Patient's Dignity: Viewpoints of Patients and Nurses in Hospitals

Barriers to ethical treatment of patients in clinical environments: A systematic narrative review

Background and Aim

It is essential that healthcare providers display ethical behavior toward their patients. Despite development of codes of ethics for clinical practice, the occurrence of unethical behaviors toward patients is alarmingly high. The present study was conducted to identify the barriers to ethical treatment of patients in clinical environments.

Methods

Through systematic narrative review, the present study investigated the barriers to ethical treatment of patients. This study was carried out in line with Assessment of Multiple Systematic Reviews 2 and Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines.

Results

Ethical challenges in clinical environments can be classified into two categories: "organizational factors" and "personal factors." Organizational factors consist of three domains: managers and regulations, organizational environment, and human resources. Personal factors consist of two domains: factors related to patients and their families and factors related to care providers.

Conclusion

Research shows that encouraging healthcare teams to adopt ethical behaviors through education and having them persistently observe ethics in their clinical practice will not completely bridge the gap between theory and practice: it seems that the clinical environment, the personal characteristics of healthcare team members and patients, and the organizational values of the healthcare system pose the greatest barrier to bridging this gap. Accordingly, in addition to raising healthcare providers' awareness of the existing issues in clinical ethics, measures should be taken to improve organizational culture and atmosphere.

The ethical pathway of individuals with stroke-A follow-up study

AIM

To analyse the ethical pathway as perceived by individuals with stroke (IwS) in the first three post-stroke months. In the novel concept of ethical pathway, dignity, privacy, and autonomy are considered as dimensions of the ethical pathway while the pathway illustrates their potential change in the post-stroke time. Furthermore, the focus of interest was on whether the perceived realisation of values is associated with the life situational factors of symptoms diminishing functioning, social environment, and self-empowerment.

METHODOLOGICAL DESIGN AND JUSTIFICATION

A follow-up study with a descriptive correlational design was used to capture the changes in the perceived realisation of values.

ETHICAL ISSUES AND APPROVAL

The study followed the ethical principles of research involving human participants. The study was approved by the ethics committee of the university and one of the university hospitals following national standards. Permission to conduct the study was obtained from the university hospitals.

RESEARCH METHODS AND INSTRUMENT

Data were collected from IwS after the onset of stroke and 3 months post-stroke with the Ethical Pathway of Individuals with Stroke instrument and background questions and were analysed statistically.

RESULTS

Thirty-six participants completed the questionnaire at both measurement points. Wide variety in the ethical pathway was detected. IwS' perceived dignity decreased and autonomy increased. Privacy did not change significantly. Of the life situational factors, IwS perceived less symptoms diminishing functioning and stronger self-empowerment while social environment was perceived as rather stable. Only one association was detected between the dimensions of the ethical pathway and life situational factors: autonomy had a low negative correlation with social environment of health care professionals.

CONCLUSIONS AND STUDY LIMITATIONS

The results provide preliminary evidence of the dynamic nature of the ethical pathway. The ethical pathway was incompletely realised for most participants and requires special attention and improvement in health care. The sample size is small and the results are therefore not generalisable.

Reflections of nursing students on the care of the person's dignity at the end of life: A qualitative study

BACKGROUND

The education of nursing students not only implies transmitting knowledge and clinical skills, but also values, attitudes, and behaviours. In healthcare, it is considered essential to respect and preserve the dignity of people. This is even more important in palliative care, where the fragility of people makes them potentially vulnerable. There is limited knowledge regarding the conceptualization and experience of nursing students and human dignity in palliative care.

AIM

To describe how 5th-year nursing students conceptualise and experience human dignity, while caring for people with terminal illness.

DESIGN

Qualitative descriptive design, with thematic content analysis as per Graneheim and Lundman.

SETTING

A palliative care centre for people on low incomes with terminal illnesses which no longer respond to curative treatments.

PARTICIPANTS

A total of 11 fifth-year nursing students who completed their professional practice in a palliative care unit.

METHODS

Data collection was conducted through guided online reflections via reflective journaling between April and November 2020. The study protocol was reviewed and approved by the Scientific Ethical Committee within the educational institution (CEC2021065).

RESULTS

Four thematic categories were identified (1) Concept of dignity; (2) Dignity: an essential element in the relationship with others, (3) Instances when the dignity of the person is not considered; (4) The value of reflection on dignity in clinical practice.

CONCLUSION

Dignity is one of the main values recognized in the person. Dignity should be promoted in the education of future nursing professionals, particularly with people who are in the final stage of life, where fragility and vulnerability it is more palpable.

