predominately women with a median age of fifty-one years. This study was approved by The Swedish Ethics Review Authority. Critical care nurses described encountering ethical challenges when life-sustaining treatments persisted to patients with minimal survival prospects and when administering pain-relieving medications that could inadvertently hasten patients' deaths. Challenges also arose when patients expressed a desire to withdraw life-sustaining treatments despite the possibility of recovery, or when family members wanted to shield patients from information about a poor prognosis; these wishes occasionally conflicted with healthcare guidelines. The critical care nurses also encountered ethical challenges when caring for potential organ donors, highlighting the balance between organ preservation and maintaining patient dignity. Critical care nurses encountered ethical challenges when caring for patients at the end of life. They described issues ranging from life-sustaining treatments and administration of pain-relief, to patient preferences and organ donation considerations. Addressing these ethical challenges is essential for delivering compassionate person-centered care, and supporting family members during end-of-life care in an intensive care context.

Dignity-related distress and recall among alert, non-delirious critically ill patients.

Critical illness is associated with multiple undesired impacts, including residual psychological distress, frequently associated with recollections of critical illness. Dignity-related distress is highly prevalent among the one-fifth of critically ill patients who are alert. The distress may be associated with unpleasant recollections of care. We examined whether patients at risk for dignity-related distress had recall of their reported distress approximately 1 week after assessment and whether this recall differed from another high-risk group, specifically patients undergoing dialysis for end-stage renal disease. The prospective cohort study included patients with critical illness and patients with end-stage renal disease enrolled from intensive care units (ICUs) and dialysis units at 1 academic center. Distress was assessed using the Patient Dignity Inventory (PDI). Participants received in-patient or telephonic follow-up 7-10 days after the initial interaction. Follow-up encounters focused on recollection of key aspects of the interpersonal interaction as well as the content of the PDI. A total of 32 critically ill patients participated in initial assessment and follow-up. In total, 26 dialysis patients participated in both phases. The groups' demographics differed. Fifty percent (n = 16) of critically ill patients and 58% (n = 15) of dialysis patients reported a mean score per item of >1.6, corresponding with severe distress on the PDI. Among the ICU patients, the 95% upper 2-sided confidence interval for the median level of recall was commensurate with the participant having had no recall of the initial interview beyond remembering that there was an interview. The end-stage renal disease group did not demonstrate significantly better recall. Dignity-related distress is high in both critically ill patients and those with end-stage renal disease; however, recollection of assessment is poor in both groups. Any intervention designed to mitigate dignity-related distress will need either to be immediately deployable or not to be reliant upon recollection for impact.

Advance directives need full legal status in persons with dementia.

Currently, in the United States, there is no legal obligation for medical professionals or civil courts to uphold patients' Advance Directives (ADs) regarding end-of-life care. The applicability and standing of ADs prepared by Alzheimer's patients is a persistent issue in bioethics. Those who argue against giving ADs full status take two main approaches: (1) appealing to beneficence on behalf of the Alzheimer's patient and (2) claiming that there is no longer any personal equivalence between the AD's creator and the subject of the AD. In this paper, I present profound arguments against both approaches. Firstly, I argue that the principle of beneficence cannot apply in the case of Alzheimer's patients, and, secondly, that the moral and legal authority of the AD need not depend on strict equivalence of personal identity. I conclude by arguing that valid ADs protect the dignity and autonomy of Alzheimer's patients and that, therefore, there are moral obligations to uphold ADs which should be reflected in public policy and legislation.

Ensuring informed consent in low-income settings: Opinion piece

In low-income healthcare settings, the implementation of informed consent faces significant challenges despite its pivotal role in upholding patient autonomy and dignity. A study conducted in southeastern Nigeria at the University of Nigeria Teaching Hospital sheds light on these challenges, particularly concerning patient satisfaction and recall of critical information post-consent. While many patients recalled details about their medical condition and planned procedures, there was notably lower recall of associated risks, emphasizing the complexity of conveying risk-related information effectively. Importantly, the study reveals a correlation between patient satisfaction with the consent process and their subsequent recall of information, underlining the intrinsic link between patient engagement, satisfaction, and comprehension. To bridge this gap, tailored communication methods and addressing patient concerns are essential. Systemic deficiencies in the consent process, including generic forms and linguistic barriers, call for interventions such as culturally sensitive consent materials and capacity building for healthcare providers. Looking forward, innovative approaches, including pictorial aids and mobile health applications, should be explored, alongside longitudinal studies to assess their impact. Ultimately, prioritizing patient satisfaction and comprehension in the consent process is crucial for upholding ethical standards in healthcare delivery, even amidst resource constraints.

