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Martineau I, Hamrouni N, Hébert J. From ontological to relational: A scoping review of conceptions of dignity invoked in deliberations on medically assisted death. BMC Med Ethics 2024; 25:96. [PMID: 39267021 DOI: 10.1186/s12910-024-01095-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 08/28/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Dignity is omnipresent in Western ethics, but it also provokes dissension and controversy. One of the most striking examples is the debate on medically assisted death, where dignity is invoked to support antagonistic positions. While some authors conclude that the concept is useless as an ethical reference, many others invite us to deepen our analysis from a multidimensional perspective, to enrich it and make it useful. This scoping study is intended to provide an overview of the different conceptions of dignity used in the assisted dying debate, to better grasp the multiple facets of the concept. METHODS The Joanna Briggs Institute's JBI Manual for Evidence Synthesis guided the scoping review. Key words were based on the researchers' expertise and were used to identify relevant literature in French and English. Eleven databases covering the last six decades were consulted. Initially, 2,071 references were found in the databases. After excluding duplicates, screening titles, abstracts, and full texts, and after a specific literature search on the concept of relational dignity, 156 papers were found to match the identified inclusion criteria. RESULTS The literature highlights the stark confrontation between two dominant conceptions of dignity: ontological and autonomist. However, a lesser-known conceptualization of dignity integrates these two perspectives, underlining the relational and social dimensions of dignity. As a result, dignity emerges as a dynamic, experiential, and dialogical concept, that modulates itself according to circumstances. This raises the possibility of breaking through the binary debate and questioning the current frameworks that define dignity. CONCLUSIONS This multidimensional conceptualization of dignity could lead to a more complete and nuanced understanding of the concept, as well as open richer normative horizons regarding the issue of medically assisted death.
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Affiliation(s)
- Isabelle Martineau
- Philosophy and Arts Department, University of Quebec at Trois-Rivieres, Trois-Rivieres, QC, Canada.
| | - Naïma Hamrouni
- Philosophy and Arts Department, University of Quebec at Trois-Rivieres, Trois-Rivieres, QC, Canada
| | - Johanne Hébert
- Department of Health Sciences, University of Quebec at Rimouski, Levis, QC, Canada
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Bahador RS, Dastyar N, Ahmadidarrehsima S, Rafati S, Rafati F. The patients' lived experiences with equitable nursing care. Nurs Ethics 2024; 31:859-874. [PMID: 37867260 DOI: 10.1177/09697330231209293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Equitable care is a fundamental value in the nursing profession. Healthcare workers have both a moral and professional duty to ensure that they do not discriminate. AIM This study aimed to explore how patients perceive equitable nursing care. RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT This descriptive phenomenological qualitative research study used purposeful sampling to select 17 patients from various departments of a general hospital in southern Iran. The participants were then interviewed using a semi-structured in-depth interview format, which aimed to delve into their experiences with equitable nursing care. The collected data were analyzed using Colaizzi's seven-step method and MAXQDA20 software. ETHICAL CONSIDERATIONS Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Ethics Committee of Jiroft University of Medical Sciences. FINDINGS The data analysis of the study identified three main themes and six subthemes that were related to the experiences of patients with equitable nursing care. The first theme, equitable care, encompassed subthemes such as nurses' dedicated efforts to facilitate patient recovery and adherence to ethical behavior. The second theme, unconscious causes of inequitable nursing care, included subthemes such as unintentional discrimination stemming from organizational constraints and unconscious biases resulting from a lack of knowledge and skills. The third theme, discriminatory care, comprised subthemes such as deliberate discrimination based on personal traits and selective discrimination. CONCLUSION The study findings indicate that achieving equitable nursing care requires a multifaceted approach. This includes effective hospital management, organizational reforms, and regulatory enhancements. Additionally, it is crucial to pay close attention to the needs of patients, enhance nurses' theoretical and practical skills in providing equitable care, fostering a culture of equality within healthcare settings, and consider the personality dimensions and moral characteristics of nurses.
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Affiliation(s)
- Raziyeh Sadat Bahador
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Neda Dastyar
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Sudabeh Ahmadidarrehsima
- Department of Nursing, Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Shideh Rafati
- Social Factors in Health Promotion Research Center, Hormozgan Health Research Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Foozieh Rafati
- Nursing and Midwifery School, Jiroft University of Medical Sciences, Jiroft, Iran
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Franco H, Caldeira S, Nunes L. Explaining the process of learning about dignity by undergraduate nursing students: A grounded theory study. Nurs Ethics 2024:9697330241265409. [PMID: 39047054 DOI: 10.1177/09697330241265409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
BACKGROUND The learning process about dignity and how undergraduate nursing students experience and use this ethical knowledge is an under-represented field in nursing research. To overcome the lack of conceptual clarity, it is important to understand what processes and dimensions students develop to support this learning outcome. OBJECTIVE This study aimed to explain the process of learning about dignity by undergraduate nursing students. RESEARCH DESIGN AND METHODS A qualitative study was conducted using the grounded theory method. PARTICIPANTS AND RESEARCH CONTEXT Data was collected through free reports and in-depth semi-structured interviews with 20 participants. A focus group was held for the selective coding. Sampling began purposefully and evolved into theoretical. Reflective and theoretical memos were generated from the data collection and constant comparison. Data analysis was performed using qualitative data analysis software using Corbin and Strauss' method. ETHICAL CONSIDERATIONS The research was approved by a specialized research ethics committee from a Health School. FINDINGS The process of learning about dignity by undergraduate nursing students revealed 'recognition of dignity' as the core category, supported by five main categories: 'proto-conscience of dignity', 'pathway to nursing', 'consciousness of dignity', 'ways of learning', and 'becoming capable'. These categories illustrate the processes and dimensions involved in nursing students' concept translation of dignity learning, allowing a theory to emerge. CONCLUSIONS The 'Recognition of Dignity' theory aims to contribute to developing educational, training, and supervision processes for nursing programs. It seeks to enhance the ethical and moral development of undergraduate nursing students by helping them understand the concept of dignity and its fundamental importance in nursing.
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Affiliation(s)
| | | | - Lucília Nunes
- Instituto Politécnico de Setúbal; Comprehensive Health Research Centre [CHRC]
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Nabirye AK, Munabi IG, Mubuuke AG, Kiguli S. Perceptions and attitudes of Nursing students towards end-of-life care: a Phenomenological Study at a tertiary hospital in Uganda. RESEARCH SQUARE 2024:rs.3.rs-4594723. [PMID: 39108492 PMCID: PMC11302713 DOI: 10.21203/rs.3.rs-4594723/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
Introduction Clinical practice is an important part of nursing education as it helps nursing students transition into competent health professionals who can provide quality services. However, research studies convey it as a significant stressor for nursing students when they are obliged to end of life during clinical practice. The perceptions of nursing students on caring for end-of-life care have not been exhaustively studied in the Ugandan context. This study was conducted to understand nursing students' perceptions of end-of-life care during clinical practice at Mulago Hospital. Methods It was a qualitative study with a phenomenology method carried out among 15 nursing students from Makerere University who were assigned to Mulago Hospital for clinical practice. Data was gathered using an in-depth interview guide, audio was captured, and transcriptions were analyzed thematically using Atlas.ti version 6. Results Three main themes emerged from the data; two themes on perceptions were (i) reactions when nursing students were informed about the physical process of caring for dying patients and (ii) how student ideas about the care changed during the process of caring for end-of-life. The third theme was the attitude of students towards patients when offering end of life care. participants described their reactions as chaotic, devastated and scared about their first-time encounter with caring for dying patients, the physical process also required preparation to handle the situation and understanding, and for positive personal values felt respected, appreciated, trusted and valued when informed about the physical process of caring for the end-of-life. Conclusion In this study, nursing students held divisive attitudes on care for dying patients. However, nursing students appear to transition from unfavorable impressions of the process and encounter of caring for dying patients to positive perceptions during the actual caregiving experience. Despite their differing perspectives on caring for dying patients, students were typically empathic towards them.
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Grassi L, Nanni MG, Riba M, Folesani F. Dignity in Medicine: Definition, Assessment and Therapy. Curr Psychiatry Rep 2024; 26:273-293. [PMID: 38809393 PMCID: PMC11147872 DOI: 10.1007/s11920-024-01506-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions. RECENT FINDINGS We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient's wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.
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Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy
| | - Michelle Riba
- Department of Psychiatry, and PsychOncology Program, University of Michigan Rogel Cancer Center, Ann Arbor, MI, USA
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64°, 44121, Ferrara, Italy.
- Integrated Department of Mental Health, University Hospital Psychiatry Unit, Ferrara, Italy.
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Bovero A, Botto R, Mellano E, Gottardo F, Berchialla P, Carletto S, Geminiani GC. Loss of Personal Autonomy and Dignity-Related Distress in End-Of-Life Cancer Patients. Am J Hosp Palliat Care 2024; 41:179-186. [PMID: 36974952 DOI: 10.1177/10499091231166373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
The objective of this cross-sectional study is to investigate Dignity-Related Loss of Personal Autonomy (DR-LPA) intended as loss of relational independence causing dignity-related distress. Moreover, it analyzes its possible relationships with demoralization, spirituality, quality of life, hope, and coping styles in a sample composed of 207 end-of-life cancer patients. These variables have been assessed through the following rating scales: Patient Dignity Inventory - Italian version, Demoralization Scale - Italian version, Functional Assessment of Cancer Therapy Scale - General Measure, Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being, Brief Coping Orientation to Problem Experienced, and Herth Hope Index. The results have shown that most of the DR-LPA items were considered a problem by most patients. Functional, social, emotional, and spiritual wellbeing, disheartenment, age, and sex emerged as significant predictors of DR-LPA. In conclusion, this study showed that DR-LPA can be a relevant concern for patients at the end-of-life and for this reason it becomes necessary for psychosocial provides to consider it to deliver better dignity conserving care.
