Maintenance Of Dignity Research Articles

MAN AND WOMAN - A CREATION FOR RELATION IN AUSTEN’S NOVELS

Jane Austen as a realist writer put genuine efforts to connect her characters with real life situations and circumstances to establish her as recognised socially realistic author. The selected novels of this chapter - Pride and Prejudice, Sense and Sensibility, Emma, Northanger Abbey, Persuasion, & Mansfield Park – are clear representation of real social lives of early 19th century. However, the representations are so knitted that it provides a bliss of reading romantic comedies. The romance, the love affairs, the restrictions for expressing love, expressions of male chauvinism or chivalry, good fortune, decent suitors, maintenance of dignity by the lady, are some of the keys induced by Jane Austen in all her narrations. The purpose remains static and it is make to feel the personal, emotional and social lives of the characters. It is like living the age with the characters and having bonds with their emotional experiences. This is a narrative technique of Jane Austen that makes her novels not only romantically successful, but also identified as socially real entities.

Dignity in the care of people with advanced illness in emergency services from the perspective of family members: A qualitative study

Background and aimPatients with advanced illness frequently attend emergency services, accompanied by their relatives. The objective of this study was to explore and describe the experiences of relatives, related to loss and preservation of dignity in end-of-life care in the emergency department. Materials and methodsDescriptive qualitative study. Eighteen in-depth interviews were conducted in the period between January 2020 and June 2020. The Atlas.Ti ® version 9 programme was used as support in the analysis of the speeches. Results3 themes emerged: 1) “the urgency of dignity” which includes aspects related to going to the emergency room and moments when dignity can be threatened; 2) “dignity in the hands of health professionals” which deals with attitudes and gaps in communication skills of professionals: 3) “care from the perspective of dignity in emergencies” which includes conditions that can help preserve dignity and those aspects of the health system that interfere in the maintenance of dignity. ConclusionThe care of these patients and their families requires specific protocols that include a humane and dignified approach, as well as intervention programmes aimed at health professionals.

Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea

BackgroundHigh-quality end-of-life (EOL) care requires both comfort care and the maintenance of dignity. However, delivering EOL in the emergency department (ED) is often challenging. Therefore, we aimed to investigate characteristics of EOL care for dying patients in the ED.MethodsWe conducted a retrospective cohort study of patients who died of disease in the ED at a tertiary hospital in Korea between January 2018 and December 2020. We examined medical care within the last 24 h of life and advance care planning (ACP) status.ResultsOf all 222 disease-related mortalities, 140 (63.1%) were men, while 141 (63.5%) had cancer. The median age was 74 years. As for critical care, 61 (27.5%) patients received cardiopulmonary resuscitation, while 80 (36.0%) received mechanical ventilation. The absence of serious illness (p = 0.011) and the lack of an advance statement (p < 0.001) were both independently associated with the receipt of more critical care. Only 70 (31.5%) patients received comfort care through opioids. Younger patients (< 75 years) (p = 0.002) and those who completed life-sustaining treatment legal forms (p = 0.001) received more comfort care. While EOL discussions were initiated in 150 (67.6%) cases, the palliative care team was involved only in 29 (13.1%).ConclusionsPatients in the ED underwent more aggressive care and less comfort care in a state of imminent death. To ensure better EOL care, physicians should minimize redundant evaluations and promptly introduce ACP.

End-of-life care in the head and neck cancer patient.

Past the point of no longer being able to control malignancies of the oral cavity and head and neck, the decision-making process must shift to one that essentially concerns itself with creating comfort for the patient. The role of family, physicians, and other caregivers becomes, in many ways, more directed as active neoplasia-related concerns become less relevant. Challenges remain significant in terms of continuing management of prior treatment-related side effects and functional impairments to providers concerning themselves with maintenance of dignity, honoring the wishes of the family, and creating full understanding of on the part of all parties concerned what the goals of treatment cessation and palliation are key as death approaches.

Living well with dementia: enhancing dignity and quality of life, using anovel intervention, Dignity Therapy.

To assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to improve the quality of life and reduce psychological and spiritual distress in older people with early stage dementia. Dementia is a syndrome with several causes that leads to a progressive decline in multiple areas of functioning. The maintenance of dignity and enhancement of quality of life are key elements of care. Meaningful communication may become more difficult with condition progression. Improvements in communication may have positive effects on the person's quality of life. Dignity Therapy is a short psychotherapeutic intervention that uses a trained therapist to take the person with dementia through a guided interview process, producing a 'generativity' document that creates a lasting, written legacy during a time when they are still able to communicate well. This was a feasibility mixed method study. Dignity Therapy was undertaken with patients diagnosed as having early stage dementia. Data were gathe-red from pre- and post-Dignity Therapy interviews, a focus group, interviews with keystakeholders, and three outcome measures: The Herth Hope Index; The Patient Dignity Inventory; Perceived Quality of Life/Satisfaction with Quality Life Ratings. This study demonstrated that Dignity Therapy is feasible, acceptable and potentially effective for older people with dementia. Three overarching themes emerged: A life in context, A key to connect and Personal legacy. We recommend that this feasibility study forms the basis for further study, advocating the prospective benefits to patients with dementia, families and nursing practice. Dignity Therapy, as a psychosocial intervention, has the potential to improve the quality of life and enhance person centred care for people with dementia.

