Loss Of Dignity Research Articles

The Practice of Continuous Palliative Sedation in Elderly Patients: A Nationwide Explorative Study Among Dutch Nursing Home Physicians

To study the practice of continuous palliative sedation (CPS) by Dutch nursing home physicians in 2007. A structured retrospective questionnaire. Nationwide nursing home physician study in the Netherlands. One thousand two hundred fifty-four nursing home physicians received a questionnaire concerning their last case of CPS in 2007; 54% (n=675) responded. Characteristics of CPS and requests for euthanasia were measured. Three hundred sixteen patients were described. The majority had cancer or dementia. The most-reported refractory symptoms were pain (52%), anxiety (44%), exhaustion (44%), dyspnea (40%), delirium (24%), loss of dignity (18%), and existential distress (16%). In 98% of cases, CPS was aimed at symptom relief. Of patients with cancer, 17% had previously requested euthanasia. The mean starting dose of midazolam was 31 mg every 24 hours (range 0-240 mg/24 h), and the mean end dose was 48 mg every 24 hours (range 0-480 mg/24 h). In addition to physical symptoms, anxiety, exhaustion, loss of dignity, and existential distress are often mentioned as refractory symptoms in the decision to start CPS by nursing home physicians. Furthermore, close to one in five patients with cancer had made a previous request for euthanasia. The dosage range of midazolam in this study fits the recommendations of the Dutch national guideline on palliative sedation, although international studies show smaller dosage ranges. Finally, prospective research about the acceptability and assessment of nonphysical symptoms as indications for CPS is recommended.

Starting out-When first name terms bring about a loss of patient dignity

Student experiences in the real world of nursing

Requests for euthanasia in general practice before and after implementation of the Dutch Euthanasia Act.

The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalizing euthanasia under strict conditions influences the number and nature of euthanasia requests. To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Retrospective dynamic cohort study comparing 5 years before (1998-2002) and 5 years after (2003-2007) implementation of the Act. Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. The mean annual incidence of requests before implementation amounted to 3.1/10,000 and thereafter to 2.8/10,000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10,000 to 2.6/10,000 (P = 0.008); the requests by females increased non-significantly from 2.6/10,000 to 3.1/10,000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females.

Compassion Fatigue: What Is It? Why Does It Matter? Recognizing the Symptoms, Acknowledging the Impact, Developing the Tools to Prevent Compassion Fatigue, and Strengthen the Professional Already Suffering From the Effects

Compassion fatigue (CF) is recognizable. It erodes the professional's ability to function at an optimum level. Depression, caregiver stress, secondary trauma, and post traumatic stress syndrome (PTSD) are very much a part of the daily landscape for today's professional. The costs are many: staff turnover, loss of self-worth, diminished productivity, poor morale, and more. We in the helping professions must acknowledge the syndrome and validate its impact on professional staff. Giving lip service to ''staff support'' is not enough. We must fully understand how CF comes about and how we can effectively support those suffering its debilitating consequences.

The Loss of Dignity at the End of Life

The Loss of Dignity at the End of Life

Gentle, Angry Women Creating Change

Today, many of us in social work are ‘‘gentle, angry people’’ (Near, 2002). We live and work in a time of war and global economic crisis. Our gentleness is formed of a tender compassion for those who suffer the impacts. Our anger is directed at the greed that has led to ‘‘billions of dollars in cuts . . . in domestic discretionary . . . and entitlement programs’’ (Abramovitz, 2009, p. 106) and the harmful effects on people who did not create these problems. We know too well the loss and pain that neoliberal policies and the actions of some of the wealthiest have produced around the world. The loss of lives, jobs, and homes. The loss of dignity and futures. The worsening health and lack of medical care. The spread of hunger and hopelessness. The increase of violence in families and communities (Golie, 2006). We know that, as always, the most marginalized people bear the heaviest brunt of material and social exigency. Despite the years of cuts in domestic services, public budgets are overburdened by debt, and social services that have survived are being retrenched. As part of the retrenchment, many social workers’ already unrealistic workloads are being increased. Others’ jobs are being eliminated altogether. Under these conditions, an unfeasible job seems more preferable than having no job, and better judgment is silenced into bitter acquiescence. So far, this is a grim story. However, as in every story of struggle, there are tendrils of resistance and alternatives scattered throughout these current events. In November 2008, for example, the United States elected its first African American president through effective grassroots organizing on a platform of change. Time will tell, but so far, President Obama has held steadily to his platform. Social and economic justice and human rights continue to be central value premises articulated by social work. Social workers find many ways to express these value commitments through their practice, education, and scholarship, even now. Among its many publications, social work continues to have a thriving feminist social work journal with a transformative mission of change.