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Affiliation(s)
- Andrea Bovero
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Rossana Botto
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Elena Mellano
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Francesco Gottardo
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Sara Carletto
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
| | - Giuliano C Geminiani
- Clinical Psychology Unit, Department of Neuroscience, Hospital 'Città della Salute e della Scienza', University of Turin, Turin, Italy
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Sandvik RKNM, Husebo BS, Selbaek G, Strand G, Patrascu M, Mustafa M, Bergh S. Oral symptoms in dying nursing home patients. Results from the prospective REDIC study. BMC Oral Health 2024; 24:129. [PMID: 38273300 PMCID: PMC10811859 DOI: 10.1186/s12903-024-03901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 01/15/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The mouth is a central organ for communication and fluid intake, also for dying nursing home patients. This study describes the prevalence and severity of oral symptoms from nursing home admission until the day of perceived dying and the day of death. METHODS A prospective, longitudinal cohort study including 696 patients who were admitted to 47 Norwegian nursing homes in 35 municipalities. During the first year of their stay, 189 died (27%), of whom 82 participants were assessed on the day they were perceived as dying and 134 on the day of death. Mouth care, nutrition, and bedsores were assessed with the Residents' Assessment Instrument for nursing homes (RAI-NH) and palliative care (RAI-PC). Pain intensity was assessed with the Mobilization-Observation-Behaviour-Intensity-Dementia-2 Pain Scale (MOBID-2). RESULTS The proportion of patients with ≥ 6 oral symptoms increased from 16% when perceived as dying to 20% on the day of death (P = 0.001). On the day of death, xerostomia (66%), dysphagia (59%), and mastication problems (50%) were the most frequently observed oral symptoms. Only 16% received mouth care every hour and 12% were in pain during this procedure. Compared to people without dementia, those with a diagnosis of dementia at admission (N = 112, 86%) had xerostomia and mastication problems more frequently (50% vs. 73%; 32% vs. 56% (P = 0.038), respectively) on the day of death. CONCLUSIONS The high extent of oral symptoms such as xerostomia, dysphagia, and mastication problems underline the need for systematic assessment and improved oral palliative care for dying nursing home patients with dementia. TRIAL REGISTRATION Clinicaltrials.gov NCT01920100 08/08/2013. First submission to BMC oral 15/03/2023.
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Affiliation(s)
- Reidun K N M Sandvik
- Department of Health and Caring sciences, Faculty of Health and Social Sciences, Western University of Applied Sciences, Haukelandsbakken 15, Bergen, N-5009, Norway.
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Neuro-SysMed Center, University of Bergen, Bergen, Norway
| | - Geir Selbaek
- The Norwegian National Centre for Ageing and Health (Ageing and Health), P.O. box 2136, Tønsberg, 3103, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Gunhild Strand
- Department of Clinical Dentistry, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Monica Patrascu
- Department of Global Public Health and Primary Care, Centre for Elderly and Nursing Home Medicine, University of Bergen, Bergen, Norway
- Department of Global Public Health and Primary Care, Neuro-SysMed Center, University of Bergen, Bergen, Norway
- Department of Automatic Control and System Engineering, Complex Systems Laboratory, University Politehnica of Bucharest, Bucharest, Romania
| | - Manal Mustafa
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Sverre Bergh
- The Research Centre for Age Related Functional Decline and Diseases, Innlandet Hospital Trust, P.O. box 68, Ottestad, 2313, Norway
- The Norwegian National Centre for Ageing and Health (Ageing and Health), P.O. box 2136, Tønsberg, 3103, Norway
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Demirbağ S, Akan DD, Baysal E. On Between Death and Life: Intensive Care Nurses. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231198575. [PMID: 37605481 DOI: 10.1177/00302228231198575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
The aim of this study is to explore intensive care nurses' perceptions and experiences about death and dying patient. This study included 15 nurses from a university hospital's intensive care units (paediatric and internal medicine). Data were collected through face-to-face, in-depth and individual interviews using the "Nurse Information Form" and "Semi-Structured Interview Form". Six major themes and sixteen sub-themes were identified on the nurses' perceptions and experiences with death. After the nurses described their perceptions of death, their responses, approaches, coping mechanisms, and effects on the dead and dying patient in care and factors affecting perceptions of death were defined. Our findings suggest that nurses, particularly those working in intensive care, should be educated/trained on death, and dying patient care. Thus, orderly psychological support should be provided to nurses.
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Affiliation(s)
- Selin Demirbağ
- Department of Child Health and Disease Nursing, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey
| | - Dilan Deniz Akan
- Department of Internal Medicine Nursing, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey
| | - Ebru Baysal
- Department of Fundamentals Nursing, Faculty of Health Sciences, Manisa Celal Bayar University, Manisa, Turkey
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Bilgiç Ş. The Meaning of Death for Nursing Students and Their Attitudes Toward Dignified Death Principles. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:1388-1401. [PMID: 33858235 DOI: 10.1177/00302228211009754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study aims to determine the meaning of death for nursing students and their attitudes toward dignified death principles. The descriptive study was conducted with nursing students studying at a state university in Turkey. The data were collected using the Personal Information Form, the Personal Meanings of Death Scale (PMDS), and the Assessment Scale of Attitudes toward the Principles of Dying with Dignity (ASAPDD). A positive and low-level significant relationship was determined between the students' age and the scores for the PMDS subdimensions and the ASAPDD. It was found that the students had positive perceptions of death and adopted the principles of a dignified death. It was determined that an increase in the students' perceptions of death positively affected their adoption of the principles of a dignified death.
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Affiliation(s)
- Şebnem Bilgiç
- Fundamentals of Nursing Department, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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Bigdeli Shamloo MB, Elahi N, Zarea K. Lived Experience of Caring for Dying Muslim Patients in Emergency Room: A Phenomenological Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231153254. [PMID: 36775852 DOI: 10.1177/00302228231153254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Death is a natural part of life, which mostly occurs in the ER. This study described the meaning of nurses' lived experience of caring for critical and dying patients in the ERs. In this qualitative study, 13 nurses who was purposefully selected. Data were collected using in-depth individual interviews. Data analysis used van Manen's hermeneutic phenomenological approach. The experiences of caring for the dying patient were divided into two parts: experiences in patients with acute and chronic problems. In patients with acute problems, four themes were extracted: fight to the death, no time for palliative and spiritual care, lacking support for the family, no privacy for peaceful death. In patients with acute problems, four themes were extracted: Facilitating a peaceful death, Allocating time for palliative and spiritual care, support for the family, Attention to privacy. Therefore, attention should be paid to the fields of care and its inadequacies.
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Affiliation(s)
- Marzieh Beigom Bigdeli Shamloo
- Clinical Research Development Unit, Ganjavian Hospital, Dezful University Medical Sciences, Dezful, Iran
- Student Research Committee, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nasrin Elahi
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Kourosh Zarea
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Martí-García C, Fernández-Férez A, Fernández-Sola C, Pérez-Rodríguez R, Esteban-Burgos AA, Hernández-Padilla JM, Granero-Molina J. Patients' experiences and perceptions of dignity in end-of-life care in emergency departments: A qualitative study. J Adv Nurs 2023; 79:269-280. [PMID: 36062865 PMCID: PMC10087743 DOI: 10.1111/jan.15432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/16/2022] [Accepted: 08/20/2022] [Indexed: 12/15/2022]
Abstract
AIMS To explore and understand the experiences of patients with advanced illness in relation to dignity during end-of-life care in emergency departments. DESIGN Qualitative study based on Gadamer's hermeneutics. METHODS Between September 2019 and February 2020, 16 in-depth interviews were carried out with advanced illness patients who attended emergency departments. The participants were informed priorly and signed informed consent. The data were analysed using an inductive strategy for finding emerging themes. The Consolidated Criteria for Reporting Qualitative Research was used for writing the study's report. RESULTS In the data analysis process, two main themes emerged that glean the experiences of patients in relation to dignity during end-of-life care in emergency departments. 'Dignity as an individual's attribute' and 'Acting with dignity: Dignity as a behavioural attribute'. CONCLUSION Patient dignity in end-of-life care is centred around the principle of control (of oneself, one's death and one's emotions). The strategies required for patients to preserve their dignity can be somewhat incompatible with the dynamics and objectives of healthcare professionals who work in emergency departments. IMPACT STATEMENT The dignity of patients with advanced illness who attend emergency departments is a relevant issue that merits being addressed from the patients' perspective. Participants have identified that dignity is a way of being and behaving in the face of illness. Emergency departments need to respect end-of-life patients' desires by supporting and accompanying them, avoiding therapeutic obstinacy. We recommend care to be centred on patients' well-being, to respect their autonomy and decision-making processes, and to allow prompt referrals to palliative care services. PATIENT OR PUBLIC CONTRIBUTION Managers from the Emergency Departments participated in the study design and patients' recruitment. Patients' relatives were informed about the study's aim, and they contributed to the development of the interview protocol.