Enrolling Brain-Dead Humans in Medical Research: Stakeholder Opinions

Background: Brain-dead humans retain many of the physiologic functions of living humans, but they are legally dead and cannot be physically harmed by participation in research. Stakeholder opinions about enrolling brain-dead humans in medical research are largely unknown. Methods: Exploratory interviews were conducted with members of three stakeholder groups—medical researchers, intensive care clinicians, and laypeople—to gauge support for and identify barriers to the conduct of research with brain-dead humans. Thematic analysis of interview transcripts was conducted based on a priori hypotheses and content analysis of interview transcripts. Results: Twenty-three of 31 participants (7/9 researchers, 8/10 clinicians, and 8/12 laypeople) indicated that research enrolling brain-dead humans who are not eligible for organ donation should be permitted, though all cited restrictions that should apply. Reservations about research involving brain-dead humans included (1) concern about maintenance of dignity or avoidance of desecration of the subject; (2) potential for a negative impact on surviving family members; (3) potential for a negative public reaction; and (4) potential for psychological harm to participating personnel. Specific restrictions that participants felt should be in place included (1) requiring consent from surviving families; (2) that such consent should be based on the substituted judgment standard; (3) that the research must have a high significance level; and (4) that the research must not interfere with organ donation or other clinical functions in the hospital. Conclusions: We found widespread support among key stakeholders for permitting research with brain-dead humans. Serious conceptual and pragmatic concerns dictate that research involving brain-dead humans should only be conducted in the context of careful limitations and safeguards.

Community-dwelling older adults' perceptions of dignity: core meanings, challenges, supports and opportunities

ABSTRACTDignity is a universally important issue for all people, and particularly vital for older adults who face multiple losses associated with ageing. In the United States of America and beyond, the maintenance of dignity is a key aim of policy and service provision for older people. Yet surprisingly little research has been conducted into the meaning of dignity to community-based older adults in the context of everyday life. As life expectancy continues to increase worldwide, unprecedented numbers of people are living longer than ever before. The majority of older adults will face declining health and other factors that may impact dignity in the course of ageing in their communities. This paper reports on a study that explored older people's understandings and experiences of dignity through focus groups and a survey. Three key components of dignity are identified: autonomy, relational and self-identity. In addition, the paper discusses a range of factors that can facilitate or inhibit a sense of dignity for older people, including long-term health issues, sensory deficits and resilience to life events. Finally, the implications of these findings for policy and practice are considered in the context of American social structures and values.

Moral Decision Making in Autonomous Systems: Enforcement, Moral Emotions, Dignity, Trust, and Deception

As humans are being progressively pushed further downstream in the decision-making process of autonomous systems, the need arises to ensure that moral standards, however defined, are adhered to by these robotic artifacts. While meaningful inroads have been made in this area regarding the use of ethical lethal military robots, including work by our laboratory, these needs transcend the warfighting domain and are pervasive, extending to eldercare, robot nannies, and other forms of service and entertainment robotic platforms. This paper presents an overview of the spectrum and specter of ethical issues raised by the advent of these systems, and various technical results obtained to date by our research group, geared towards managing ethical behavior in autonomous robots in relation to humanity. This includes: 1) the use of an ethical governor capable of restricting robotic behavior to predefined social norms; 2) an ethical adaptor which draws upon the moral emotions to allow a system to constructively and proactively modify its behavior based on the consequences of its actions; 3) the development of models of robotic trust in humans and its dual, deception, drawing on psychological models of interdependence theory; and 4) concluding with an approach towards the maintenance of dignity in human-robot relationships.

Editorial: What do we know about dignity in care?

During a recent conference on Dignity in Health and Social Care in London, I claimed that we already know a good deal about dignity in care. I was rightly challenged by colleagues from Scandinavia. They suggested that the relationship between philosophical and empirical work in dignity is not at all clear. Their intervention has caused me to reflect on their question and to have it as a theme for this editorial. So what can we say we know about dignity in care? It seems likely that we will agree on the following: that dignity is a contested concept; that philosophical work suggests a wide range of perspectives; that empirical research suggests common themes and subjective elements of dignity in care; that we are, as suggested above, perplexed by the relationship between philosophical and empirical work in dignity; that attempts to measure dignity will not be straightforward; that dignity matters in healthcare for patients, families and professionals; and that we have to understand what contributes to and remedies dignity deficits in care. Writing in the Journal of Medical Ethics in 2003, American bioethicist Ruth Macklin, described dignity as ‘a useless concept’ arguing that autonomy was the more useful and necessary value. In 2008, Steven Pinker argued that ‘the problem is that ‘‘dignity’’ is a squishy, subjective notion hardly up to the heavyweight moral demands assigned to it’. Despite criticism and scepticism about the value and usefulness of dignity, the concept has generated a great deal of philosophical literature and debate. In the USA, the President’s Council on Bioethics commissioned a substantial anthology on Human dignity and bioethics in 2008. A wide range of perspectives on dignity have been published in ethics journals. Writing in Nursing Ethics in 1998, David Seedhouse and Leila Shotton (Toiviainen) defined dignity in terms of the inter-relationship between circumstances and competencies, that is, the maintenance of dignity is dependent on the person’s ability to exercise competencies or to have help to do so. I distinguished between dignity as a self-regarding and otherregarding value in an article in 2004. The philosopher, Lennart Nordenfelt, identified four ‘varieties of dignity’: dignity of merit; dignity of moral or existential stature; dignity of identity; and Menschenwurde and this has been critiqued in relation to nursing practice. More recently, the concept of dignity has been examined through a historical lens by Rieke Van Der Graaf and Johannes Van Delden. They identified four forms of dignity as relational, unconditional, subjective and Kantian forms. Alasdair Cochrane outlines four of the ‘most plausible conceptions of dignity’ as: dignity as virtuous behaviour; dignity as inherent moral worth; Kantian dignity; and dignity as species integrity. These are only some of the many perspectives in the philosophical literature and what is clear is that there is no consensus. Dignity is contested and debate is likely to continue.

