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Fuseini AG, Rawson H, Redley B, Ley L, Mohebbi M, Kerr D. Self-reported dignity and factors that influence dignity in hospitalised older adults: A cross-sectional survey. J Clin Nurs 2023; 32:7791-7801. [PMID: 37604797 DOI: 10.1111/jocn.16850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/09/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE This study examined levels of self-reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana. BACKGROUND Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self-reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa. SETTING A large teaching hospital in the northern region of Ghana. PARTICIPANTS Hospitalised older adults. METHODS A cross-sectional survey was used to gather data from a convenience sample of 270 older inpatients, using the Hospitalized Older Adults' Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist. RESULTS More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations. CONCLUSION Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times. RELEVANCE TO CLINICAL PRACTICE The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender-sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions. PATIENT OR PUBLIC CONTRIBUTION Survey questionnaires were completed by hospitalised older adults at the study setting.
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Affiliation(s)
- Abdul-Ganiyu Fuseini
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Helen Rawson
- Monash Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Lenore Ley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong Waterfront Campus, Geelong, Victoria, Australia
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Kerr L, Newman P, Russo P. 'I don't want to impose on anybody': Older people and their families discuss their perceptions of risk, cause and care in the context of falls. Int J Older People Nurs 2023; 18:e12578. [PMID: 37776081 DOI: 10.1111/opn.12578] [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: 05/01/2023] [Revised: 08/28/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Falls in hospitalised patients remain an ongoing challenge for healthcare systems internationally. Limited research exists on the perspectives of older people on falls risk, cause and care. OBJECTIVES This study explored the experiences of patients and their families after a fall in a healthcare facility. METHODS Semi-structured interviews were conducted with patients and families to explore the experience of having a fall. Data were analysed thematically. RESULTS The themes that emerged from the 14 interviews included the following: explanations; physical environment; communication; experiences of care; perceptions of risk; ageism; feelings towards the fall; and independence and dignity. CONCLUSIONS This research emphasises the diversity in older people's experiences after experiencing a fall. Falls prevention should be incorporated as one part of healthy, dignified ageing. IMPLICATIONS FOR PRACTICE Falls prevention and management strategies should be multifactorial, including enhanced communication with the patient and their families. When engaging in education and awareness, falls prevention should be positioned as one component of independent and dignified healthy ageing.
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Affiliation(s)
- Lucille Kerr
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | | | - Philip Russo
- Cabrini Health, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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Fuseini AG, Mohebbi M, Redley B, Rawson H, Ley L, Kerr D. Development and psychometric validation of the hospitalized older adults' dignity scale for measuring dignity during acute hospitalization. J Adv Nurs 2023; 79:4058-4073. [PMID: 37226570 DOI: 10.1111/jan.15714] [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: 09/10/2022] [Revised: 02/06/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
AIM To develop and validate a culturally appropriate patient-reported outcome measure for measuring dignity for older adults during acute hospitalization. DESIGN A three-phased exploratory sequential mixed-method design was used. METHODS Domains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre-testing were undertaken using standard instrument development techniques. Two-hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test-retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study. RESULTS We established the 15-item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5-factor structure: shared decision-making (3 items); healthcare professional-patient communication (3 items); patient autonomy (4 items); patient privacy (2 items); respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test-retest reliability were demonstrated. CONCLUSION We established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity-related care in the future. IMPACT The development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity-related measures for older adults (i.e. shared decision-making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For example, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.
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Affiliation(s)
- Abdul-Ganiyu Fuseini
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | | | - Bernice Redley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Helen Rawson
- Monash Nursing and Midwifery, Monash University, Clayton, Australia
| | - Lenore Ley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Burwood, Australia
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Fuseini AG, Rawson H, Ley L, Kerr D. Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives. J Clin Nurs 2023; 32:1286-1302. [PMID: 35322497 DOI: 10.1111/jocn.16286] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/04/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to explore older adults' perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana. BACKGROUND Maintaining hospitalised older adults' dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults' perspectives of dignified nursing care in the African context. STUDY DESIGN A qualitative descriptive research design. METHODS Twenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi-structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study. RESULTS The following four themes were identified: Effective nurse-patient communication, Maintaining patients' privacy, Respectful and compassionate care provision and Providing quality and safe care. Dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care. Identified barriers to dignity included inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy. CONCLUSIONS Several enablers and barriers to dignified nursing care have been identified that have been discussed in previous studies. The unique factors identified in the Ghanaian context were family members' involvement in physical care influenced by cultural and religious beliefs, environmental barriers to privacy and dignity and inadequate involvement in decision making. RELEVANCE TO CLINICAL PRACTICE Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members. Future planning of healthcare infrastructure needs to consider the importance of private cubicles with disability-accessible ensuite bathrooms for patients' comfort and privacy.