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Affiliation(s)
| | | | - Cayetano Fernández-Sola
- Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | | | | | | | - José Granero-Molina
- Department of Nursing Science, Physiotherapy and Medicine, University of Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Santiago, Chile
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Laranjeira C, Dourado M. "Dignity as a Small Candle Flame That Doesn't Go Out!": An Interpretative Phenomenological Study with Patients Living with Advanced Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17029. [PMID: 36554911 PMCID: PMC9778832 DOI: 10.3390/ijerph192417029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Long-term illness, such as chronic obstructive pulmonary disease (COPD), can expose people to existential suffering that threatens their dignity. This qualitative study explored the lived experiences of patients with advanced COPD in relation to dignity. An interpretative phenomenological approach based on lifeworld existentials was conducted to explore and understand the world of the lived experience. Twenty individuals with advanced COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages III and IV) were selected using a purposive sampling strategy. In-depth interviews were used to collect data, which were then analysed using Van Manen's phenomenology of practice. The existential experience of dignity was understood, in essence, as "a small candle flame that doesn't go out!". Four intertwined constituents illuminated the phenomenon: "Lived body-balancing between sick body and willingness to continue"; "Lived relations-balancing between self-control and belongingness"; "Lived Time-balancing between past, present and a limited future"; and "Lived space-balancing between safe places and non-compassionate places". This study explains how existential life phenomena are experienced during the final phases of the COPD trajectory and provides ethical awareness of how dignity is lived. More research is needed to investigate innovative approaches to manage complex care in advanced COPD, in order to assist patients in discovering their inner resources to develop and promote dignity.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena–Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention (RECI I&D), Piaget Institute, 3515-776 Viseu, Portugal
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
| | - Marília Dourado
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, R. Larga, 3004-504 Coimbra, Portugal
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Rangel JC, Holmes D, Perron A, Miller GE. Biopower under a state of exception: stories of dying and grieving alone during COVID-19 emergency measures. MEDICAL HUMANITIES 2022; 48:471-479. [PMID: 35470156 PMCID: PMC9072775 DOI: 10.1136/medhum-2021-012255] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
During the COVID-19 pandemic, restrictions for visitors and caregivers in healthcare settings and long-term care (LTC) facilities were enacted in the larger context of public health policies that included physical distancing and shelter-in-place orders. Older persons residing in LTC facilities constituted over half of the mortality statistics across Canada during the first wave of the COVID-19 pandemic. Using the poststructuralist work of Agamben, Foucault and Mbembe we conducted a thematic analysis on news reports. The extracts of media stories presented in our paper suggest that the scholarship on (bio)power and necropolitics is central for understanding the ways the COVID-19 crisis reveals the pragmatic priorities-and the 'health' and political values-that undergird the moral imagination of the public, including the educated classes of advanced Western democracies. Our critical analysis shows that by isolating individuals who were sick, fragile, and biologically and socially vulnerable, undifferentiated population management policies like social distancing, when piled on the structural weakness of health systems, reproduced inequities and risk for those in need of medical care, advocacy, and social companionship in acute moments of illness, death and grief. Considering the unprecedented deployment of governmental power via public health interventions based on social regulation to protect the population during the crisis-how can we understand so much death and suffering among the most vulnerable?
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Affiliation(s)
- J Cristian Rangel
- DIME, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Dave Holmes
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Amélie Perron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Granville E Miller
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
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14
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Luneckaitė Ž, Riklikienė O. Dignity at the end of life: from philosophy to health care practice - Lithuanian case. New Bioeth 2022; 40:28-48. [PMID: 35857277 DOI: 10.1007/s40592-022-00160-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 05/09/2022] [Accepted: 06/09/2022] [Indexed: 01/11/2023]
Abstract
Regulation and clinical practices regarding end of human life care differ among the nations and countries. These differences reflect the history of the development of state health systems, different societal values, and different understandings of dignity and what it means to protect or respect dignity. The result is variation in the ethical, legal, and practical approaches to end-of-life issues. The article analyzes the diversity of strategies to strengthen dignity at the end of life of terminally ill patients and to highlight the legal preconditions and limitations for implementing these strategies in independent Lithuania, as a former state of the Soviet Union. It is based on the critical analysis of philosophical literature, legal national and international documents and scientific evidence related to the issue. The author argues that the legal system in Lithuania is not sufficient to ensure the patient's dignity at the end of life and remains far behind other Western European countries. Legal regulations in Lithuania do not guarantee the right of the patient to express his or her will regarding the future treatment, including the refusal of resuscitation, do not regulate the termination of burdensome, non-viable and meaningless treatment that is undesired by the patient, and limit the accessibility of palliative care with its necessary quality and comfort.
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Affiliation(s)
- Žydrūnė Luneckaitė
- Department of Bioethics, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, A.Mickevičiaus str. 9, LT-44307, Kaunas, Lithuania
| | - Olga Riklikienė
- Faculty of Nursing, Nursing Clinic, Medical Academy, Lithuanian University of Health Sciences, A.Mickevičiaus str. 9, LT-44307, Kaunas, Lithuania.
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15
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Morgan J, Gazarian P. A good death: A synthesis review of concept analyses studies. Collegian 2022. [DOI: 10.1016/j.colegn.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Liang A, Gao C, Xu W, Shen Y, Liu C, Lu Z, Yang Y. Individual factors in dignified care: a cross-sectional study of critical care nurses. J Nurs Manag 2022; 30:3286-3294. [PMID: 35969503 DOI: 10.1111/jonm.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/29/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
AIM To determine the level of dignified care provided by critical care nurses and to explore the associated individual factors. BACKGROUND Dignity is a fundamental right of human beings. Critically ill patients are dependent on nurses. Their need for respect and dignity is liable to be neglected in intensive care unit settings. Both critically ill survivors and dying patients suffer mental anguish due to loss of dignity. METHOD This was a cross-sectional study of 526 critical care nurses working at intensive care units for adults in Zhejiang Province, China. Data were collected from February 2021 to May 2021 using the Intensive Care Unit Dignified Care Questionnaire, Wong and Law Emotional Intelligence Scale, Jefferson Scale of Empathy-Health Professional, Nurses Professional Values Scale-Revised. RESULTS The total score of dignified care was 67.37 (8.83), with the standard score as 74.07 (12.99). Participants who performed poorly in absolute and relative dignity accounted for 8.4% and 31.2% of the total sample, respectively. Emotional intelligence (β = 0.379, p < .001), empathy (β = 0.319, p < .001), professional values (β = 0.147, p < .001), age (β = 0.075, p = .003), and training in dignified care (β = 0.074, p = .010) were associated with dignified care, explaining 67.6% of the variance. CONCLUSION The average level of participants' behaviors of maintaining patient dignity was medium. Critical care nurses need to improve their ability to maintain relative dignity of patients. Emotional intelligence, empathy, professional values, age level, and training in dignified care were predictors of dignified care. IMPLICATIONS FOR NURSING MANAGEMENT Improving emotional intelligence, empathy, and professional values of critical care nurses and training them (especially less experienced nurses) will enhance their ability in dignified care. This study provides a novel perspective to help nursing managers develop interventions to promote humanized care in the intensive care unit.
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Affiliation(s)
- Andong Liang
- School of nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, China
| | - Chenchen Gao
- School of nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, China
| | - Wenxian Xu
- School of nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, China
| | - Yucong Shen
- School of nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, China
| | - Chuanchuan Liu
- Department of Orthopedics, the First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, China
| | - Zhongqiu Lu
- Emergency Department, the First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, China
| | - Yeqin Yang
- School of nursing, Wenzhou Medical University, University Town, Chashan, Wenzhou, Zhejiang, China
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17
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Chua KZY, Quah ELY, Lim YX, Goh CK, Lim J, Wan DWJ, Ong SM, Chong CS, Yeo KZG, Goh LSH, See RM, Lee ASI, Ong YT, Chiam M, Ong EK, Zhou JX, Lim C, Ong SYK, Krishna L. A systematic scoping review on patients' perceptions of dignity. Palliat Care 2022; 21:118. [PMID: 35787278 PMCID: PMC9251939 DOI: 10.1186/s12904-022-01004-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022] Open
Abstract
Background A socioculturally appropriate appreciation of dignity is pivotal to the effective provision of care for dying patients. Yet concepts of dignity remain poorly defined. To address this gap in understanding and enhance dignity conserving end-of-life care, a review of current concepts of dignity is proposed. Methods To address its primary research question “How do patients conceive the concept of dignity at the end of life?”, this review appraises regnant concepts and influences of dignity, and evaluates current dignity conserving practices. To enhance accountability, transparency and reproducibility, this review employs the Ring Theory of Personhood (RToP) as its theoretical lens to guide a Systematic Evidence Based Approach guided Systematic Scoping Review (SSR in SEBA) of patient perspectives of dignity. Three independent teams of reviewers independently analysed included articles from a structured search of PubMed, Embase, PsycINFO, Scopus, CINAHL and Cochrane Databases using thematic and content analyses. The themes and categories identified were compared and combined using the Funnelling Process to create domains that guide the discussion that follows. Results Seventy-eight thousand five hundred seventy-five abstracts were identified, 645 articles were reviewed, and 127 articles were included. The three domains identified were definitions of dignity, influences upon perceptions of dignity, and dignity conserving care. Conclusions This SSR in SEBA affirms the notion that dignity is intimately entwined with self-concepts of personhood and that effective dignity conserving measures at the end of life must be guided by the patient’s concept of dignity. This SSR in SEBA posits that such personalised culturally sensitive, and timely support of patients, their family and loved ones may be possible through the early and longitudinal application of a RToP based tool. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01004-4.