Opinions and experiences of operating room nurse on ethical sensitivity: a phenomenological study

The aim of this study is to examine the opinions and experiences of operating room nurses about ethical sensitivity phemenologically. This phenomenological study, which is in the qualitative research design, was conducted with 14 operating room nurses. Prior to the study, a pilot study was conducted with three nurse families. The interviews were conducted using a face-to-face in-depth semi-structured interview form and the data were analyzed with Colaizzi’s phenomenological method. Interview data were collected between 15 June 2022 and 15 October 2022 in the country. Three categories, seven main themes, and twenty-three sub-themes emerged as a result of the interviews. In the theme of ethical dilemmas experienced by operating room nurses, there are sub-themes of professional ethics, teamwork, and patient dignity and benefit. There are physical and psychological sub-themes in the theme of ethical sensitivity perception and practices of operating room nurses, and among the subthemes, ensuring patient privacy, providing professional competence, providing psychological support to the patient, being friendly and communicating effectively, and respecting the patient’s autonomy come to the fore. Views of operating room nurses on the importance of ethical principles were discussed under the headings of profession and patient. Our results are valuable in that they shed light on the perspectives and experiences of the operating room nurses while maintaining ethical sensitivity. The high ethical sensitivity perceptions of operating room nurses are associated with an increase in the quality of care. It is thought that the high perception of ethical sensitivity of operating room nurses is an important factor that increases the satisfaction of individuals receiving care and the job satisfaction and quality of care of nurses.

Nursing care in patients with terminal cancer in the palliative care unit during the pandemic, nursing perspectives

Introduction: during the pandemic, nursing staff in the palliative care unit had to quickly adapt to an unknown situation, marked by uncertainty and constant changes in their action protocols.Objective: determine the perception of nursing care in patients with terminal-stage cancer in times of pandemic in the palliative care unit in a hospital in the city of Guayaquil.Method: qualitative, exploratory and phenomenological approach, guiding an interview with 15 nurses of the palliative care service.Results: the absence of an institutional model of palliative care in the hospital stands out, although the Ministry of Public Health (MSP) guidelines themselves are used and are not socialized. Despite the dedication of the health team, there are shortcomings in resources, a lack of specialized training and the need to select personnel with a vocation for palliative care. The needs of the patients include the eradication of symptoms and the relief of physical discomfort, while the needs of the nurse refer to the change in the service due to the emotional impact produced by the suffering of the patients. During the course of Covid-19, the isolation of the patient was generated, promoting their loneliness and anguish, in addition, the lack of resources, medical assistance and the support of their families predominated.Conclusions: comprehensive care, covering medical, psychological, social, economic and spiritual aspects, emerges as a crucial factor to alleviate physical discomfort, provide emotional support and preserve the dignity of patients during this stage

Staff perceptions of the use of the patient dignity inventory (PDI) in a Welsh palliative care service

Background Dignity-related psychological distress can often be unidentified and untreated within palliative care services. The Patient Dignity Inventory (PDI) measures the factors associated with an individual’s sense of dignity-related psychological distress. This study aimed to obtain staff members’ perspectives on the feasibility of utilising the PDI in a palliative care service in Wales. Method Seven experienced staff members were recruited from a Welsh Cancer and Palliative Care service. A thematic analysis of data collected via semi-structured interviews revealed three key themes and nine associated subthemes. Main findings The first theme was ‘Positive Outcomes and Uses’, which included three subthemes: Supporting Staff in their Clinical Practice, Patient Empowerment and Flexibility of Use. The second theme was 'Staff Concerns' that had two subthemes: Causing Distress and Confidence in Existential Conversations. The third theme was 'Barriers and Considerations to Implementation', which included Cultural Considerations, Staff Support and Length of the Measure. Conclusions The findings suggest that the PDI could be valuable to clinical staff in supporting the identification of dignity difficulties and/or distress among patients. However, steps should be taken to address barriers to successful implementation and increased staff training on the measure.

Personal dignity in people with early-stage dementia: A longitudinal study.