Trends and determinants of end-of-life practices in ALS in the Netherlands

In the Netherlands, the proportion of patients with amyotrophic lateral sclerosis (ALS) who choose the option of euthanasia or physician-assisted suicide (PAS) is relatively high (20%). The objective of this study was to determine which factors influence end-of-life practices in ALS and whether rates are changing over time. In a cohort survey, 204 physicians and 198 informal caregivers (response rates 75% and 80%) of patients with ALS who died between 2000 and 2005 filled out questionnaires of the end-of-life circumstances of the patient. Results were compared with those of a similar study performed during the period 1994-1998. In 2000-2005, 16.8% of the patients decided on euthanasia or PAS compared to 20.2% in 1994-1998. Thirty-one (14.8%) patients died during continuous deep sedation (CDS) in 2000-2005. Euthanasia or PAS, but not CDS, were significantly associated with religion not being important to the patient, being more educated, and dying at home. Euthanasia or PAS were not associated with quality of care items or symptoms of depression. Loss of function was similar in both groups. Informal caregivers of patients who died after euthanasia or PAS more frequently reported fear of choking (p = 0.003), no chance of improvement (p = 0.001), loss of dignity (p = 0.02), being dependent on others (p = 0.002), and fatigue (p = 0.018) as reasons for shortening life. Hopelessness was associated with euthanasia or PAS, as with CDS. The frequency of euthanasia or physician-assisted suicide (PAS) in amyotrophic lateral sclerosis (ALS) appeared stable over time and 1 in 7 patients died during CDS. CDS is relatively common in ALS, but appears to have other determinants than euthanasia or PAS. Subjective factors may be important in explaining euthanasia or PAS in ALS.

Privacy and dignity in continence care: research review

People with incontinence problems are particularly vulnerable to feeling a loss of dignity. A recent study on dignity in care settings explored the factors important to residents in maintaining dignity during continence care.

Reasons why people in Switzerland seek assisted suicide: the view of patients and physicians.

Assisted suicide is permitted in Switzerland provided that assistance is not motivated by selfish reasons. Suicides are commonly performed with the assistance of right-to-die organisations and the use of a lethal dose of barbiturates prescribed by a participating physician. We examined the reasons physicians provided for writing the prescription and the reasons patients gave for requesting assistance in dying. We analysed all reported cases of assisted suicide that were facilitated by right-to-die organisations between 2001 and 2004 in the city of Zurich, and for which both the medical report and the optional letter written by the decedent providing information on their reasons for seeking assistance in suicide (N = 165). The reasons most often reported by physicians (ph), as well as persons who sought help (p), were: pain (ph: 56% of all assisted suicides, p: 58%), need for long-term care (ph: 37%, p: 39%), neurological symptoms (ph: 35%, p: 32%), immobility (ph: 23%, p: 30%) and dyspnoea (ph: 23%, p: 23%). Control of circumstances over death (ph: 12%, p: 39%); loss of dignity (ph: 6%, p: 38%); weakness (ph: 13%, p: 26%); less able to engage in activities that make life enjoyable (ph: 6%, p: 18%); and insomnia and loss of concentration (ph: 4%, p: 13%) were significantly more often mentioned by decedents than by physicians. Both prescribing physicians and;patients provided with assistance to die quite often mentioned pain and other concerns, many of which were objectively assessable and related to unbearable suffering or unreasonable disability. Concerns referable to autonomy and individual judgement were more often noted by people seeking help than by the prescribing physicians.