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Affiliation(s)
- Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Xue Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Jieyu Lim
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Darius Wei Jun Wan
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Simone Meiqi Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Chi Sum Chong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Kennan Zhi Guang Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Laura Shih Hui Goh
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Ray Meng See
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore.,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Min Chiam
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Jamie Xuelian Zhou
- Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Simon Yew Kuang Ong
- Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore.,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.,Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
| | - Lalit Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, 1E Kent Ridge Road, Level 11, Singapore, 119228, Singapore. .,Division of Supportive and Palliative Care, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Division of Cancer Education, 11 Hospital Crescent, National Cancer Centre, Singapore, 169610, Singapore. .,Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore. .,Academic Palliative Care Unit, United Kingdom Cancer Research Centre, University of Liverpool, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK. .,Centre of Biomedical Ethics, National University of Singapore, 21 Lower Kent Ridge Rd, Singapore, 119077, Singapore. .,The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
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18
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Liang A, Xu W, Shen Y, Yang Y, Hu Q, Xu Z, Pan P, Lu Z. Intensive care unit dignified care: Development and validation of a questionnaire. Nurs Ethics 2022; 29:1683-1696. [PMID: 35730540 DOI: 10.1177/09697330221096777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Patient dignity is sometimes neglected in intensive care unit (ICU) settings, which may potentially cause psychological harm to critically ill patients. However, no instrument has been specifically developed to evaluate the behaviors of dignified care among critical care nurses. AIM This study aimed to develop and evaluate ICU Dignified Care Questionnaire (IDCQ) for measurement of self-assessed dignity-conserving behaviors of critical care nurses during care. METHODS The instrument was developed in 3 phases. Phase 1: item generation; phase 2: a two-round Delphi survey and a readability pilot study; phase 3: cross-sectional survey with model estimation. The questionnaire was evaluated by item analysis, exploratory and confirmatory factor analysis, assessment of internal consistency reliability, and test-retest reliability. The investigation was conducted using a convenience sample of 392 critical care nurses from 6 cities in Zhejiang Province, China, of which 30 participated in the test-retest reliability survey 2 weeks later. ETHICAL CONSIDERATIONS The study was approved by ethics committee. All participants provided written informed consent before the survey. The questionnaire survey was anonymous. RESULTS The results showed acceptable reliability and validity of the IDCQ. The 17-item final version questionnaire was divided into 2 dimensions: absolute dignity and relative dignity. These two factors accounted for 62.804% of the total variance, and model fitting results were acceptable. The Cronbach's alpha coefficient of the questionnaire was 0.94, and the test-retest intraclass correlation coefficient (ICC) was 0.88 after 2 weeks. CONCLUSIONS This study developed a brief and reliable instrument (IDCQ) to assess dignified care in ICU nursing. It can help critical care nurses identify their behaviors in maintaining patient dignity and discover their deficiencies. It may also serve as a clinical nursing management tool to help reduce patient disrespect experience in ICU.
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Affiliation(s)
- Andong Liang
- School of Nursing, 26453Wenzhou Medical University, Wenzhou, China
| | - Wenxian Xu
- School of Nursing, 26453Wenzhou Medical University, Wenzhou, China
| | - Yucong Shen
- School of Nursing, 26453Wenzhou Medical University, Wenzhou, China
| | - Yeqin Yang
- School of Nursing, 26453Wenzhou Medical University, Wenzhou, China
| | - Qiongshuang Hu
- Department of Neurosurgery, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhenzhen Xu
- Department of Gynecology, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peipei Pan
- Department of Cardiovascular Medicine, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhongqiu Lu
- Emergency Department, 89657The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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19
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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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20
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Bravo G, Arcand M, Trottier L. L’aide médicale à mourir pour les personnes atteintes d’un trouble neurocognitif majeur : analyse des commentaires de participants à une enquête. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1084450ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nous avons récemment réalisé une enquête postale panquébécoise pour connaître les attitudes de divers groupes face à l’idée d’étendre l’aide médicale à mourir (AMM) à des personnes en situation d’inaptitude. Nous présentons ici les résultats d’analyses qualitatives des commentaires laissés par les répondants à la fin du questionnaire. Celui-ci avait été posté à quatre groupes cibles : des aînés de 65 ans ou plus (n=621), des proches aidants de personnes atteintes d’un trouble neurocognitif majeur (n=471), des infirmières (n=514) et des médecins (n=653) qui prenaient soin de tels patients au moment de l’enquête. Des 1 050 questionnaires retournés, 420 incluent des commentaires. Ces commentaires ont été codés en rubriques, thèmes et sous-thèmes, et la fréquence des rubriques comparée entre les quatre groupes cibles. Le codage a permis d’identifier 23 thèmes et cinq sous-thèmes que nous avons regroupés en sept rubriques principales : 1) le répondant, 2) l’enquête et son questionnaire, 3) les personnes visées par l’extension, 4) leur proches, 5) le système de santé, 6) le cadre législatif qui balise les soins en fin de vie, et 7) la société en général. Ces rubriques ont été repérées dans les quatre groupes cibles, bien qu’à des fréquences différentes pour cinq d’entre elles. La présente étude met ainsi en lumière une panoplie de facteurs susceptibles d’influencer les attitudes face à l’extension de l’AMM aux personnes inaptes. Elle illustre par ailleurs la valeur ajoutée de soumettre des commentaires à une analyse systématique pour mieux comprendre les résultats d’une enquête postale.
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Affiliation(s)
- Gina Bravo
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche sur le vieillissement, CIUSSS de l’Estrie – CHUS, Sherbrooke, Canada
| | - Marcel Arcand
- Centre de recherche sur le vieillissement, CIUSSS de l’Estrie – CHUS, Sherbrooke, Canada
- Département de médecine de famille et d’urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Lise Trottier
- Centre de recherche sur le vieillissement, CIUSSS de l’Estrie – CHUS, Sherbrooke, Canada
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21
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Stevens E, Price E, Walker L. Dressings and dignity in community nursing. Br J Community Nurs 2021; 26:526-531. [PMID: 34731040 DOI: 10.12968/bjcn.2021.26.11.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although dignity has been widely explored in the context of healthcare, it has rarely been the subject of empirical exploration when care is delivered by community district nursing teams. This paper demonstrates how a commonplace community nursing task (changing dressings) can constitute a clinical lens through which to explore the ways in which community nurses can influence patients' dignity. This ethnographic study involved two research methods: interviews with patients and nurses (n=22) and observations of clinical interactions (n=62). Dignity can manifest during routine interactions between community nurses and patients. Patient-participants identified malodour from their ill-bodies as a particular threat to dignity. Nurses can reinforce the dignity of their patients through relational aspects of care and the successful concealment of 'leaky' bodies.
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Affiliation(s)
- Emma Stevens
- Staff Tutor, School of Health, Wellbeing and Social Care, The Open University, Milton Keynes
| | - Elizabeth Price
- Senior Lecturer in Social Work, Faculty of Health Sciences, University of Hull
| | - Liz Walker
- Professor of Health and Social Work Research, Faculty of Health Sciences, University of Hull
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22
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Chung JH, Kim SH, Suh SY, Cheng SY, Mori M, Yamaguchi T, Chen PJ, Morita T, Tsuneto S. Differences between dedicated and not dedicated hospice physicians in symptoms and signs improvement among advanced cancer patients. Medicine (Baltimore) 2021; 100:e26915. [PMID: 34397931 PMCID: PMC8360492 DOI: 10.1097/md.0000000000026915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/22/2021] [Indexed: 01/04/2023] Open
Abstract
The hospice and palliative care can improve the symptoms and signs of terminal cancer patients. The purposes of this study are how to improve terminally ill cancer patients' symptoms and signs and how the dedicated palliative care service effects on these improvements.From January 2017 to March 2019, among 919 terminally ill cancer patients admitted to the palliative care units in 11 hospitals of South Korea, we analyzed 334 patients with prospective cohort method and categorized them into non-dedicated hospice care group of 234 and dedicated hospice care group of 100.Symptoms improvement of dyspnea, fatigue, drowsiness, and dry mouth during the first week of admission were respectively 298 (89.2%), 25 (7.5%), 204 (61.1%), 76 (22.8%). Signs improvement of myoclonus, respiratory secretion, leg edema, and ascites between admission and a week after were 5 (1.5%), 41 (12.3%), 47 (14.1%), 12 (3.6%). Significant differences between dedicated hospice care physician group and non-dedicated hospice care physician group were shown in drowsiness (67.5% vs 46%, P < .001) and respiratory secretion (15% vs 6%, P < .028). Compared to non-dedicated care group, the odds ratio for more than 2 symptoms or signs was 1.78 (95% confidence interval, 1.05-3.02) in the dedicated care group after adjusting confounding variables.In conclusion, terminally ill cancer patients who received palliative or hospice service showed significant improvement in symptoms and signs. And, family doctors (dedicated hospice physician group) performed better than oncologists (non-dedicated physician group).