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Affiliation(s)
| | - Helen Rawson
- Monash Nursing and Midwifery, Monash University, Melbourne, Vic., Australia
| | - Lenore Ley
- School of Nursing and Midwifery, Deakin University, Melbourne, Vic., Australia.,Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, Vic., Australia
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Fuseini A, Ley L, Rawson H, Redley B, Kerr D. A systematic review of patient-reported dignity and dignified care during acute hospital admission. J Adv Nurs 2022; 78:3540-3558. [PMID: 35841334 PMCID: PMC9795980 DOI: 10.1111/jan.15370] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 12/30/2022]
Abstract
AIMS To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients. DESIGN A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for reporting systematic reviews. DATA SOURCES Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward-forward searching using Web of Science and Scopus databases. REVIEW METHODS Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross-Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus. RESULTS Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations. CONCLUSION Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients. IMPACT The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.
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Affiliation(s)
- Abdul‐Ganiyu Fuseini
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
| | - Lenore Ley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
| | - Helen Rawson
- Nursing and Midwifery, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Bernice Redley
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
| | - Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, School of Nursing and MidwiferyDeakin University, Geelong Waterfront CampusGeelongVictoriaAustralia
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Naderi Z, Gholamzadeh S, Ebadi A, Zarshenas L. Development and psychometric properties of the hospitalized elder abuse questionnaire (HEAQ): a mixed methods study. BMC Geriatr 2022; 22:715. [PMID: 36038844 PMCID: PMC9426014 DOI: 10.1186/s12877-022-03400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older patients are more vulnerable and prone to abuse and neglect in hospitals and acute care settings. The present study aimed to develop and assess the psychometric properties of a questionnaire for screening abuse in hospitalized older adults. METHODS This study was conducted from October 2017 to September 2019 using the exploratory sequential mixed-methods research design. The participants were selected among those admitted to various wards of six teaching hospitals affiliated with Shiraz University of Medical Sciences, Shiraz, Iran. In the qualitative phase of the study, using the inductive content analysis method, the concept of abuse in hospitalized older adults was extracted through individual in-depth semi-structured interviews with 16 older patients and 11 family caregivers. Based on qualitative findings and a review of existing literature, an initial version of the questionnaire was developed. In the quantitative phase of the study, the psychometric properties (face, content, construct, and convergent validity; internal consistency and stability) of the questionnaire were examined. RESULTS Based on qualitative findings and literature review, a pool of 154 candidate items was defined. These items were reduced to 37 after initial refinement, qualitative and quantitative face and content validity, and item analysis. The outcome of principal component analysis further reduced the number of items to 27, which were grouped into 5 components, namely "Shortcomings in management and care facility", "Neglect of professional commitments", "Physical and psychological abuse", "Protracted treatment process", and "Invasion of privacy". The explained variance of these 5 components was 50.09% of the overall variability of the questionnaire. The convergent validity of the questionnaire was acceptable (P < 0.00, r = - 0.44). Cronbach's alpha coefficient and intraclass correlation coefficient for the entire questionnaire were 0.89 and 0.92, respectively; indicating high reliability and stability of the questionnaire. CONCLUSION The hospitalized elder abuse questionnaire (HEAQ) has acceptable psychometric properties. It is recommended to use HEAQ to screen for suspected cases of abuse of hospitalized older adults.
