Patient dignity in an acute hospital setting: A case study

https://doi.org/10.1016/j.ijnurstu.2008.08.003Get rights and content

Abstract

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.

Introduction

Patients in varied settings have identified the importance of dignity to them (Chochinov et al., 2002, Matiti, 2002, Joffe et al., 2003) and respecting people's rights to dignity is inherent in nursing (International Council of Nurses (ICN), 2006). However, dignity has been described as an ambiguous, vague concept (Shotton and Seedhouse, 1998, Tadd et al., 2002, Macklin, 2003). Some studies indicated that patients are vulnerable to a loss of dignity in hospital (Seedhouse and Gallagher, 2002, Matiti, 2002, Jacelon, 2003) but what threatens patients’ dignity and how patients’ dignity can be promoted has been little investigated, particularly in acute hospital settings. In this paper, findings from a qualitative case study are presented which provide insights into the meaning of dignity, how dignity is threatened in hospital and how dignity can be promoted.

Section snippets

The requirement for nurses to respect patients’ dignity

In the United Kingdom (UK), dignity has been on the NHS agenda for some time with health policies supporting dignified care for patients being produced by all four UK countries’ health departments. In England, Department of Health (DH) documents increasingly emphasise that patients’ dignity should be respected, while acknowledging that this is not always the case. In 2001 the DH published the Essence of Care (DH, 2001a) which included benchmarks for best practice in privacy and dignity for all

Method

The aims of the study were to investigate in an acute hospital setting:

  • (1)

    The meaning of patient dignity;

  • (2)

    ‘How patients’ dignity is threatened;

  • (3)

    ‘How patients’ dignity is promoted.

A multi-method qualitative case study design was used. No previous studies were identified which used this approach. Case studies are suitable for developing an understanding of a phenomenon in its real-life context and any appropriate range of data collection methods can be used (Yin, 2003). Using Yin's (2003) framework,

Findings

The themes presented are: the meaning of patient dignity, patient factors affecting dignity, the impact of the hospital environment on dignity and how staff behaviour affects dignity.

Discussion

The study involved only one English hospital and specifically one ward's staff and patients, although three senior nurses had hospital-wide roles and hospital documents were examined. Ideally, a multiple case study design would have been used with other acute hospitals involved but these require extensive resources and are often beyond the resources of a single researcher (Yin, 2003). The data collection sources focused on patients and staff but relatives’ views might have provided a different

Conclusion

Promoting dignity is central to humanistic nursing theory and nurses have a professional duty to promote patients’ dignity. Increasingly, UK health policies have emphasised the importance of patient dignity. As little research about patient dignity has been conducted in acute hospital settings, this study's findings have contributed to this limited body of knowledge.

Patient dignity in hospital was found to comprise feelings, physical presentation and behaviour and can be promoted or threatened

Acknowledgement

The author would like to express her gratitude to Professor Ann Taket and Dr Dee Burrows for their doctoral supervision, Dr Bob Cant for his support during this paper's preparation, and the patients and staff who participated in the study.

References (77)

  • I. Baker

    Dignity is not useless. British Medical Journal. Rapid response to Macklin, R. 2003. Dignity is a useless concept

    British Medical Journal

    (2003)
  • H. Bastian

    An offensive slogan. British Medical Journal. Rapid response to Macklin, R. 2003. Dignity is a useless concept

    British Medical Journal

    (2003)
  • T. Bayer et al.

    Dignity: the voice of older people

    Quality in Ageing

    (2005)
  • G. Byrne

    Participant–observer data collection

    Professional Nurse

    (2000)
  • M. Calnan et al.

    Views on dignity in providing health care for older people

    Nursing Times

    (2005)
  • A.V. Campbell

    Core values in healthcare or why the patient isn’t an afterthought

    Quality in Ageing

    (2005)
  • H.M. Chochinov et al.

    Dignity and psychotherapeutic considerations in end-of-life care

    Journal of Palliative Care

    (2004)
  • M.L. Coventry

    Care with dignity: a concept analysis

    Journal of Gerontological Nursing

    (2006)
  • Dean, R., 2003. Transforming the moment: humour and laughter in palliative care. Unpublished PhD Thesis. The University...
  • Department of Health, 2001a. Essence of Care: Patient-focused Benchmarking for Health Care Practitioners. DH,...
  • Department of Health, 2001b. The National Service Framework for Older People. DH,...
  • Department of Health, 2005. Research Governance Framework for Health and Social Care, 2nd ed. DH,...
  • Department of Health, 2006a. A New Ambition for Old Age: Next Steps in Implementing the National Service Framework for...
  • Department of Health, 2006b. About the Dignity in Care campaign. Available from http://www.dh.gov.uk. Accessed August...
  • S.P.D. Enes

    An exploration of dignity in palliative care

    Palliative Medicine

    (2003)
  • E. Fenton et al.

    Growing old with dignity: a concept analysis

    Nursing Older People

    (2002)
  • N.M. Ford

    Human dignity is fundamental. British Medical Journal. Rapid response to Macklin, R. 2003. Dignity is a useless concept

    British Medical Journal

    (2003)
  • A. Gallagher et al.

    Dignity in care: the views of patients and relatives

    Nursing Times

    (2002)
  • D.A. Gaut

    Development of a theoretically adequate description of caring

    Western Journal of Nursing Research

    (1983)
  • Great Britain, 1998. Human Rights Act c. 42. HMSO,...
  • J. Haddock

    Towards further clarification of the concept ‘dignity’

    Journal of Advanced Nursing

    (1996)
  • Health Advisory Service 2000, 1998. ‘not because they are old’: an independent inquiry into the care of older people on...
  • International Council of Nurses

    Nurses and human rights: International Council of Nurses position statement

    Nursing Ethics

    (2001)
  • International Council for Nurses, 2006. Code of Ethics for Nurses. ICN,...
  • C.S. Jacelon

    The dignity of elders in an acute care hospital

    Qualitative Health Research

    (2003)
  • C.S. Jacelon

    Managing personal integrity: the process of hospitalization for elders

    Journal of Advanced Nursing

    (2004)
  • C.S. Jacelon et al.

    A concept analysis of dignity in older adults

    Journal of Advanced Nursing

    (2004)
  • B.B. Jacobs

    Respect for human dignity in nursing: philosophical and practical perspectives

    Canadian Journal of Nursing Research

    (2000)
  • Cited by (195)

    • A global approach to privacy, confidentiality, and dignity

      2023, Ethics for Health Promotion and Health Education
    View all citing articles on Scopus
    View full text