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Affiliation(s)
- Jae Ho Chung
- Department of Internal Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Sun Hyun Kim
- Department of Family Medicine, Catholic Kwandong University, International St. Mary's Hospital, Incheon, South Korea
| | - Sang-Yeon Suh
- Department of Family Medicine, Palliative Care Center, Dongguk University Ilsan Hospital, Goyang, South Korea
- Department of Medicine, School of Medicine, Dongguk University, Seoul, Korea
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, and School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Dignity-conserving palliative care in a diverse population: A qualitative study of physicians' perspective. Palliat Support Care 2021; 20:196-202. [PMID: 33952366 DOI: 10.1017/s147895152100050x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preserving personal dignity is an important aim of palliative care. Little is known about how physicians perceive and preserve dignity of patients from non-western migration backgrounds. Insight in this is important given the increased demand for culturally sensitive palliative care. AIM To gain insight in how Dutch physicians perceive and preserve dignity in the last phase of life for patients from non-western migration backgrounds. DESIGN Qualitative thematic analysis of semi-structured interviews. PARTICIPANTS Fifteen physicians experienced in palliative care. RESULTS Physicians experienced dilemmas in preserving dignity of non-western patients in three situations: (a) relief of suffering in the terminal phase, (b) termination of interventions and treatment, and (c) disclosure of diagnosis. Physicians wanted to grant the needs of patients in the last phase of their lives, which was central to physicians' view on dignity, but dilemmas arose when this conflicted with physicians' other personal and professional values. To make the dilemmas manageable, physicians assessed whether needs of patients were authentic, but due to linguistic, cultural, and communication barriers, this was difficult with non-western patients. To find a way out of the dilemmas, physicians had three strategies: accept and go along with patient's wishes, convince or overrule the patient or family, or seek solutions that were acceptable for all. CONCLUSIONS Physicians encounter dilemmas providing palliative care for people from non-western backgrounds. Future physicians can be trained in connective strategies and seeking middle grounds to optimally preserve patients' dignity while being in concordance with their personal and professional values.
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Xiao J, Ng MSN, Yan T, Chow KM, Chan CWH. How patients with cancer experience dignity: An integrative review. Psychooncology 2021; 30:1220-1231. [PMID: 33893677 DOI: 10.1002/pon.5687] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND A diagnosis of cancer and its treatments can be associated with a prominent issue of loss of dignity or an undermined sense of dignity for patients. Research is increasingly being conducted into how patients with cancer experience dignity, with the aim to build clinical foundations for care that preserves patients' sense of dignity. AIM This review summarises and synthesises the available empirical literature on the experience of dignity in patients with cancer regarding both the perception of dignity and associated factors. METHOD An integrative review method was used. A literature search was conducted in 11 databases using the search terms 'dignity' OR 'existential' OR 'existentialism' combined with 'cancer'. The Mixed Methods Appraisal Tool (version 2011) was adopted to appraise the methodological quality of the included studies. RESULTS Nine qualitative studies and 13 quantitative studies met the selection criteria and were included in the review. The ways that patients with cancer perceived dignity include autonomy/control, respect, self-worth, family connectedness, acceptance, hope/future and God/religious. Factors associated with dignity include demographics, physical and psychosocial distress, experiences of suffering and coping strategies. CONCLUSION Dignity-conserving care should respect patients' human autonomy to strengthen their sense of self-worth, acceptance, hope, reinforce family connectedness, and foster coping strategies to control the physical, psychosocial factors and experience of sufferings that threaten their sense of dignity.
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Affiliation(s)
- Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Marques S N Ng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Tingting Yan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Park SA, Park HJ. The Relationships Between Oncology Nurses' Attitudes Toward a Dignified Death, Compassion Competence, Resilience, and Occupational Stress in South Korea. Semin Oncol Nurs 2021; 37:151147. [PMID: 33895014 DOI: 10.1016/j.soncn.2021.151147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/27/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES In recent years, South Korea has become more concerned about a dignified death and the 'well-dying' law has been enacted. Oncology nurses' perceptions of death are crucial in maintaining dying patients' sense of dignity; fostering their physical, mental, and spiritual quality of life; and ensuring that they die a comfortable death. This study accordingly examined the relationships between attitudes towards a dignified death, compassion competence, resilience, and occupational stress to provide basic data to promote better attitudes towards death among oncology nurses in South Korea. DATA SOURCES This study, conducted between 2 to 31 January 2018, adopted a descriptive cross-sectional design. Oncology nurses (N = 329) participated, and the differences in their attitudes towards a dignified death correlating to their demographic and work-related characteristics were analysed using t-tests and analyses of variance. Pearson's correlations were used to examine the relationships between nurses' attitudes towards a dignified death, compassion competence, resilience, and occupational stress. CONCLUSION Participants' attitudes towards a dignified death were weaker than those of the general population but stronger than those of non-oncology nurses. Attitudes towards a dignified death were significantly correlated with compassion competence and resilience-traits that appear to enable nurses' efficient response to various stressful situations. IMPLICATIONS FOR NURSING PRACTICE Educational programmes should promote nurses' compassion competence and resilience. Nurses should receive death-related education to reduce the stress that arises from providing end-of-life care and enhance their attitudes towards a dignified death.
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Affiliation(s)
- Sun-A Park
- Assistant Professor, Department of Nursing, University of Suwon, Hwaseong-si, Gyeonggi-do, South Korea.
| | - Hee Jung Park
- Deputy Chief of Ward Nursing, National Cancer Center, Goyang, Gyonggi, Korea
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Dorji N, Lapierre S. Perception of death and preference for end-of-life care among Asian Buddhists living in Montreal, Canada. DEATH STUDIES 2021; 46:1933-1945. [PMID: 33464176 DOI: 10.1080/07481187.2021.1872743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dying with dignity is important in Western culture. The aim of this qualitative study was to explore how Asian Buddhists, exposed to Western cultures, perceive death and dying with dignity, and examine their preferences for end-of-life care. We interviewed 15 Asian Buddhists living in Montreal (Canada). Participants regarded death as inevitable, while a good/dignified death had to be natural, peaceful, and, most of all, conscious. Most preferred palliative care to medical-aid-in-dying and emphasized death preparation through daily contemplation of impermanence. Care providers' understanding and respect of Buddhist patients' perception of a dignified death might help facilitate this important transition.
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Affiliation(s)
- Nidup Dorji
- Department of Public Health, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Faculty of Human Sciences, Université du Québec à Montréal, Montréal, Canada
| | - Sylvie Lapierre
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Faculty of Human Sciences, Université du Québec à Montréal, Montréal, Canada
- Department of psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Franco H, Caldeira S, Nunes L. Dignity in nursing: A synthesis review of concept analysis studies. Nurs Ethics 2020; 28:734-749. [PMID: 33249957 DOI: 10.1177/0969733020961822] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nursing research using concept analysis plays a critical role for knowledge development, particularly when concerning to broad and foundational concepts for nursing practice, such as dignity. This study aimed to synthesize research concerning concept analysis of dignity in nursing care. Based on a literature review, electronic databases were searched (MEDLINE, CINAHL, COCHRANE, SCOPUS, EBSCOhost, and PubMed) using the terms "dignity," "human dignity," "concept analysis," and nurs*. Papers in Portuguese or English were included. The research synthesis was conducted independently by two reviewers. A total of 35 citations were identified and seven papers were included. Six studies were elected using Walker and Avant concept analysis methodology while one applied the Beth Rodgers evolutionary model. The concept of dignity has been studied by nurses, and its attributes, antecedents, consequences, and similar concepts were synthesized into a definition. Dignity emerged as a fundamental concept in nursing ethics and the main attributes synthesized were personhood (intrinsic), sociability (relational/behavioral), respect, and autonomy. The antecedents identified were: facilitators-patient focus care, recognition (of the attributes of dignity), education, and ethical competence; threats-vulnerability and organizational environment. The consequences were positive coping, empowerment, and dignity preservation. The synthesis of these seven studies using concept analysis provided a clear definition of dignity. These findings challenge future research and education, particularly for the study of undergraduate and postgraduate nursing education programs to enhance skills for preserving patient dignity in clinical practice.
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Affiliation(s)
- Hugo Franco
- 70869Polytechnic Institute of Setubal, Portugal; Universidade Católica Portuguesa, Portugal
| | | | - Lucília Nunes
- 70869Polytechnic Institute of Setubal, Portugal; NURSE'IN Nursing Research Unit for South and Islands, Portugal
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Dignity-conserving care for persons with palliative care needs — identifying outcomes studied in research: An integrative review. Palliat Support Care 2020; 18:722-740. [DOI: 10.1017/s1478951520000139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesWith people living longer, palliative care may be required for lengthier periods of time. This puts demands on healthcare organizations to provide optimal palliative care. Maintaining dignity is central for any person's health and quality of life, but especially for a person with palliative care needs. Dignity-conserving care needs to be evaluated to increase knowledge about outcomes and how to assess these. The purpose of this integrative review was to identify outcomes studied within dignity-conserving care and how these have been operationalized.MethodsAn integrative review was conducted in 26 quantitative or mixed-method studies and study protocols. Thematic synthesis with an abductive approach was used for analysis.ResultsSeven themes of studied outcomes were identified, as well as four cluster themes: themes related to Illness-Related Concerns, themes related to the Dignity-Conserving Repertoire, themes related to the Social Dignity Inventory, and themes regarding Overarching Dignity Issues. Most outcomes studied dealt with Illness-Related Concerns within the themes of “Performance, symptoms and emotional concerns” and “End-of-life and existential aspects”. Themes linked to the Social Dignity Inventory had the lowest number of outcomes studied. Outcomes regarding overarching dignity issues such as “Dignity-related distress” and “Quality of life” were common. However, the results lacked concrete communication outcomes.Significance of resultsThe results will underpin future research in which dignity-conserving care is implemented and evaluated, and contribute to the provision of evidence-based palliative care. A greater focus on outcomes within cluster themes related to the Dignity-Conserving Repertoire and the Social Dignity Inventory is needed, as is more focus on communication outcomes.