Beyond mere respect: new perspectives on dignity for healthcare workplace learning

Introduction

Although dignity in workplace learning in healthcare is gathering interest, we know little about stakeholders' conceptualizations in this area across professional groups. Dignity breaches in workplace learning are common, often with serious and long-lasting consequences for the affected. Conceptualizations shape behaviours and experiences. To prevent dignity violations in students' learning, it is thus important to understand stakeholders' understandings of the topic. This study therefore explores the dignity conceptualizations around workplace learning that students, placement educators and university staff hold across seven allied health professional groups.

Methods

Using a social constructionist perspective, we conducted individual and group narrative interviews (n = 51) with students, placement educators and university workplace learning staff from seven allied health professional groups. We used the 5-step Framework Analysis to explore and develop themes, identifying differences and similarities across stakeholder groups.

Results

We identified eight distinct, yet interrelated, dimensions of dignity from participants' narratives: dignity as respect, dignity as self-x (the various relationships we have with ourselves), dignity as feeling safe, dignity as understanding otherness, dignity as supporting others, dignity as equality, dignity as professionalism, and dignity as belonging. Dignity as respect was identified across all participants, although mutual respect and a culture of respect were only present in academic participants' talk. The remaining seven dimensions all present important factors extending our understanding of the construct of dignity.

Discussion

In line with existing research, our study identifies the absence of an unambiguous, positive conceptualization of dignity in workplace learning among stakeholders. It adds novelty in two ways: by identifying dignity dimensions that require informed action beyond respecting others, and by revealing a tension between dignity as professionalism and dignity as equality. We suggest revising existing dignity concepts in workplace learning to address this tension and to reinforce that active care, team integration and skilled support are all non-negotiable elements of dignified behaviour within workplace learning.

Perceived dignity is an unrecognized source of emotional distress in patients with rheumatic diseases: Results from the validation of the Mexican version of the Patient Dignity Inventory

INTRODUCTION

Dignity has rarely been explored in patients with rheumatic diseases (RMDs), which contrasts with patients´ observations that dignity is a relevant area for research focus. The study's primary objective was to adapt and validate the Mexican version of the Patient Dignity Inventory (PDI-Mx) in patients with RMDs, and to estimate the proportion of patients with distress related to perceived dignity (DPD) assessed with the PDI-Mx.

METHODS

This cross-sectional study was developed in 2 phases. Phase 1 consisted of pilot testing and questionnaire feasibility (n = 50 patients), PDI-Mx content validity (experts' agreement), construct validity (exploratory factor analysis), discriminant validity (Heterotrait-Monotrait correlations' rate [HTMT]), criterion validity (Spearman correlations) and PDI-Mx reliability with internal consistency (Cronbach's alpha) and test-retest (intra-class correlation coefficients [ICC]) in 220 additional outpatients (among whom 30 underwent test-retest). Phase 2 consisted of quantifying DPD (PDI-Mx cut-off ≥54.4) in 290 outpatients with RMDs.

RESULTS

Overall, patients were representative of typical outpatients with RMDs from a National tertiary care level center. The 25-item PDI-Mx was found feasible, valid (experts' agreement ≥82%; a 4-factor structure accounted for 68.7% of the total variance; HTMT = 0.608; the strength of the correlations was moderate to high between the PDI-Mx, the Depression, Anxiety, and Stress scale dimensions scores, and the Health Assessment Questionnaire Disability Index score) and reliable (Cronbach's ɑ = 0.962, ICC = 0.939 [95%CI = 0.913-0.961]). DPD was present in 78 patients (26.9%).

CONCLUSIONS

The PDI-Mx questionnaire showed good psychometric properties for assessing DPD in our population. Perceived dignity in patients with RMDs might be an unrecognized source of emotional distress.

A qualitative meta-synthesis of patient dignity from the perspective of caregivers

BACKGROUND

The concept of dignity remains disputed, with most studies defining dignity based on its external dimension. Although its inherent dimension is a rooted attribute of dignity, it has received scarce attention. Caregivers have close relationships with their care recipients and thus may perceive their patient's inherent as well as external dimensions of dignity. Therefore, in this study, we aimed to identify, analyze, and synthesize evidence on human dignity presented in qualitative studies from the perspective of caregivers to gain a deeper comprehension of the preservation of patients' dignity by their caregivers.

METHODS

A qualitative meta-synthesis was performed by searching for relevant qualitative literature via systematic electronic databases, including MEDLINE, PsycINFO, ProQuest, CINAHL, Embase, Health Source, and Web of Science, from inception to March 15, 2022.