Reasons why people in Switzerland seek assisted suicide: the view of patients and physicians.

Assisted suicide is permitted in Switzerland provided that assistance is not motivated by selfish reasons. Suicides are commonly performed with the assistance of right-to-die organisations and the use of a lethal dose of barbiturates prescribed by a participating physician. We examined the reasons physicians provided for writing the prescription and the reasons patients gave for requesting assistance in dying. We analysed all reported cases of assisted suicide that were facilitated by right-to-die organisations between 2001 and 2004 in the city of Zurich, and for which both the medical report and the optional letter written by the decedent providing information on their reasons for seeking assistance in suicide (N = 165). The reasons most often reported by physicians (ph), as well as persons who sought help (p), were: pain (ph: 56% of all assisted suicides, p: 58%), need for long-term care (ph: 37%, p: 39%), neurological symptoms (ph: 35%, p: 32%), immobility (ph: 23%, p: 30%) and dyspnoea (ph: 23%, p: 23%). Control of circumstances over death (ph: 12%, p: 39%); loss of dignity (ph: 6%, p: 38%); weakness (ph: 13%, p: 26%); less able to engage in activities that make life enjoyable (ph: 6%, p: 18%); and insomnia and loss of concentration (ph: 4%, p: 13%) were significantly more often mentioned by decedents than by physicians. Both prescribing physicians and;patients provided with assistance to die quite often mentioned pain and other concerns, many of which were objectively assessable and related to unbearable suffering or unreasonable disability. Concerns referable to autonomy and individual judgement were more often noted by people seeking help than by the prescribing physicians.

A phenomenological study of the postoperative experiences of patients undergoing surgery for colorectal cancer

Purpose This study was designed to investigate patients' experience during the postoperative phase of recovery following colorectal resection with end-to-end anastomosis. Method and sample This was a descriptive phenomenological study reliant upon individual interviews. The sample was purposefully drawn from those admitted for surgery. Interviews continued until no new data could be identified from the transcripts. Key results After initial relief that surgery was over, the experience was dominated by ‘tubes and drains’, the consequences of epidural anaesthesia and ongoing pain relief. Themes encompassed loss of dignity and control, inability to eat and drink and lack of sleep. Some found it embarrassing discussing and coping with intimate bowel issues in a communal environment, particularly in mixed sex wards. Patients' emotional state initially reflected their physical condition rather than their disease; as independence was regained, awareness that they were suffering from cancer recurred and was associated with fear and anxiety. Variations in requirements for information were evident indicating that communication does not always equate with understanding. Participants passed through a stage of complete dependence to a degree of renewed independence at discharge, which was itself associated with mixed emotions. For some, there was relief while others were anxious about leaving the ‘safety’ of the hospital environment. Conclusions These findings provide considerable insight into the experience of colorectal surgery and so can make a significant contribution to the planning and delivery of care; they have the potential to impact on the care received by those with colorectal cancer.

Understanding the meaning of human dignity in Korea: a content analysis

This study aims to understand the meaning of human dignity among adults in Korea. A qualitative study design is utilized. Data were collected with non-structured questions in a sample of 74 Korean adults and analyzed with qualitative content analysis. There were 4 categories, 31 themes and 106 theme clusters classified. The four categories that emerged were: fullness of dignity; loss of dignity; reinforcement of dignity; and enfeeblement of dignity. The results of this study may contribute to healthcare professionals understanding of Korean adults human dignity.

A Comparison of Patient Acceptance and Preferences Between CT Colonography and Conventional Colonoscopy in Colorectal Cancer Screening