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Dignity: The Cornerstone of Nursing Care Among Hospitalized Mothers of Infants in Neonatal Intensive Care Unit. J Perinat Neonatal Nurs 2020; 34:E44-E50. [PMID: 33079813 DOI: 10.1097/jpn.0000000000000522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: One of the most important areas of nursing care delivery is "dignity." Because of the increase in hospitalized infants in neonatal intensive care units in recent years, this has led to an increased focus on "family care and maternal dignity." Given the importance of understanding the phenomenon of maternal dignity in order to improve cooperation in the care of their infants and promote family-centered care, this study aims to describe the lived experience of hospitalized mothers of infants within the context of dignity. This is a descriptive phenomenological qualitative research study. Twenty mothers were invited to participate in this study using purposeful sampling. The data were generated through individual, semistructured interviews and field notes were developed during the interviews. Data were analyzed using the Colaizzi method.Findings of the study were presented in 3 themes: "privacy," "respecting individual identity," and "authority," and 7 additional subthemes. Mothers in this study needed to take care of their infants in an environment where their personal privacy is preserved, their individual identity is respected, and they have sufficient authority in obtaining medical decisions. It is essential that healthcare teams and policy makers of health organizations provide an appropriate supportive environment in terms of promoting mothers' dignity in different dimensions and subsequently improving family-centered care.
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Freeman LA, Pfaff KA, Kopchek L, Liebman J. Investigating palliative care nurse attitudes towards medical assistance in dying: An exploratory cross-sectional study. J Adv Nurs 2019; 76:535-545. [PMID: 31650568 DOI: 10.1111/jan.14252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/24/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022]
Abstract
AIM To investigate palliative care nurse attitudes towards medical assistance in dying. DESIGN An exploratory cross-sectional study design. METHODS A mailed letter recruited participants with data collection occurring on a secure online survey platform between November 2017-February 2018. Data analyses included descriptive and bivariate statistics and stepwise linear regression. RESULTS Palliative care nurse attitudes towards medical assistance in dying were explained by perceived expertise in the social domain of palliative care, personal importance of religion/faith, professional importance of religion/faith, and nursing designation. CONCLUSION This study reveals the perceived importance of religion, versus religious affiliation alone, as significant in influencing provider attitudes towards assisted dying. Further research is needed to understand differences in attitudes between Registered Nurses and Registered Practical Nurses and how the social domain of palliative care influences nurse attitude. IMPACT Organizations must prioritize nursing input, encourage open interprofessional dialogue and provide support for ethical decision-making, practice decisions, and conscientious objection surrounding medical assistance in dying. Longitudinal nursing studies are needed to understand the impact of legislation on quality and person-centred end-of-life care and the emotional well-being/retention of palliative care nurses.
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Affiliation(s)
| | | | - Lauren Kopchek
- Faculty of Nursing, University of Windsor, Windsor, Canada
| | - Jordyn Liebman
- Faculty of Nursing, University of Windsor, Windsor, Canada
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Kukora S, Keefer P, Pituch K, Firn J. Thematic Analysis of Interprofessional Provider Perceptions of Pediatric Death. J Pediatr Nurs 2019; 47:92-99. [PMID: 31082685 DOI: 10.1016/j.pedn.2019.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 11/15/2022]
Abstract
PURPOSE Though provider and patient perceptions of death are characterized in the adult population literature, there is limited information related to providers' perceptions in pediatric and neonatal patients. The purpose of this study was to better understand how interprofessional care team members perceive and experience neonatal and pediatric end-of-life situations. DESIGN AND METHODS This survey questionnaire was administered to interprofessional providers following their participation in an institutional workshop, as part of an ongoing institutional effort to improve end-of-life experiences for patients/family and providers. Interprofessional care providers completed an electronic survey consisting of closed-ended and one open-ended question to elicit their perceptions of their participation in end of life care for a recent neonatal/pediatric patient in the period before the child's death. RESULTS The qualitative analysis of 306 free-text responses commenting on the deaths of 138 patients, contained within 880 completed mixed-method surveys, is described. Thematic analysis of the free text discovered three primary themes from the data: favorable aspects of the death experience, unfavorable aspects of the experience, and combined favorable and unfavorable aspects. Four subthemes contributed to the themes; namely, language, parental presence, trust/rapport in provider relationships and inclusion in decision-making, communication, and culture. CONCLUSIONS Multiple factors contribute to how interprofessional care providers perceive end-of-life care experiences for neonatal/pediatric patients. The same death may be perceived differently by different providers. PRACTICE IMPLICATIONS Understanding favorable and unfavorable aspects of providing end-of-life care will support strategies to provide resources, education and support to facilitate coping and resiliency in care providers.
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Affiliation(s)
- Stephanie Kukora
- University of Michigan Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Ann Arbor, United States of America; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America.
| | - Patricia Keefer
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States of America; Stepping Stones Pediatric Palliative Care Program, University of Michigan Department of Pediatrics, Ann Arbor, MI, United States of America
| | - Kenneth Pituch
- Stepping Stones Pediatric Palliative Care Program, University of Michigan Department of Pediatrics, Ann Arbor, MI, United States of America
| | - Janice Firn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, United States of America; Department of Learning Health Sciences, Division of Professional Education, University of Michigan Medical School, Ann Arbor, MI, United States of America
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Mohammadi F, Oshvandi K, Med HK. Male nursing students' perception of dignity in neonatal intensive care units. Nurs Ethics 2019; 27:381-389. [PMID: 31177916 DOI: 10.1177/0969733019848040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Maintaining dignity is one of the most important human rights. However, maintaining and promoting the dignity of nursing students as an important caregiver group has scarcely been considered. Dignity can be viewed as an abstract concept particularly in relation to the perspective of male nursing student perspective. Therefore, more investigation is required to explore the male students' understanding of the concept of dignity. OBJECTIVES The purpose of this study is to define and explain the concept of dignity among male nursing students in the neonatal intensive care unit. RESEARCH DESIGN This is a qualitative content analysis study. The data were collected through semi-structured individual interviews. The data were analyzed by conventional content analysis method. PARTICIPANTS AND RESEARCH CONTEXT Twenty male nursing students in public health centers in Iran were selected by targeted sampling to achieve data saturation between February 2017 and November 2017. FINDINGS The findings of this study were presented in three main themes, including "extensive support," "belief in ability," and "participation in decision making," and 7 sub-categories of data were extracted. ETHICAL CONSIDERATIONS The study's protocol was approved by the Research Ethics Committee of the Shiraz University of Medical Sciences and the ethical principles were followed throughout the study. DISCUSSION AND CONCLUSION According to the findings of the study, male nursing students required extensive support, and their academic and practical skills required to be respected; in addition, they should be involved in decision making, because in such an environment, the dignity of these students will be maintained and promoted. Therefore, it is suggested that a cultural, professional, and institutional background in which all components of the male nursing student's dignity are protected and emphasized should be provided.
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Affiliation(s)
| | - Khodayar Oshvandi
- Mother and Child Care Research Center,Hamadan University of Medical Sciences, Hamadan, Iran
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Cao Y, Li WW, Xue Y. Dying and relational aftermath concerns among terminal cancer patients in China. DEATH STUDIES 2019; 44:586-595. [PMID: 31058583 DOI: 10.1080/07481187.2019.1609135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The need to make sense of one's mortality is of central concern for death studies. We aimed to explore the meaning of aftermath concerns in the process of preparing for death. Using a qualitative approach, we explored aftermath concerns among 25 participants with terminal cancer in China. Three aftermath concern themes were developed from the participants' narratives: mental concerns about parents, material concerns about children, and spiritual concerns about the self. Aftermath concerns are relational because they are not about what happens within an individual, but between individuals which are manifested within the broader cultural, social, economic, and political contexts.
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Affiliation(s)
- Yanmei Cao
- Department of Psychology, Shanxi Medical University, Taiyuan, China
| | - Wendy Wen Li
- Department of Psychology, James Cook University, Townsville, Australia
| | - Yunzhen Xue
- Department of Psychology, Shanxi Medical University, Taiyuan, China
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Mohammadi F, Tabatabaei HS, Mozafari F, Gillespie M. Caregivers' perception of women's dignity in the delivery room: A qualitative study. Nurs Ethics 2019; 27:116-126. [PMID: 31046562 DOI: 10.1177/0969733019834975] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Dignified care is one of the moral responsibilities of professional caregivers. However, in many cases the dignity of hospitalized patients, especially women in the delivery room, is not maintained. Dignity is an abstract concept and there has been no previous research exploring the dignity of pregnant women in the delivery room in Iran. OBJECTIVES The objective of this study is to define and explain the concept of dignity for pregnant women in the delivery room from the perspectives of professional caregivers. RESEARCH DESIGN This is qualitative research. The data were collected through in-depth semi-structured individual interviews. The conventional content analysis method was used to analyze the data. In qualitative content analysis, participant narrative is examined in-depth and sorted into categories and themes. PARTICIPANTS AND RESEARCH CONTEXT Potential participants who met the entrance criteria for this study were approached between July 2016 and February 2017. In all, 20 professional caregivers working in the delivery room setting within Iranian general hospitals were invited to participate in the study. The sampling was done through targeted sampling until saturation was achieved. ETHICAL CONSIDERATIONS The research ethics committee of the Shiraz University of Medical Sciences has approved the study's protocol and all commonly recognized ethical principles were followed throughout the study. FINDINGS The findings of this study were presented in three main themes, including "privacy," "respecting patients' preferences," and "comprehensive attention" and eight categories. DISCUSSIONS AND CONCLUSION Women in the delivery room need to be taken care of in an environment where healthcare staff promote the preservation of dignity through maintaining privacy, by providing attentive care and through ensuring that patient preferences regarding care and treatment are respected. In such an environment, the dignity of these women would be maintained and desirable outcomes achieved.
