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Silverstein A, Easton V, Barrows C, Sawyer K, Coughlin R, Mali N, Kessler A, Robinson M, Sirrine E, Spears M, Wrigley J, Baker JN, Kaye EC. Dignity in the Pediatric Population: A Systematic Review. J Pain Symptom Manage 2024:S0885-3924(24)00862-5. [PMID: 39032678 DOI: 10.1016/j.jpainsymman.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/10/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
CONTEXT Children are a uniquely vulnerable patient population with restricted abilities for self-advocacy and autonomy, risking infringement upon their dignity. Yet the concept of dignity in pediatrics remains underexplored relative to the adult literature and other outcome measures. OBJECTIVES To characterize how dignity is defined, evaluated, and/or measured in pediatrics. METHODS We conducted a systematic review following PRISMA guidelines across the following databases: MEDLINE, Embase, Cumulative Index of Nursing and Allied Health, PsycINFO, Global Health, Social Science Premium Collection, and Dissertation and Theses. We included publications from database inception through April 2023, in English, involving children aged 0-18 years, and prioritizing dignity as a central theme with a focus on defining, evaluating, or measuring dignity. Study descriptions and pertinent characteristics were extracted and synthesized using a predefined form. RESULTS Forty-four articles met inclusion criteria; fewer than half comprised original research (20/44, 45%). Most studies (38/44, 86%) included description of the meaning of dignity, with emergence of salient themes around respect, communication, agency/autonomy, and privacy. Less than half (19/44, 43%) included a measurement or evaluation of dignity; approximately one-third described dignity therapy. More than one-third of publications focused on dignity at end of life (17/44, 39%) and included discussions of palliative care and hospice (15/44, 34%). CONCLUSION Relatively few published studies describe dignity in pediatrics. Opportunities exist to broaden scholarship on this topic in partnership with patients, families, and clinicians, with the goal of assessing and strengthening dignity-centered care across the illness course and at the end of life.
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Affiliation(s)
- Allison Silverstein
- Section of Palliative Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Veronica Easton
- Department of Internal Medicine, St. Bernards Medical Center, Jonesboro, AR, USA
| | - Cory Barrows
- Section of Hospice and Palliative Medicine, University of Tennessee Health Science Center, University, Memphis, TN, USA
| | - Kimberly Sawyer
- Section of Palliative Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Rachel Coughlin
- Section of Palliative Medicine, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Nidhi Mali
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amber Kessler
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew Robinson
- Department of Internal Medicine, Baptist Memorial Hospital, Memphis, TN, USA
| | - Erica Sirrine
- Department of Social Work, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Jordan Wrigley
- Biomedical Library, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Justin N Baker
- Division of Quality of Life and Pediatric Palliative Care, Stanford University, Palo Alto, CA, USA
| | - Erica C Kaye
- Division of Quality of Life and Palliative Care, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Liu Y, Wang R, Qiao S, Liu F, Wang L, Su Y. How dignity-related distress interact with quality of life in young adult patients with cancer during the active treatment stage: A network analysis. Psychooncology 2022; 31:1564-1571. [PMID: 35793432 DOI: 10.1002/pon.5998] [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: 03/11/2022] [Revised: 06/25/2022] [Accepted: 07/03/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Young adult patients with cancer are a growing concern. By means of network analysis, this study aimed to explore the interplay between dignity-related distress and quality of life (QoL) in young adult patients with cancer when they undergo active treatments. METHODS In this cross-sectional study, 309 young adults aged 18-39 and diagnosed with malignant tumors were recruited from an oncology center in China between September 2020 and August 2021. Participants completed the Patient Dignity Inventory and SF-36 questionnaires. Network analysis was applied to examine the network structure. RESULTS Overall, the core facets of dignity-related distress were negatively related to QoL and its corresponding domains, either directly or indirectly. Developmental distress played a central role among estimated networks and strongly interplayed with most QoL domains, especially the mental domains. Symptom distress was the only facet consistently interplayed with the physical domains of QoL (i.e., physical function and bodily pain). The social aspects were also revealed in the association between limited social support and vitality. CONCLUSIONS Early attention must be paid to guarantee the need of preserving dignity and enhancing QoL for young adult patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuqi Liu
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Rui Wang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Shiman Qiao
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fuyan Liu
- Department of Radiotherapy, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Lanzhong Wang
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China
| | - Yonggang Su
- School of Foreign Languages and Literature, Shandong University, Jinan, Shandong, China.,School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China.,Shandong Provincial Key Laboratory of Mental Disorders, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
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Yektatalab S, Noghabi FA, Momennasab M, Ebadi A, Zare N. Exploring children’s dignity: A qualitative approach. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/94093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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Parent's experiences of their child's withdrawal syndrome: a driver for reciprocal nurse-parent partnership in withdrawal assessment. Intensive Crit Care Nurs 2018; 50:71-78. [PMID: 30224222 DOI: 10.1016/j.iccn.2018.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 11/20/2022]
Abstract
Withdrawal assessment in critically ill children is complicated by the reliance on non-specific behaviours and compounded when the child's typical behaviours are unknown. The existing approach to withdrawal assessment assumes that nurses elicit the parents' view of the child's behaviours. OBJECTIVE AND RESEARCH METHODOLOGY This qualitative study explored parents' perspectives of their child's withdrawal and preferences for involvement and participation in withdrawal assessment. Parents of eleven children were interviewed after their child had completed sedation weaning during recovery from critical illness. Data were analysed using thematic analysis. SETTING A large children's hospital in the Northwest of England. FINDINGS Parents experienced varying degrees of partnership in the context of withdrawal assessment and identified information deficits which contributed to their distress of parenting a child with withdrawal syndrome. Most parents were eager to participate in withdrawal assessment and reported instances where their knowledge enabled a personalised interpretation of their child's behaviours. Reflecting on the reciprocal nature of the information deficits resulted in the development of a model for nurse-parent collaboration in withdrawal assessment. CONCLUSION Facilitating nurse-parent collaboration in withdrawal assessment may have reciprocal benefits by moderating parental stress and aiding the assessment and management of withdrawal syndrome.