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Affiliation(s)
- Zeinab Naderi
- Department of Nursing, Sirjan School of Medical Sciences, Sirjan, Iran
| | - Sakineh Gholamzadeh
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ladan Zarshenas
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Kerr D, Martin P, Furber L, Winterburn S, Milnes S, Nielsen A, Strachan P. Communication skills training for nurses: Is it time for a standardised nursing model? PATIENT EDUCATION AND COUNSELING 2022; 105:1970-1975. [PMID: 35301988 DOI: 10.1016/j.pec.2022.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/10/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Debra Kerr
- Centre for Quality and Patient Safety, Institute for Health Transformation, Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
| | - Peter Martin
- Centre for Organisational Change in Person-Centred Healthcare, Deakin University, School of Medicine, Faculty of Health, Geelong, VIC, Australia; University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Lynn Furber
- Healthcare Communication Matters, London, UK
| | - Sandra Winterburn
- Norwich Medical School, University of East Anglia, Faculty of Medicine and Health Sciences, UK
| | - Sharyn Milnes
- University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
| | - Annegrethe Nielsen
- Department of Nursing, University College Copenhagen, Copenhagen, Denmark
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Fuseini AG, Bayi R, Alhassan A, Atomlana JA. Satisfaction with the quality of nursing care among older adults during acute hospitalization in Ghana. Nurs Open 2022; 9:1286-1293. [PMID: 34985206 PMCID: PMC8859075 DOI: 10.1002/nop2.1169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/15/2021] [Accepted: 12/15/2021] [Indexed: 11/06/2022] Open
Abstract
Aim This study assessed the level of satisfaction with the quality of nursing care among hospitalized older adults and the factors associated with it. Design This was a quantitative descriptive cross‐sectional survey. Methods We used a validated questionnaire to collect data from a convenience sample of 206 older adults from three government hospitals in Tamale, Ghana. Data were analysed using descriptive statistics, independent sample t test and one‐way ANOVA. Results Most of the participants (72.3%) reported moderate levels of satisfaction with the quality of nursing care, while 23.8% reported high levels of satisfaction. The association between gender, religion and level of satisfaction with nursing care was not statistically significant. However, patients differed on levels of satisfaction based on healthcare facility: patients at the Tamale Central Hospital were more satisfied with the quality of nursing care than those at the Tamale Teaching Hospital. There is a need for capacity building and sensitization workshops on the rudiments of geriatric care for nurses in the metropolis to serve as an impetus for improvement in the quality of care.
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Affiliation(s)
| | - Rahinatu Bayi
- Zebilla District Hospital, Upper East Region, Zebilla, Ghana
| | - Afizu Alhassan
- Nursing and Midwifery Training College, Kpembe, Salaga, Ghana
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Segevall C, Björkman Randström K, Söderberg S. Meanings of participation in care for older people after hip fracture surgery and nurses working in an orthopaedic ward. Int J Qual Stud Health Well-being 2021; 16:1970302. [PMID: 34431443 PMCID: PMC8405062 DOI: 10.1080/17482631.2021.1970302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE The aim of this study was to elucidate meanings of participation in care for older people after hip fracture surgery and nurses working in an orthopaedic ward. METHODS A qualitative phenomenological hermeneutical design was used. We conducted personal interviews with a narrative approach with 11 older people recovering from hip fracture surgery and 12 nurses working in an orthopaedic ward. RESULTS The results show that for older people, participation meant being a co-creator in their own care, founded on being met with sensitivity and support, being told what is going to happen, taking responsibility and asking questions and being able to influence care. For nurses, patient participation meant meeting the patients' needs and requests by being open and allowing them to influence care while at the same time recognizing that the patients' possibility to influence care was limited. CONCLUSION The study shows that for older people and nurses, the phenomenon of participation has similar meanings but also differences. When older people participate in their care, they become a co-creator in care and confirmed as a person. This highlights the importance of a nurse-patient relationship built on trust, connectedness and communication based on a shared understanding.
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Affiliation(s)
- Cecilia Segevall
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
| | | | - Siv Söderberg
- Department of Nursing Sciences, Mid Sweden University, Östersund, Sweden
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Kisvetrová H, Tomanová J, Hanáčková R, Greaves PJ, Steven A. Dignity and Predictors of Its Change Among Inpatients in Long-Term Care. Clin Nurs Res 2021; 31:274-283. [PMID: 34369174 PMCID: PMC8822202 DOI: 10.1177/10547738211036969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to identify any differences in the dignity
evaluation of geriatric inpatients after 1 month of hospitalization in a
long-term care wards (LTC) and predictors of this change. This follow-up study
included 125 geriatric inpatients who filled the Patient Dignity Inventory
(PDI-CZ), Geriatric Depression Scale, Barthel Index, and Mini-Mental State
Examination. In the initial measurement, the patients rated of PDI-CZ item “Not
able to perform tasks of daily living” the worst. One month after, the items
“Not able to perform tasks of daily living,” “Not able to attend to bodily
functions,” and “Not feeling worthwhile or valued” were improved. Patients with
higher education, for whom self-sufficiency improved and depression decreased,
rated their dignity more positively 1 month after the hospitalization in LTC.
Our findings suggest that these factors are important for the maintenance of the
dignity of older adults hospitalized in LTC.
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Affiliation(s)
- Helena Kisvetrová
- Palacký University Olomouc, Czech
Republic
- Helena Kisvetrová, Centre for Research and
Science, Faculty of Health Sciences, Palacký University Olomouc, Hnevotinska 3,
Olomouc 775 15, Czech Republic.
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