Background/AimsColorectal cancer, one of the most common cancers in developed countries, is curable when diagnosed at an early stage. However, for better screening, both a test that patients will tolerate and diagnostic accuracy are required. We compared patient experiences and preferences between computed tomographic (CT) colonography and conventional colonoscopy (CC) under conscious sedation.MethodsPatients referred to the gastrointestinal clinic for CC were enrolled to also undergo CT colonography prior to CC. After each procedure, patients completed a questionnaire in which variables, such as abdominal pain, abdominal discomfort, and loss of dignity, were assessed using a 7-point Likert scale, with the highest score representing the worst experience. To verify response stability, a telephone questionnaire followed within 24 h after each procedure. Patients were then asked about their preference for CT colonography or CC.ResultsData were collected from 51 patients who fulfilled all requirements, including CT colonography, CC, the two questionnaires after each procedure, and a follow-up questionnaire. Severity of abdominal pain, abdominal discomfort, and a loss of dignity were reported to be higher in CT colonography than in CC (p<0.01). In addition, the preference for CC was significantly higher than that for CT colonography (p<0.01).ConclusionsAlthough CT colonography is a safe and noninvasive screening test for colorectal cancer, further study is required to increase patient acceptance.

Attribution style of patients with depression

The role of attribution in psychopathology has been investigated most systematically within the depression context. The presumption which makes people depressive consists, to an excessive degree, of internal, stable and global attributions to negative occurrences. Negative attributions for unpleasant events are associated with the loss of self-respect which follows. OBJECTIVE Establishing the characteristics of attribution style of depressive patients. The investigation included 62 subjects. The first group consisted of 32 patients with endogenous depression in remission. The second group included 30 healthy subjects. The characteristics of attribution style, in both groups, were tested by the Attribution Style Questionnaire (ASQ). The group of depressive patients, in comparison with healthy subjects, exhibited a significantly more marked internal attribution for negative events (t(60) = -3.700; p < 0.01) and global internal negative attributions (t(60)= -4.023; p < 0.01). There was no significant difference between the groups in the stability of these negative attributions (t(60)= -1.937; p > 0.05), and also the composite score which represents the measure of hopelessness did not make a significant difference between depressive and healthy subjects (t(60)= -1.810; p > 0.05). Depressive patients exhibit an inclination towards internal and global attribution for negative events. These negative attributions do not have stable character, i.e. these attributions vary in time. Characteristics of attribution judgments of depressive people do not represent a permanent pattern within their cognitive style.

Manual handling risks in the bariatric (obese) patient pathway in acute sector, community and ambulance care and treatment

As part of a larger research project the patient pathway was mapped for an emergency admission to identify the manual handling major risks. Focus group interviews were held with 25 key stakeholders from the acute, community and ambulance healthcare sectors and social services at 3 venues across the United Kingdom (UK). A detailed qualitative iterative analysis used 'cause and effect' or fishbone (Ishikawa) diagrams to identify key issues. Five themes emerged as generic risks throughout the bariatric patient pathway, these were: patient factors including body shape, mobility, pain, co-operation, privacy, comfort and dignity; building (or vehicle) space and design, including space, clearance, floor surface, and safe working load of floor; equipment (manual handling and clinical) and furniture, including fit, maximum weight capacity, availability, suitability, compatibility, size, and effort to move; communication both within and between organisations; and organisational and staff issues, including policies, culture and staff availability and training. It was concluded that buildings, vehicles and equipment need to be designed to 'fit' a range of bariatric shapes and sizes so that bariatric patients could be accommodated in safety and comfort, and with minimal loss of dignity.

Problems encountered managing pressure ulceration of the sacrum

Pressure ulcers cause a great deal of distress, loss of dignity for the patient and can be problematic in terms of management. Pressure ulceration in the sacral area may lead to added complications if the patient has problems with urinary and faecal incontinence. Maintenance of the patient's skin integrity is vital to avoid added discomfort and distress due to moisture lesions. Prevention of wound and dressing contamination with urine and faeces is difficult and can lead to increases in clinical risk (infection) and cost if not managed successfully.

The Lived Experience of Genocide Rape Survivors in Rwanda

The purpose of this study was to explore the lived experience of women who were raped during the 1994 genocide in Rwanda. A phenomenological approach was used and this study was carried out in Rwanda in three different locations. The 7 participants took part in three semi-structured, individual interviews which were audiotaped. Participants reported many themes unique to Rwandan women survivors of genocide. These themes included violation by perceived inferiors, loss of dignity and respect, loss of identity, social isolation, loss of hope for the future (i.e., HIV/AIDS), the ongoing torture of rape babies, and developing a sense of community. Rwandan women survivors of the 1994 genocide have lived through unimaginable suffering. Limited information is available regarding the experiences of these rape survivors and this information could create awareness and some understanding of what these women endured. This study can help nurses to understand the sequelae of war and rape and thus have needed information which can be used to offer assistance to women in these circumstances.