RESULTS

Nine studies were eligible for inclusion and included in the meta-synthesis. Three overarching categories were identified: integrated person, "rootedness" and "growth" atmosphere, and balanced state.

CONCLUSIONS

Dignity is rooted in its inherent dimension, whereas its external dimension may promote individual dignity. Furthermore, caregiver-patient relationships may be a key factor linking the inherent dimension of dignity with its external dimension. Thus, further studies should focus on the mechanism of relationships in preserving dignity.

The relationship between futile medical care and respect for patient dignity: a cross-sectional study

BACKGROUND

Various technologies and interventions at intensive care units can lead to futile medical care for critically ill patients. Futile medical care increases patients' suffering and costs, reduces nurses' attention to patients, and thus affects patients' dignity. This study aimed to investigate the relationship between futile medical care and respect for patient dignity from the perspective of nurses working in intensive care units of medical centers.

METHODS

We conducted this cross-sectional study on 160 nurses working in intensive care units in Kerman. We measured nurses' perceptions of futile care and respect for patient dignity using futile care and patients' dignity questionnaire. We used linear regression model to investigate the effect of futile care on the patient dignity.

RESULTS

The mean severity and frequency of futile care in the intensive care unit were 57.2 ± 14.3 and 54.1 ± 19, respectively. Respect for patient privacy and respectful communication were desirable, while patients' autonomy was not desirable. We found a significant direct relationship (p = 0.006) between the severity of futile care and respect for patient dignity, with every unit increase in futile care, a 0.01 unit increase was available in patient dignity. We observed no significant association between frequency of futile care and dignity.

CONCLUSION

Our results indicated the effect of futile care on nurses' respect for patient dignity. Nurses must raise their awareness through participating in training classes and specialized workshops to improve the level of care, the quality of care, and respect for patient dignity.

Self-report instruments for measuring patient dignity: A psychometric systematic review

AIMS

To synthesize and evaluate the psychometric properties of self-report instruments that measure patient dignity.

DESIGN

A psychometric systematic review.

DATA SOURCES

A comprehensive search of studies published from inception until February 17, 2022, was performed using PubMed, Embase, CINAHL, Web of Science, and Scopus.

REVIEW METHODS

The methodological quality of the psychometric studies was evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

RESULTS

Eleven self-report instruments that evaluate dignity were identified. For most instruments, psychometric properties, including reliability, cross-cultural validity, responsiveness, and measurement error, had not been adequately examined. The Patient Dignity Inventory (PDI), the Jacelon's Attributed Dignity Scale (JADS), and the Inpatient Dignity Scale (IPDS) had acceptable content validity, structure validity, and internal consistency to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care.

CONCLUSION

The PDI, the JADS, and the IPDS are recommended for future clinical practice and research to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. Early identification of patients' dignity-related problems in nursing care can prevent negative health outcomes and help develop a timely intervention to promote patients' health and recovery.

IMPACT

Given that the psychometric properties of the existing self-report dignity instruments have not been systematically assessed, the present review utilized comprehensive methods according to COSMIN to evaluate and determine the most appropriate measure for research and practice. The PDI, the JADS, and the IPDS demonstrated satisfactory psychometric properties and are, thus, recommended for clinical and research applications. Nursing professionals can employ these instruments to assess and promptly identify dignity issues among both young and older adults in hospitals and communities.

A Qualitative Systematic Review of Access to Substance Use Disorder Care in the United States Criminal Justice System

BACKGROUND

The majority of patients with a substance use disorder (SUD) in the United States do not receive evidence-based treatment. Research has also demonstrated challenges to accessing SUD care in the US criminal justice system. We conducted a systematic review of access to SUD care in the US criminal justice system.

METHODS

We searched for comprehensive qualitative studies in multiple databases through April 2021, and two researchers reviewed 6858 studies using pre-selected inclusion criteria. Once eligibility was determined, themes were extracted from the data. This review provides a thematic overview of the US qualitative studies to inform future research-based interventions. This review was conducted in compliance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA).

RESULTS

There were 6858 unique abstract results identified for review, and seven qualitative studies met the inclusion criteria. Two themes were identified from these results: (1) managing withdrawal from medication-assisted treatment, and (2) facilitators and barriers to treatment programs in the criminal justice system.

CONCLUSIONS

Qualitative research evaluating access to SUD care in the US criminal justice system varied, with some interventions reported not rooted in evidence-based medicine. An opportunity may exist to develop best practices to ensure evidence-based treatment for SUDs is delivered to patients who need it in the US criminal justice system.