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Peičius E, Urbonas G, Harrison WD, Urbonienė A, Kuznecovienė J, Butkevičienė R, Astromskė K, Kalėdienė R. Dignity Violations and Barriers to Dignity Assurance for Terminally Ill Patients at the End of Life: A Cross-Sectional Analysis. Medicina (B Aires) 2022; 58:medicina58020294. [PMID: 35208617 PMCID: PMC8875998 DOI: 10.3390/medicina58020294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/01/2022] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives: Investigation into forms of behavior that violate dignity is not the typical way to look for means of dignity preservation, but it may be the optimal way to prevent improper behavior. Numerous studies document that maintaining and improving patient dignity at the end of life require an understanding of factors posing threats to dignity in health care organizations. This study aimed to assess associations between dignity-violating behaviors and barriers to the assurance of dignity in health care settings from the perspective of health professionals. Materials and Methods: An anonymous survey of health professionals was conducted in Lithuania in May 2021 by using a convenience sampling method (N = 168). Two scales were developed and included in the questionnaire. One scale measured respondents’ perceptions of Dignity Violations that they had witnessed. The other scale measured their opinions about Barriers to Dignity Assurance of terminally ill patients in clinical settings. Data analysis began with descriptive statistics, followed by exploratory principal component analysis (PCA) to identify the underlying structure of each scale. The variables assigned to distinct components in the PCA were combined into reflective latent variables in a path model. The path model of the relationships between the latent constructs was tested for significant links by implementing the partial least squares structural equation modeling technique. Results: Dehumanization, Humiliation, Inattentiveness, Control, Demonization, and Manipulation were identified as major forms of dignity-violating behavior. In addition, Organizational Barriers and Patient as an Obstacle were identified as two major types of barriers to the assurance of patient dignity. Both organizational and patient-oriented barriers were directly or indirectly associated with all forms of violations of patient dignity. Conclusions: The Dignity Violations scale showed potential for estimating professionals’ observations of dignity violations in health care settings. Perceived high workloads, staff shortages, insufficient resources, and lack of organizational support were identified as negative organizational factors that may result in increased risk of seeing patients as obstacles to providing care that preserves the dignity of terminally ill patients.
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Affiliation(s)
- Eimantas Peičius
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (G.U.); (W.D.H.); (A.U.); (J.K.); (R.B.)
- Correspondence:
| | - Gvidas Urbonas
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (G.U.); (W.D.H.); (A.U.); (J.K.); (R.B.)
| | - W. David Harrison
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (G.U.); (W.D.H.); (A.U.); (J.K.); (R.B.)
| | - Aušra Urbonienė
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (G.U.); (W.D.H.); (A.U.); (J.K.); (R.B.)
| | - Jolanta Kuznecovienė
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (G.U.); (W.D.H.); (A.U.); (J.K.); (R.B.)
| | - Rūta Butkevičienė
- Department of Bioethics, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (G.U.); (W.D.H.); (A.U.); (J.K.); (R.B.)
| | - Kristina Astromskė
- Department of Health Management, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (K.A.); (R.K.)
| | - Ramunė Kalėdienė
- Department of Health Management, Lithuanian University of Health Sciences, Tilžės St. 18, LT-47181 Kaunas, Lithuania; (K.A.); (R.K.)
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Turnbull I, Taylor D, Beatty A, Trimble J, Cabrera E. The Evolution of Dignity: An Intervention Model to Engage and Retain HIV-Positive Black Women in Care. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2021; 11:134-148. [PMID: 36818207 PMCID: PMC9930504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The Black community is currently battling two pandemics, one is HIV, and the other is COVID-19. Similarly, as with HIV, COVID-19 has shone a spotlight on our healthcare system's structural failings and revealed the disproportionate impact on the Black community, particularly Black women. Black women accounted for the largest proportion of new HIV diagnoses (58 %) among all women in 2018 and represented about one-quarter of new HIV diagnoses among all Black Americans. Additionally, Black women's exposure to an abundance of misinformation about the COVID-19 infection resulted in an increased risk of complications and death from the COVID-19 virus compared to other racial and ethnic groups. Factors that increase HIV transmission risks for Black women include living in poverty, intimate partner violence, and stigma associated with HIV. Moreover, environmental, physical, cultural, financial, social, and psychological barriers are identified as unique challenges for this population's cohort. After being diagnosed with HIV, Black often were unable to access quality HIV care. Access and retention in care are tantamount to the overall well-being of women who are HIV positive. Frequently healthcare providers may attempt to engage and retain patients using only clinical measures. Our non-clinical intervention, The Evolution of Dignity, supports medical outcomes by creating a process that empowers women to motivate themselves toward improved health outcomes while ensuring their engagement and retention in care. Thus, by implementing our comprehensive intervention, all of the necessary elements contributing and promoting improved service utilization and medical adherence are integrated.
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Affiliation(s)
- Ivy Turnbull
- Deputy Executive Director, AIDS Alliance for Children Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Chair, National Black Women's HIV/AIDS Network, Inc, 1813 Laurel Street, Columbia, SC 29201-2626, Tel: 202-754-1858,
| | - Deane Taylor
- Member, Advisory Board, AIDS Alliance for Women, Infants, Children, Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Tel: 312-498-8629,
| | - Alicia Beatty
- Member, Advisory Board, AIDS Alliance for Women, Infants, Children, Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Tel:215-704-7380,
| | - June Trimble
- 1525 Kentucky Avenue, Lancaster, TX 75134, Tel: 469-664-2117,
| | - Elizabeth Cabrera
- Member, Advisory Board, AIDS Alliance for Women, Infants, Children, Youth & Families, 1627 Eye St. NW, Suite 835, Washington, DC 20006, Tel: 469-569-0160,
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