Shame On You, Shame On Me? Nussbaum on Shame Punishment

abstract Shame punishments have become an increasingly popular alternative to traditional punishments, often taking the form of convicted criminals holding signs or sweeping streets with a toothbrush. In her Hiding from Humanity, Martha Nussbaum argues against the use of shame punishments because they contribute to an offender's loss of dignity. However, these concerns are shared already by the courts which also have concerns about the possibility that shaming might damage an offender's dignity. This situation has not led the courts to reject all uses of shaming, but only to accept shaming within certain safeguards. Thus, despite Nussbaum's important reservations against shame punishments, it may still be possible for her to accept shaming within specific parameters such as those set out by the courts that protect the dignity of an offender. As a result, she need not be opposed to the use of legitimate shame punishment.

Patient dignity in an acute hospital setting: A case study

Background Nurses have a professional duty to respect patients’ dignity. There is a dearth of research about patients’ dignity in acute hospital settings. Objective The study investigated the meaning of patient dignity, threats to patients’ dignity, and how patient dignity can be promoted, in acute hospital settings. Design A qualitative, triangulated single case study design (one acute hospital), with embedded cases (one ward and its staff, and 24 patients). Setting The study was based on a 22-bedded surgical ward in an acute hospital in England. Participants Twenty-four patients, aged 34–92 years were purposively selected. There were 15 men and 9 women of varied socio-economic backgrounds. They could all communicate verbally and speak English. Twelve patients, who had stayed in the ward at least 2 days, were interviewed following discharge. The other 12 patients were observed and interviewed on the ward. The ward-based staff (26 registered nurses and healthcare assistants) were observed in practice. 13 were interviewed following observation. Six senior nurses were purposively selected for interviews. Methods The data were collected during 2005. The Local Research Ethics Committee gave approval. Unstructured interviews using topic guides were conducted with the 24 patients, 13 ward-based staff and 6 senior nurses. Twelve 4-h episodes of participant observation were conducted. The data were analysed thematically using the framework approach. Findings Patient dignity comprised feelings (feeling comfortable, in control and valued), physical presentation and behaviour. The environment, staff behaviour and patient factors impacted on patient dignity. Lack of environmental privacy threatened dignity. A conducive physical environment, dignity-promoting culture and other patients’ support promoted dignity. Staff being curt, authoritarian and breaching privacy threatened dignity. Staff promoted dignity by providing privacy and interactions which made patients feel comfortable, in control and valued. Patients’ impaired health and older age rendered them vulnerable to a loss of dignity. Patients promoted their own dignity through their attitudes (rationalisation, use of humour, acceptance), developing relationships with staff and retaining ability and control. Conclusion Patients are vulnerable to loss of dignity in hospital. Staff behaviour and the hospital environment can influence whether patients’ dignity is lost or upheld.

Withholding and withdrawing treatment : practical applications of ethical principles in end-of-life care

Many people fear the process of dying rather than the fact of dying. This fear is often associated with interventions that may be undertaken at the end of life as well as with the knowledge that suffering may be a part of dying and that both may be associated with loss of dignity of the individual. The paper discusses the statement that withholding or withdrawing treatment can be considered a sound clinical decision when reached in discussion with the patient (if competent), the family and the clinical care team. This decision is not taken lightly and it may not be easy to reach consensus on the decision. It is therefore important that the discussion and decision making are based on established bioethical principles. In the practical setting of care for patients at the end of life the four principles of ethics articulated by Beauchamp and Childress 1 are a useful guide for the clinical team. It is important to determine the goals of care and to enter into the discussion with these goals in mind. Treatment should then be focused on achieving realistic goals of care within an ethical framework. Beauchamp and Childress articulated four principles of bioethics: respect for autonomy, beneficence, non-maleficence and justice.