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Khademi M, Mohammadi E, Vanaki Z. On the violation of hospitalized patients' rights: A qualitative study. Nurs Ethics 2017; 26:576-586. [PMID: 28604227 DOI: 10.1177/0969733017709334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: Nurses have always been known as an advocate for the rights of patients. The recognition of what is perceived as the violation of patients' rights can help nurses to understand patients' concerns and priorities. Thus, it helps nurses play their supportive roles more effectively. OBJECTIVE: The aim of this study was to explore different dimensions of the violation of patients' rights. RESEARCH DESIGN: Data were collected utilizing unstructured interviews and field notes. Data analysis was conducted using the qualitative content analysis approach. Prolonged engagement, maximum variation sampling, and member check were among the factors which enriched the research. PARTICIPANTS AND RESEARCH CONTEXT: The sample consisted of 18 patients and 11 members of their families. They were purposively selected from two hospitals in Tehran during 2009-2012. ETHICAL CONSIDERATIONS: The research was approved by the Ethics Committee of the university and hospitals. FINDING: The patients' rights were violated in a variety of ways. There were three main dimensions to this issue: (a) care recession including deprivation of the caregiver's presence and the delay/lack of needed responses; (b) receiving mechanical care including superficiality, lack of emotion, and failure to understand the situation; and (c) being disrespected including humility and aggression. CONCLUSION: The patients and their families consider any shortcomings in relation to the patient and the quality of care as the violation of the rights. The findings of the study imply sensitizing managers toward providing appropriate conditions as well as educating nurses to observe patients' rights. It is suggested that the processes leading to the violation of patients' rights be discovered and prevented in the future.
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Affiliation(s)
- Mojgan Khademi
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Iran; Tarbiat Modares University, Iran
| | | | - Zohreh Vanaki
- Faculty of Medical Sciences, Nursing Department, Tarbiat Modares University, Iran
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Abstract
In this paper, we draw on a phenomenological-philosophical foundation to clarify the meaning of dignity as a coherent phenomenon. Consistent with an evocation of its central meanings, we then introduce and delineate seven kinds of dignity that are intertwined and interrelated. We illustrate how these kinds of dignity can provide a useful template to think about its qualities, its 'rupture' and its 'restoration' in human life, particularly in relation to health and social care contexts. We then consider the implications of these relational and experiential views for current debates about the notion of dignity: Is dignity a useless concept? Is dignity objective or subjective? What are the useful ways of characterizing different varieties of dignity? We conclude by pointing to a metaphor that may hold the sense and meaning of our deepest human dignity: The gathering of both value and vulnerability, in which human value does not depend on the eradication of human vulnerability, but occurs within its very context.
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Affiliation(s)
- Kathleen Galvin
- Faculty of Health and Social Care, University of Hull, Hull, UK
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Tuck I. Does the concept of dignity warrant further research, and can the work be moved forward? Res Gerontol Nurs 2014; 7:246-7. [PMID: 25423624 DOI: 10.3928/19404921-20141113-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Narayan K, Hooker C, Jarrett C, Bennett D. Exploring young people's dignity: a qualitative approach. J Paediatr Child Health 2013; 49:891-894. [PMID: 24251655 DOI: 10.1111/jpc.12430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 11/27/2022]
Abstract
AIM Human dignity as an important consideration in health care has been primarily investigated from an adult perspective. This paper explores young people's perceptions of dignity and how it impacts on their health-care experience. METHOD A qualitative pilot study was undertaken at the Children's Hospital, Westmead in from 2010 to 2011. Semistructured interviews were conducted with five inpatients, and data were analysed using a grounded theory approach. RESULTS The adolescents interviewed perceived dignity as a way of protecting their personhood. Privacy and maintaining integrity were the means by which dignity could be preserved in a health-care setting. CONCLUSIONS The study found that young people had unique perceptions of privacy and personhood with regards to dignity. Of the concepts of dignity in the existing literature, the dignity of identity was most applicable to adolescents' conceptions. This understanding of young people's views of dignity could prevent dignity violations in health care and beneficially impact their development.