Maintainance of patients' dignity during hospitalization: Comparison of staff–patient observations and patient feedback through interviews

Patients' rights such as the need for dignity and respect are essential in the provision of quality care. This exploratory clinical study explored patient dignity within the acute hospital environment through observation of staff-patient interactions and interviews with patients. Dignity can be influenced through two major mediums-maintenance of the physical environment and the communication style of the nurse. The findings identified deviations to ideal practice in the maintenance of the physical environment and communication styles of the nursing staff. Maintenance of dignity and privacy were not identified by patients during the interviews as being under threat despite deviations to ideal practice being observed. Patients possibly accept that 'ideal practice' is not always provided to them because nurses are 'busy', or other factors take precedence in this environment. It is possible that a prevailing culture influences patients' perceptions of whether dignity is maintained.

An analysis of the concept dignity

Dignity is a highly abstract, vague concept that is difficult to measure within the context of general nursing. Despite this, it is a central phenomenon to nursing and so it is crucial that health care workers have a clear depiction of dignity. This concept analysis uses the framework established by Walker and Avant [Walker, L.O., Avant, K.C., 1995. Strategies for Theory Construction in Nursing, third ed., Appleton and Lange, Connecticut] in order to heighten knowledge and awareness of the concept dignity. This approach also ensures that the concept is not being used erroneously. Respect, autonomy, empowerment and communication have been identified within the literature as being the defining attributes of dignity. Within these, further attributes are defined, which explain the complex, ambiguous concept that it is. This concept analysis is important for areas where the maintenance of dignity may be unintentionally overlooked. This can be related to many Emergency Departments in various parts of the world, where patients are awaiting beds. This is prevalent and has been slowly worsening for more than a decade [Derlet, R.W., Richards, J.R., 2000. Overcrowding in the Nation's emergency departments: complex causes and disturbing effects. Annals of Emergency Medicine 35 (1), 63-68; Schneider, S., Zwemer, F., Doniger, A., Dick, R., Czapranski, T., Davis, E., 2001. Rochester, New York: A decade of emergency department overcrowding. Academic Emergency Medicine 8, 1044-1050; Nairn, S., 2003. The politics of beds. Accident and Emergency Nursing 11, 68-74]. Commonly patients are nursed in a corridor, which does not lend itself to upholding the dignity, privacy and confidentiality of those patients [Ball, J., Dixon, M., Dolan, B., Holt, L., Wilkinson, R., 2000. Why are we waiting? Emergency Nurse 8 (1), 173-180]. However, patients' dignity should be maintained at all times and health care workers need to recognise that they themselves need dignity in order to promote dignity in others.

Childbearing Women’s Perceptions of Nursing Care That Promotes Dignity

To gain an understanding of the perceptions of childbearing women about the maintenance of dignity while laboring and giving birth. Descriptive qualitative study. A university community in the western United States. Twenty low-risk primiparous women who had recently given birth to healthy term neonates. Semistructured audio-taped interviews were conducted in the homes of participants using an interview guide. The following themes were identified: (a) nurses played a pivotal role in preserving dignity during childbirth, (b) women appreciated feeling valued and respected, and (c) dignity was enhanced by nursing care that gave women their preferred level of control. Nursing behaviors that demonstrate valuing and respect of childbearing women are essential in preserving the quality of the birth experience.

Patient-centred care in the management of postoperative orthopaedic patients with an acute confusional state

The aim of this paper is to briefly examine some definitions of the complex phenomenon of an acute confusional state and to explore the nurse's role in the management and aftercare of an older person who experiences this. Seminal and more recent research will be reviewed. It is intended to discuss two differing definitions of an acute confusional state, prior to expanding on the context of the condition and then describing a nursing strategy. Also, it will be argued that maintenance of dignity, self-esteem and self-confidence in situations that can all too readily lead to ridicule and shame, are essential aspects of the management process, if true patient-centred care is to be achieved.