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Affiliation(s)
- Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Iran
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Bylund-Grenklo T, Werkander-Harstäde C, Sandgren A, Benzein E, Östlund U. Dignity in life and care: the perspectives of Swedish patients in a palliative care context. Int J Palliat Nurs 2019; 25:193-201. [DOI: 10.12968/ijpn.2019.25.4.193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tove Bylund-Grenklo
- Senior Lecturer, Department of Caring Science, University of Gävle, and (affiliated) Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Carina Werkander-Harstäde
- Senior Lecturer, Department of Health and Caring Sciences, Linnaeus University, Växjö, and Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Anna Sandgren
- Associate Professor, Department of Health and Caring Sciences, Linnaeus University, Växjö and Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Eva Benzein
- Professor, Department of Health and Caring Sciences, Linnaeus University, Kalmar and Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrika Östlund
- Associate Professor, Research Supervisor, Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle; (affiliated) Faculty of Medicine and Health, School of Health Sciences, Örebro University; and (affiliated) Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Östlund U, Blomberg K, Söderman A, Werkander Harstäde C. How to conserve dignity in palliative care: suggestions from older patients, significant others, and healthcare professionals in Swedish municipal care. BMC Palliat Care 2019; 18:10. [PMID: 30678669 PMCID: PMC6346549 DOI: 10.1186/s12904-019-0393-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 01/11/2019] [Indexed: 01/07/2024] Open
Abstract
Background An essential aspect of palliative care nursing is to conserve the dignity of the patient. A Dignity Care Intervention (DCI) has been developed in Scotland to facilitate this role for nurses. The DCI is now being adapted to a Swedish context (DCI-SWE) and a central step is to identify culturally relevant, dignity-conserving care actions. These care actions will be incorporated into the DCI-SWE. Therefore, the aim of this study was to suggest care actions for conserving dignity in palliative care from the perspectives of the patients, significant others (SOs), and health care professionals (HPs) in municipality care in Sweden. Methods This study used a descriptive design with a qualitative approach. Data from 20 participants were collected through semi-structured individual interviews with patients (n = 3), SOs (n = 4), two focus groups with nurses (n = 9) and one focus group with physicians (n = 4) in two Swedish municipalities. These data were deductively analysed using qualitative content analysis with the Chochinov model of dignity as framework. Results With the Chochinov model of dignity as a framework, care actions based on suggestions from the participants were identified and presented under three themes: Illness related concerns, Dignity conserving repertoire, and Social dignity inventory. The study found both specific concrete care actions and more general approaches. Such general approaches were found to be relevant for several dignity related issues as all-embracing attitudes and behaviours. However, these general approaches could also be relevant as specific care actions to conserve dignity in relation to certain issues. Care actions were also found to be linked to each other, showing the importance of a holistic perspective in conserving dignity. Conclusions As part of the adaption of the DCI from a Scottish to a Swedish context, this study added relevant care actions for collaborative planning of individualised care in mutual dialogues between nurses and those they care for. The adapted intervention, DCI-SWE, has the potential to help the nurses in providing palliative care of evidence-based quality.
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Affiliation(s)
- Ulrika Östlund
- Centre for Research & Development, Uppsala University/Region Gävleborg, 80188, Gävle, SE, Sweden. .,Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Carina Werkander Harstäde
- Centre for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
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Franco ME, Salvetti MDG, Donato SCT, Carvalho RTD, Franck EM. PERCEPTION OF DIGNITY OF PATIENTS IN PALLIATIVE CARE. ACTA ACUST UNITED AC 2019. [DOI: 10.1590/1980-265x-tce-2018-0142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: to understand the perception of dignity of patients in palliative care and to identify factors that may increase or decrease the sense of dignity. Method: an exploratory study with a qualitative approach, carried in a Palliative Care Center in São Paulo (Brazil), with the Chochinov’s Dignity Model as theoretical framework and content analysis as methodological framework. The participants of this study were 20 patients in palliative care, assessed through semi-structured interviews based on three questions: "What is dignity for you?", "What increases your dignity?", "What decreases your dignity?" The interviews were recorded with the patients’ authorization, from September to November 2017, and transcribed for content analysis. Results: the analysis of the perception of dignity allowed the identification of three categories: Correct person, Autonomy/independence and Socio-political factors. The factors that increased the sense of dignity were the following: Care, Independence/autonomy, Leisure/positive thinking/being with friends. And those that decreased it were the following: Behaviors/attitudes, Health status and Economic situation. Conclusion: the perception of dignity of patients in palliative care was influenced by health professionals and caregivers. Being a “correct person”, maintaining autonomy, being cared for and respected has increased the sense of dignity. Urban violence and the lack of compliance with accessibility policies have reduced the sense of dignity among palliative care patients.
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Lim K, Kim JW, Yoo S, Heo E, Ji H, Kang B. Design of a Hospice Referral System for Terminally Ill Cancer Patients Using a Standards-Based Health Information Exchange System. Healthc Inform Res 2018; 24:317-326. [PMID: 30443420 PMCID: PMC6230540 DOI: 10.4258/hir.2018.24.4.317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives The demand for hospice has been increasing among patients with cancer. This study examined the current hospice referral scenario for terminally ill cancer patients and created a data form to collect hospice information and a modified health information exchange (HIE) form for a more efficient referral system for terminally ill cancer patients. Methods Surveys were conducted asking detailed information such as medical instruments and patient admission policies of hospices, and interviews were held to examine the current referral flow and any additional requirements. A task force team was organized to analyze the results of the interviews and surveys. Results Six hospices completed the survey, and 3 physicians, 2 nurses, and 2 hospital staff from a tertiary hospital were interviewed. Seven categories were defined as essential for establishing hospice data. Ten categories and 40 data items were newly suggested for the existing HIE document form. An implementation guide for the Consolidated Clinical Document Architecture developed by Health Level 7 (HL7 CCDA) was also proposed. It is an international standard for interoperability that provides a framework for the exchange, integration, sharing, and retrieval of electronic health information. Based on these changes, a hospice referral scenario for terminally ill cancer patients was designed. Conclusions Our findings show potential improvements that can be made to the current hospice referral system for terminally ill cancer patients. To make the referral system useful in practice, governmental efforts and investments are needed.
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Affiliation(s)
- Kahyun Lim
- Office of e-Health Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Whun Kim
- Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sooyoung Yoo
- Office of e-Health Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunyoung Heo
- Office of e-Health Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyerim Ji
- Office of e-Health Research and Business, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Mohammadi F, Rakhshan M, Molazem Z, Zareh N, Gillespie M. Caregivers’ perception of dignity in teenagers with autism spectrum disorder. Nurs Ethics 2018; 26:2035-2046. [DOI: 10.1177/0969733018796679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Maintaining dignity is one of patients is one of the main ethical responsibilities of caregivers. However, in many cases, the dignity of patients, especially autistic teenagers is not maintained. The extent to which dignity needs are met for this group within the Iranian care system is difficult to determine as dignity is an abstract concept, and there are few related research studies reported. Objectives: The objective of this study is to find out caregivers perspectives on dignity in teenagers with autistic spectrum disorder. Research design: This study uses a qualitative research design. The data were collected through individual, semi-structured interviews and field notes developed during the interviews. In order to analyze the data, qualitative conventional content analysis was used. Participants and research context: In all, 16 professional caregivers for autistic teenagers working in public hospitals were recruited based on a targeted sampling method to reach data saturation from February 2016 to July 2017. Findings: The findings of this study were presented in three main themes, “privacy,” “respecting individual identity,” and “comprehensive support,” and 11 categories. Ethical consideration: This study’s protocol was approved by the Research Ethics Committee of medical universities located in Southeast of Iran and the required ethical principles were followed throughout. Discussion and conclusion: Based on the findings of this study from the perspective of caregivers, autistic teenagers need to be cared for and educated in a respectful environment where their privacy is maintained, their individual identities are respected, and they receive comprehensive familial, social, and financial support. These conditions would maintain the dignity of such teenagers and would result in appropriate behavioral outcomes. Therefore, it is suggested that a cultural, professional and institutional background in which all components of the autistic teenager’s dignity are protected and emphasized be provided.
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Aydın Er R, İncedere A, Öztürk S. Respectful care of human dignity: how is it perceived by patients and nurses? JOURNAL OF MEDICAL ETHICS 2018; 44:675-680. [PMID: 29925608 DOI: 10.1136/medethics-2017-104666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/16/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Dignified care protects the patient's rights and provides appropriate ethical care while improving the quality of nursing care. In this context, the opinions of nurses and patients who receive nursing care about dignified care are important. The aim of this study was to explore the opinions and experiences of Turkish patients and nurses about respectful care of human dignity. METHODS This descriptive cross-sectional study was conducted in Turkey. Participants were inpatients at cardiology, neurology and neurosurgery clinics and nurses working in these clinics. The data for the study were collected from face-to-face interviews using questionnaires. The percentages of characteristics and preferences of the participants were calculated, and the results were analysed using statistical tests. RESULTS A total of 150 patients and 78 nurses participated in the study. The patients stated that the protection of their rights was the most important factor for dignified nursing care. The nurses stated that being careful to not expose the patients' body and being respectful of the patients' privacy were important in dignified nursing care. The age of the patient, duration of the disease, number of hospitalisations and length of time the nurses had been working at the clinic caused significant changes in the factors considered important in dignified care. CONCLUSIONS Our findings provide a perspective on dignified care in the Turkish healthcare setting. There were some differences between patients and nurses in the factors considered important for dignified care. The discussion with patients and nurses related to care and practices that protect or detract from human dignity can provide insights to ethics.