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Affiliation(s)
- Kruthika Narayan
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Hooker
- Centre for Values, Ethics and Law in Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Carmen Jarrett
- Centre for the Advancement of Adolescent Health, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David Bennett
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for the Advancement of Adolescent Health, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
The aim of this study was to identify key aspects in the exchange of information and to determine how nurses communicate news to hospitalised children. For this study, we applied the critical incident technique with 30 children aged between 8 and 14 years. Data were collected in paediatric units in a hospital in Alicante (Spain) using participant observation and semi-structured interviews. The analysis yielded three main categories: the children's reaction to the information, nursing staff behaviour as a key aspect in the exchange of information and communication of news as well as children's experience. This article emphasises the need to promote children's consent and participation in nursing interventions. An analysis of these aspects will verify whether children's rights are being respected and taken into account in order to promote children's well-being and adaptation to hospitalisation.
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Gallagher A, Zoboli ELCP, Ventura C. Dignity in care: where next for nursing ethics scholarship and research? Rev Esc Enferm USP 2013; 46 Spec No:51-7. [PMID: 23250258 DOI: 10.1590/s0080-62342012000700008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 09/14/2012] [Indexed: 11/22/2022] Open
Abstract
Dignity is recognised as both a central and also a contested value in bioethics discourse. The aim of this manuscript is to examine some of the key strands of the extensive body of dignity scholarship and research literature as it relates to nursing ethics and practice. The method is a critical appraisal of selected articles published in Nursing Ethics and other key manuscripts and texts identified by researchers in the UK and Brazil as influential. The results suggest a wide and rather confusing range of perspectives and findings albeit with some overall themes relating to objective and subjective features of dignity. In conclusion, the authors point to the need for more sustained philosophical engagement contextualising human dignity within a plurality of professional values. Future empirical work should explore what matters to patients, families, professionals and citizens in different cultural contexts rather than foregrounding qualitative research with such a contested concept.
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Affiliation(s)
- Ann Gallagher
- International Centre for Nursing Ethics, School of Health and Social Care, University of Surrey, UK.
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Jönsson L, Hallström I, Lundqvist A. "The logic of care" - parents' perceptions of the educational process when a child is newly diagnosed with type 1 diabetes. BMC Pediatr 2012; 12:165. [PMID: 23083125 PMCID: PMC3489565 DOI: 10.1186/1471-2431-12-165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 10/17/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The number of new cases of type 1 diabetes mellitus (T1DM) has increased substantially in recent years and it is now one of the most common long-term endocrine disorders in childhood. In Sweden the child and family are hospitalised in accordance with the national guidelines for one to two weeks at diagnosis. The purpose of this study was to describe parents' perceptions of the educational process when their child is newly diagnosed with T1DM. METHODS Qualitative interviews were performed in the south western part of Sweden with ten mothers and eight fathers of children, diagnosed with T1DM, at three to six months after they had received the diagnosis. The interviews were analysed using deductive content analysis and Mol's philosophical theory. RESULTS The results show that almost all parents had experienced the educational process as being satisfactory. However, most parents felt that the teaching needed to be adapted to the individual families and to help them to learn to live with diabetes in their everyday lives. Rather than merely teaching according to a fixed schedule and cramming knowledge, the education should be parent-centered and provide time for grief and shock. There should also be a greater emphasis on why certain things should be done rather than on what should be done. The routines learned at the hospital made the efforts to be good parents managing the child's disease, and continuing to lead a normal family life, a difficult task. CONCLUSIONS In order to optimize the educational process for families with children newly diagnosed with T1DM an increased focus on the families' perceptions might be helpful in that this could lead to further revelations of the educational process thus making it more understandable for the family members involved.
