Patients’ attitudes, the hospital environment, and staff behaviour affected patients’ dignity on a surgical ward
What is the meaning of dignity for patients in an acute care hospital? How is dignity threatened or promoted?
Purposeful case sample of 24 patients 34–92 years of age (mean age 64 y, 62% men) who were admitted to hospital and stayed on the ward for ⩾2 days; and 26 ward-based staff (nurses and healthcare assistants) and 6 senior nurses.
Patients were observed on the ward during twelve 4-hour sessions, and field notes were taken. 12 patients and 13 ward-based staff were interviewed immediately after observation; 12 other patients were interviewed within 2 weeks of discharge. 6 senior nurses were interviewed separately. Questions addressed the meaning of dignity; effects of hospital setting, staff, or situations on patient dignity; and how to promote dignity. Detailed notes, including verbatim speech, were taken; patient interviews after discharge and those with senior nurses were audiotaped and transcribed. Data were coded and analysed for themes.
4 themes were found. (1) The meaning of patient dignity reflected feeling comfortable, in control, and valued; dressing appropriately without bodily exposure; and respect. (2) Patient factors affecting dignity included impaired health leading to dependence on others. For example, a patient described having a catheter and urine bag changed as undignified. Older patients felt more uncomfortable with bodily exposure. For example, a patient >70 years of age said, “I’m a man who was brought up in the innocent age and your body being touched and played with by women and that kind of thing is a bit difficult.” Despite this, patients adjusted their attitudes by accepting that bodily exposure was an inevitable part of nurses’ jobs, thus allowing them to feel more comfortable. Patients also promoted dignity with humour and building good relationships with staff. (3) The hospital environment affected dignity positively and negatively. Most patients and staff felt that the physical layout of the ward (open space and cleanliness) promoted privacy and dignity; only 2 patients would have preferred single rooms. Small ward bays enabled patients to bond with and receive support from others who had similar conditions, and thus they felt less embarrassed during clinical procedures. Overall, patients found other patients on the ward to be caring, respectful, and friendly. Senior nurses praised the leadership of the ward manager in maintaining a “dignity-promoting ward.” However, a shortage of hospital beds increased movement of patients between wards, which led to mixed-sex wards and the potential for bodily exposure in front of opposite-sex patients. Attachment to catheters and intravenous infusions increased bodily exposure, thus compromising privacy and dignity. (4) Staff behaviour affecting dignity included authoritarian interactions with patients and occasional intrusions by staff during clinical procedures. However, staff were generally aware of the importance of patient privacy. Nurses promoted dignity by pulling around curtains to minimise bodily exposure and made patients feel comfortable by interacting with humour and reassurance. Patients indicated that staff behaviour promoting dignity included giving explanations, providing choices, seeking consent, courteousness, helpfulness, and consideration.
The meaning of dignity for patients in hospital included feeling comfortable, in control, and valued; avoiding bodily exposure; and respect. Dignity was affected both negatively and positively by patient factors, the hospital environment, and staff behaviour.
Baillie L. Patient dignity in an acute hospital setting: a case study. IntJ Nurs Stud 2009;46:22–36.
The case study by Baillie examined the dignity of patients in an acute care setting from the viewpoints of patients, staff, and researcher as observer. Although the study was limited to a single acute care site in a rural hospital and had a homogenous sample of participants, the findings reiterate the importance of promoting dignity within nursing. The findings remind practitioners of what constitutes patient-centred nursing care in the context of promoting patients’ dignity, a basic human right in health care. They reinforce the value of respectful interpersonal interactions with patients and between nurses in promoting patient dignity irrespective of common systems-related barriers such as staff shortages, increased workload, and non-conducive physical environments. Additionally, the effect of ward culture and leadership (as identified by nurses) and patient camaraderie (as identified by patients) on patient dignity suggests the need for reflective practice at individual and global levels, further emphasising the complexity of dignity in health care. Although this study validates factors that promote dignity and proposes suitable strategies for nursing practice, the challenge for nurses is to address the question of how to consistently and effectively nurture a shared dignity-promoting culture as values and conditions of target cultures can influence the direction of behavioural change.1 As such, the first step may be for nurses to make explicit efforts through constructive feedback to support one another in their dignity-promoting behaviours—cognitive, interpersonal communication, and physical interventions. For future consideration, viewing dignity as a sense of shared connectedness between humans may provide an additional lens to the how question when considering dignity.2 32 3 Examining the meaning of dignity across cultural groups may add valuable insights to multicultural care.