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Affiliation(s)
- Rahime Aydın Er
- Department of History of Medicine and Ethics, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Aysel İncedere
- Department of Psychiatric Rehabilitation, The Institute of Health Sciences, Kocaeli University, Kocaeli, Turkey
| | - Selda Öztürk
- Department of Nursing, Faculty of Health Sciences, Trakya University, Edirne, Turkey
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Development and Validity of the Nursing Care Scale and Nurse's Difficulty Scale in Caring for Dying Patients With Cancer and Their Families in General Hospitals in Japan. J Hosp Palliat Nurs 2018; 21:174-182. [PMID: 30063557 PMCID: PMC6400446 DOI: 10.1097/njh.0000000000000482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study develops and examines the validity and reliability of 2 scales, respectively, for evaluating nursing care and the experience of difficulties providing nursing care for dying patients with cancer and their families. A cross-sectional anonymous questionnaire was administered to nursing staff caring for dying patients with cancer and their families in 4 general hospitals and a university hospital in Japan. The instruments assessed were the Nursing Care Scale for Dying Patients and Their Families (NCD) and the Nurse’s Difficulty Scale for Dying Patients and Their Families (NDD). Of the 497 questionnaires sent to nurses, 401 responses (80%) were analyzed. Factor analyses revealed that the NCD and NDD consisted of 12 items with 4 subscales: “symptom management,” “reassessment of current treatment and nursing care,” “explanation to family,” and “respect for the patient and family’s dignity before and after death.” These scales had sufficient convergent and discriminative validity, sufficient internal consistency (α of subscales: NCD, 0.71-0.87; NDD, 0.74-0.93), and sufficient test-retest reliability (intraclass correlation coefficient of subscales: NCD, 0.59-0.81; NDD, 0.67-0.82) to be used as self-assessments and evaluation tools in education programs to improve the quality of nursing care for the dying patients and their families.
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Hernández-Marrero P, Fradique E, Pereira SM. Palliative care nursing involvement in end-of-life decision-making: Qualitative secondary analysis. Nurs Ethics 2018; 26:1680-1695. [PMID: 29807491 DOI: 10.1177/0969733018774610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nurses are the largest professional group in healthcare and those who make more decisions. In 2014, the Committee on Bioethics of the Council of Europe launched the "Guide on the decision-making process regarding medical treatment in end-of-life situations" (hereinafter, Guide), aiming at improving decision-making processes and empowering professionals in making end-of-life decisions. The Guide does not mention nurses explicitly. OBJECTIVES To analyze the ethical principles most valued by nurses working in palliative care when making end-of-life decisions and investigate if they are consistent with the framework and recommendations of the Guide; to identify what disputed/controversial issues are more frequent in these nurses' current end-of-life care practices. DESIGN Qualitative secondary analysis. PARTICIPANTS/CONTEXT Three qualitative datasets including 32 interviews from previous studies with nurses working in palliative care in Portugal. ETHICAL CONSIDERATION Ethical approval was obtained from the Ethics Research Lab of the Instituto de Bioética (Ethics Research Lab of the Institute of Bioethics) (Ref.04.2015). Ethical procedures are thoroughly described. FINDINGS All participant nurses referred to autonomy as an ethical principle paramount in end-of-life decision-making. They were commonly involved in end-of-life decision-making. Palliative sedation and communication were the most mentioned disputed/controversial issues. DISCUSSION Autonomy was highly valued in end-of-life care and decision-making. Nurses expressed major concerns in assessing patients' preferences, wishes, and promoting advance care planning. Nurses working in palliative care in Portugal were highly involved in end-of-life decision-making. These processes embraced a collective, inclusive approach. Palliative sedation was the most mentioned disputed issue, which is aligned with previous findings. Communication also emerged as a sensitive ethical issue; it is surprising, however, that only three nurses referred to it. CONCLUSION While the Guide does not explicitly mention nurses in its content, this study shows that nurses working in palliative care in Portugal are involved in these processes. Further research is needed on nurses' involvement and practices in end-of-life decision-making.
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Affiliation(s)
| | - Emília Fradique
- Hospital de Santa Maria, Portugal; Instituto S. João de Deus, Portugal
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Kisvetrová H, Vévodová Š, Školoudík D. Comfort-Supporting Nursing Activities for End-of-Life Patients in an Institutionalized Environment. J Nurs Scholarsh 2017; 50:126-133. [PMID: 28869697 DOI: 10.1111/jnu.12341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Comfort promotion plays a significant role in end-of-life patient care. The objective of this study was to determine the utilization rate of comfort supporting nursing activities in end-of-life patients in an institutionalized environment in the Czech Republic in relation to the age of the registered nurses (RNs), length of work experience, education level, and type of workplace. DESIGN A cross-sectional, descriptive study was designed. A questionnaire with Likert scales included 31 activities of dying care and spiritual support interventions. The sample comprised 907 RNs working in 49 institutions in nine regions of the Czech Republic. The Kruskal-Wallis test, Mann-Whitney U post-hoc test with Bonferroni correction of significance, Spearman's correlation analysis, and logical regression model were used for statistical evaluation. FINDINGS The least frequently implemented activity by RNs was "Show the patient's willingness to discuss death" and the most frequent activity was "Threat to the patient's dignity and respect." The highest utilization rate of nursing activities was reported in the physical dimension, while the lowest utilization rate of nursing activities was in the social dimension set. Significant predictors for the high utilization rate of physical dimension set activities were hospice care departments, long-term care facilities (LTCFs), and the age of RNs. Hospice departments were also a predictor of high utilization rate of activities in the psychological, spiritual, and social dimension set activities. CONCLUSIONS With the exception of hospice departments, RNs used activities encouraging psychological, spiritual, and social comfort for end-of-life patients less frequently than the physical dimension. CLINICAL RELEVANCE RNs in hospitals and LTCFs focus insufficiently on the spiritual and psychosocial comfort of end-of-life patients. This study is of particular significance to educators who prepare the next generation of nurses.
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Affiliation(s)
- Helena Kisvetrová
- Phi Gamma, Associate Professor, The Centre for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - Šárka Vévodová
- Head of Department of Humanities and Social Sciences, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
| | - David Školoudík
- Professor, Vice-Dean, and Director of The Centre for Research and Science, Faculty of Health Sciences, Palacký University, Olomouc, Czech Republic
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Bidabadi FS, Yazdannik A, Zargham-Boroujeni A. Patient's dignity in intensive care unit: A critical ethnography. Nurs Ethics 2017; 26:738-752. [PMID: 28835156 DOI: 10.1177/0969733017720826] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Maintaining patient's dignity in intensive care units is difficult because of the unique conditions of both critically-ill patients and intensive care units. OBJECTIVES The aim of this study was to uncover the cultural factors that impeded maintaining patients' dignity in the cardiac surgery intensive care unit. RESEARCH DESIGN The study was conducted using a critical ethnographic method proposed by Carspecken. PARTICIPANTS AND RESEARCH CONTEXT Participants included all physicians, nurses and staffs working in the study setting (two cardiac surgery intensive care units). Data collection methods included participant observations, formal and informal interviews, and documents assessment. In total, 200 hours of observation and 30 interviews were performed. Data were analyzed to uncover tacit cultural knowledge and to help healthcare providers to reconstruct the culture of their workplace. ETHICAL CONSIDERATION Ethical approval for the study from Ethics committee of Isfahan University of Medical Sciences was obtained. FINDINGS The findings of the study fell into the following main themes: "Presence: the guarantee for giving enough attention to patients' self-esteem", "Instrumental and objectified attitudes", "Adherence to the human equality principle: value-action gap", "Paternalistic conduct", "Improper language", and "Non-interactive communication". The final assertion was "Reductionism as a major barrier to the maintaining of patient's dignity". DISCUSSION The prevailing atmosphere in subculture of the CSICU was reductionism and paternalism. This key finding is part of the biomedical discourse. As a matter of fact, it is in contrast with dignified care because the latter necessitate holistic attitudes and approaches. CONCLUSION Changing an ICU culture is not easy; but through increasing awareness and critical self-reflections, the nurses, physicians and other healthcare providers, may be able to reaffirm dignified care and cure in their therapeutic relationships.
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Affiliation(s)
- Farimah Shirani Bidabadi
- Student Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ali Zargham-Boroujeni
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Harstäde CW, Blomberg K, Benzein E, Östlund U. Dignity-conserving care actions in palliative care: an integrative review of Swedish research. Scand J Caring Sci 2017; 32:8-23. [DOI: 10.1111/scs.12433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Carina Werkander Harstäde
- Centre for Collaborative Palliative Care; Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health; School of Health Sciences; Örebro University; Örebro Sweden
| | - Eva Benzein
- Centre for Collaborative Palliative Care; Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
| | - Ulrika Östlund
- Centre for Collaborative Palliative Care; Department of Health and Caring Sciences; Linnaeus University; Växjö Sweden
- Centre for Collaborative Palliative Care; Department of Health and Caring Sciences; Linnaeus University; Kalmar Sweden
- Centre for Research & Development; Uppsala University/Region Gävleborg; Gävle Sweden
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Caldeira S, Vieira M, Timmins F, McSherry W. From the struggle of defining to the understanding of dignity: A commentary on Barclay (2016) “In sickness and in dignity: A philosophical account of the meaning of dignity in health care”. Int J Nurs Stud 2017; 67:1-2. [DOI: 10.1016/j.ijnurstu.2016.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
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