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Affiliation(s)
- Lisbeth Jönsson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Inger Hallström
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anita Lundqvist
- Department of Health Sciences, Lund University, Lund, Sweden
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Nahid Dehghan Nayeri, Karimi R, Sadeghee T. Iranian nurses and hospitalized teenagers’ views of dignity. Nurs Ethics 2011; 18:474-84. [DOI: 10.1177/0969733011403552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Respect for human dignity is a basic and crucial component of nursing care. Illness with restricted physical ability and being confined to bed can compromise the dignity of patients. The views of adolescents regarding dignity in care have not previously been researched. This article details a descriptive-analytic study in which survey data was collected from all nurses and compared with a convenience sample of 180 hospitalized adolescents in two hospitals in Iran. The data was analyzed with SPSS software. A significant difference between nurses and hospitalized ill adolescents’ perceptions was identified in relation to: understanding the importance of privacy (p < 0.001); observance of privacy (p < 0.001); importance of interaction between nurses and patients (p = 0.019); and the observance of interaction between nurses and patients (p < 0.001). Attention to adolescents’ views about dignity can help nurses to improve quality of care for this group.
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Affiliation(s)
- Nahid Dehghan Nayeri
- Tehran University of Medical Sciences, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran,
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Mikkelsen G, Frederiksen K. Family-centred care of children in hospital - a concept analysis. J Adv Nurs 2011; 67:1152-62. [DOI: 10.1111/j.1365-2648.2010.05574.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Streuli JC, Michel M, Vayena E. Children's rights in pediatrics. Eur J Pediatr 2011; 170:9-14. [PMID: 20461530 DOI: 10.1007/s00431-010-1205-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 11/25/2022]
Abstract
The United Nations Convention of Children's Rights (UNCRC) introduced in 1989 has generated a global movement for the protection of children's rights and has brought about a paradigm change in how children are perceived. Pediatric healthcare professionals are interacting with children and therefore with children's rights on a daily basis. However, although at least 18 of the 54 articles are relevant for pediatric practice, there is limited systematic training on how pediatricians can support children's rights in the clinical setting. This article discusses the principles and aims of the UNCRC and proposes a comprehensive checklist of rights vis-à-vis issues that arise in clinical practice.
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Affiliation(s)
- Jürg C Streuli
- Institute of Biomedical Ethics, University of Zurich, Pestalozzistr. 24, CH-8032, Zürich, Switzerland.
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Rullander AC, Isberg S, Karling M, Jonsson H, Lindh V. Adolescents' experience with scoliosis surgery: a qualitative study. Pain Manag Nurs 2010; 14:50-9. [PMID: 23452527 DOI: 10.1016/j.pmn.2010.07.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 07/14/2010] [Accepted: 07/14/2010] [Indexed: 11/19/2022]
Abstract
This article reports a study of adolescents' narrated experiences of undergoing scoliosis surgery. Six adolescents were interviewed. Open and semistructured questions were asked, and a qualitative content analysis of the text was performed. The results are presented in three main categories followed by subcategories. The three main categories of experience were emotional, physical, and social. The emotional aspects that emerged were fear, nightmares, nervousness, and helplessness. These had a great impact on adolescents' well-being before, during, and after the hospital visit. The physical aspects were mobilization, scars, different hip levels, pain, nausea, appetite, and urinary catheter. These aspects caused much discomfort, mostly during the hospital visit. The social aspects were friends, power, coaching and comfort, and sports. Some of the social aspects had a strong negative impact on the adolescents' well-being mostly after the hospital visit. This study suggests that both before and long after the surgery adolescents have strong emotions that they should be better prepared and helped to manage. To optimize perioperative care an interdisciplinary, a holistic approach must be taken that incorporates the complexity and whole of the adolescent's experiences. The findings of this study suggest that perioperative care of adolescents during scoliosis surgery needs to be optimized. To improve patients' psychologic preparation before surgery pediatric nurses should learn more about the individual patient and make care plans from a holistic perspective. Follow-up after discharge should address emotional, social, and physical aspects of the adolescent's health.
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Abstract
In this grounded theory analysis I sought to understand dignity violation in health care and to explore the context in which such violations take place. I found that dignity violation in health care occurs through processes of rudeness, indifference, condescension, dismissal, disregard, dependence, intrusion, objectification, restriction, labeling, contempt, discrimination, revulsion, deprivation, assault, and abjection. The conditions that promote these processes reside in the positions of the actors involved; in the asymmetrical relationships between the actors; in the health care setting itself, which is characterized by multiple tensions-including those between needs and resources, crisis and routine, experience and expertise, and rhetoric and reality; and in the embeddedness of health care in a broader social order of inequality. These findings suggest several interventions that might mitigate dignity violation in health care.
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Affiliation(s)
- Nora Jacobson
- Centre for Addiction and Mental Health and Department of Psychiatry, Toronto, Ontario, Canada.
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Abstract
The concept of human dignity is a term commonly used in professional codes and standards for biomedical healthcare disciplines and professional nursing practice. What is the definition of this ethical concept? This column offers a unique definition from a nursing disciplinary perspective. Common straight thinking or ethical questions emerging with the application of the concept in practice are offered along with a discussion of misunderstandings regarding the use of the concept in nursing practice and in professional healthcare arenas.
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