A psychosocial problem faced by people with early-stage dementia (PwESD) is the perception of threats to personal dignity. Insights into its dynamics are important for understanding how it changes as dementia advances and to develop suitable interventions. However, longitudinal studies on this change in PwESD are lacking. To determine how perceptions of dignity and selected clinical and social factors change over 1year in home-dwelling PwESD and the predictors associated with changes in perceptions of dignity over 1year. A longitudinal study was conducted. The sample included 258 home-dwelling Czech PwESD. Data were collected using the Patient Dignity Inventory (PDI-CZ), Mini-Mental State Examination, Bristol Activities of Daily Living Scale, Geriatric Depression Scale and items related to social involvement. Questionnaires were completed by the PwESD at baseline and after 1year. The study was approved by the ethics committee and informed consent was provided by the participants. People with Early-Stage Dementia rated the threat to dignity as mild and the ratings did not change significantly after 1year. Cognitive function, self-sufficiency, vision, and hearing worsened, and more PwESD lived with others rather than with a partner after 1year. Worsened depression was the only predictor of change in perceived personal dignity after 1year, both overall and in each of the PDI-CZ domains. Predictors of self-sufficiency and pain affected only some PDI-CZ domains. Perceptions of threat to dignity were mild in PwESD after 1year, although worsened clinical factors represented a potential threat to dignity. Our findings lead us to hypothesise that perceived threats to personal dignity are not directly influenced by health condition, but rather by the social context.

Philosophy of transcendental cinema and its applications in psychiatry. The case of lost highway by david lynch

IntroductionThanks to Paul Schrader, transcendental cinema was distinguished from the slow cinema trend. What distinguishes it from it are the precise psychological portraits of the characters and the aptly reproduced world of internal experiences. Transcendental cinema draws from the philosophy of existentialism, presenting the assumptions of the human psyche. In D. Lynch’s cinematography, we can find faithful representations of mental disorders, such as dissociative fugue, depersonalization, mania or psychosis. Based on the “Lost Highway” (1997), we will prove that D. Lynch, with his cinematography, not only provides knowledge about mental disorders, but also gives patients humanity and dignity. The series also resembles a meditation session in the style of mindfulness, which, when practiced, helps a person affected by mental illness in his recovery process.ObjectivesThe aim of this work is to indicate the accurate record of the inner characters’ experiences in D. Lynch’s cinematography, which provides us with knowledge about mental disorders of an individual. By creating a visual image that affects many senses, transcendental cinema sensitizes us and makes us aware of the suffering of a patient affected by mental disorders. The session, while drawing on the philosophy of mindfulness, becomes a meditative session, therapeutic for both us and the protagonist.MethodsIn this research we use the approach proposed by Paul Schrader and David Lynch to analyze analyze transcendental cinema as an art that combines philosophy, cinematography and psychiatry. As a representation of the experiences of a person outgoing the therapy basen on psychoanalysis.ResultsMany studies indicate the positive impact of mindfulness meditation on physical and mental health. Through long scenes, transcendental cinema draws attention to individual stimuli reaching our body, non-judgmental noticing them, focusing on one thought and one sensation, draws from the philosophy of mindfulness, becoming a meditative session in itself. Therefore, a film screening provides us with knowledge about the internal experiences of a psychiatric patient, indicates the form of therapy and at the same time leads us through a therapeutic meditation session.ConclusionsWe believe that the transcendental cinema represented by David Lynch can be treated not only as a representation of mental disorders and the suffering associated with them, but also as a meditative, healing and liberating session. Not only for the person affected by the disorder, but also for us as viewers.Disclosure of InterestNone Declared

Responsiveness of inpatient care and provision of dignity: Insights from a patient experience survey in Israel

The paper contributes to the literature on the responsiveness of care, patient dignity, and disparities in the provision of health services. It does so by evaluating indicators of patient responsiveness while focusing on aspects of dignified treatment. The data were taken from the Patient Experience Survey of General Public Hospitals conducted by the Israel Ministry of Health in 2018. The analysis focuses on two indicators of responsiveness (i.e., actual) and three indicators of patient satisfaction with responsiveness (i.e., satisfaction). The analysis reveals that variations of these indicators are associated with patients' sociodemographic attributes and the hospitals' characteristics. However, while the likelihood of the actual provision of responsive care tends to be lower for vulnerable patients, the satisfaction of vulnerable populations with responsiveness tends to be higher. The data also reveal that the likelihood of responsive treatment and patient satisfaction with this tends to be lower for patients hospitalized in smaller hospitals and hospitals located in the periphery. The findings and their meaning are discussed in the context of studies on responsiveness of care, health disparities, dignified treatment, and patient satisfaction with the provision of health services.