Dehumanization in intensive care units and standard wards: A survey for a comparative cross-sectional study

OBJECTIVES

Dehumanization refers to the practice of treating patients as objects rather than individuals with dignity and respect.

METHODS

This study explores dehumanization in healthcare, specifically mechanistic dehumanization and self-dehumanization, which can result in poor care and negative outcomes. A cross-sectional observational study was conducted using a dehumanization questionnaire given to 324 nurses in various departments. The study took place at ANONYMIZED, from September to November 2022. The questionnaire analyzed emotions like anger, impatience, and apathy, identified as key dehumanizing factors.

RESULTS

Results indicated that these emotions were prevalent in nurses' perceptions of patients. Interestingly, while Intensive Care nurses often involved families in patient care, leading to higher satisfaction, ward department nurses sometimes viewed patient or family relationships as obstacles. Despite this, 66 % of nurses reported satisfaction with the care provided, while 12 % were indifferent.

CONCLUSIONS

The study concludes that the root of dehumanization lies in nurses' inability to feel emotions, the impersonality of care, and the sterility of assistance, leading to self-dehumanization. To combat this, the study suggests strengthening nursing autonomy and education and fostering a positive work environment. The way nurses perceive themselves directly impacts their treatment of patients.

Rethinking dehumanization, empathy, and burnout in healthcare context

Dehumanization has been characterized as common in medical settings, despite limited work directly examining this. In this context, everyday dehumanization is believed to be largely unconscious and unintentional, resulting from a variety of factors often related to structural and organizational aspects of healthcare. This article adopts the patients' and the healthcare providers' perspective to explore how dehumanization can have helpful and hurtful effects on patient outcomes and provider well-being. Future directions include more direct assessment of dehumanization in healthcare settings, centering the needs and experiences of people with mental illness and comorbid conditions, and improving our understanding of dehumanization relative to emotion regulation processes.

Relationship among symptoms, quality of life, and complementary and alternative medicines use among patients undergoing hemodialysis in French-speaking Switzerland

BACKGROUND

Chronic renal disease is considered a main public health problem due to its high prevalence in the population. The solution of choice currently available is kidney transplantation but when this option is not available, blood purification treatments, notably haemodialysis (HD), are necessary. The presence of chronic renal disease combined with this demanding medical procedure leads to a hard symptomatology. To face this situation, HD patients often resort to complementary and alternative medicines (CAM) as they perceive that the healthcare professionals aren't paying enough attention to their quality of life. Given this background, we aim to describe the prevalence and the type of the CAM used among HD patients and their possible relations with patients' symptomatology and quality of life.

METHODS

We interviewed 88 patients, undergoing hemodialysis in three hemodialysis centers in French-speaking Switzerland, about the presence of symptoms, their quality of life, and the possible use of CAM. Cluster analysis was used to create patients' profiles about CAM use and regression analysis to explore the links between symptoms' presence, patients' quality of life, and CAM use.

RESULTS

Our results show a large use of CAM: almost two HD patients out of three uses at least one CAM. Using cluster analysis, we were able to identify five patients' profiles: non-users (37.5% of our sample), users of herbal medicine (20.5%), users of prayer-based practices (18.2%), people mainly using massages (9.1%), and a residual group including the users of other CAMs, with a predominance of meditation (14.8%). As expected, we observe a negative relation between the number of declared symptoms and patients' quality of life. Contrarily, we observe no relation between the use of CAM and the presence of symptoms. Our results show a positive relationship between the use of CAM and patients' overall perception of health as well as the psychological dimension of their quality of life. No relationship is observed with other dimensions of quality of life, notably the physical dimension.

CONCLUSIONS

Our results suggests that CAMs aren't used as a substitute of official medicine but as a parallel support to HD patients' quality of life.

'Scanxiety': Content analysis of pre-MRI patient experience on Instagram

INTRODUCTION

Distress and anxiety are commonly reported during the Magnetic Resonance Imaging (MRI) experience with prior studies suggesting the pre-MRI period is a time of heightened distress. There is a paucity of literature exploring preprocedural distress and anxiety, in particular qualitative research analysing patient experience. Instagram is rapidly becoming an important social media platform though which to conduct health research. A gradually increasing number of studies have examined social media to gain insight into patient experience within medical radiation science (MRS). This study is considered as the first to explore patient experience of MRI using Instagram as a data source.

METHODS

This study investigated the patient experience during the pre-MRI period by performing a content analysis on open-source Instagram posts. Ethical approval for the study was sought and approved by the Charles Sturt University, Human Research Ethics Committee.

RESULTS

Six themes emerged from the extracted data; Journey to the MRI, Waiting, Anticipating the MRI procedure, Preparing for the MRI procedure, Negative interaction, and Fear of the results.

CONCLUSION

The findings of this study provide novel self-reported and unsolicited insight into the diverse, multifactorial, and often concomitant nature of preprocedural MRI anxiety and distress.

IMPLICATIONS FOR PRACTICE

This study adds to a growing body of literature advocating for a compassionate, holistic, and person-centered approach when caring for patients in MRI that also considers their emotional and psychological wellbeing.

Self-dehumanization and other-dehumanization toward students with special educational needs: examining their prevalence, consequences and identifying solutions-a study protocol

BACKGROUND

Students with special educational needs (SEN) often face dehumanization, which negatively impacts their mental health, daily functioning, and educational outcomes. This study seeks to address the research gap in dehumanization literature by examining the prevalence, dynamics, and consequences of self-dehumanization and other-dehumanization among SEN students. Moreover, by utilizing psychological experiments, the study aims to identify potential intervention strategies and make recommendations to minimize the negative psychological consequences derived from the dual model of dehumanization.

METHODS

This two-phase, mixed-methods study incorporates cross-sectional surveys and quasi-experimental designs. Phase 1 investigates the self-dehumanization of SEN students and other-dehumanization from non-SEN peers, teachers, parents, and the public. Phase 2 involves four experimental studies to evaluate the effectiveness of interventions emphasizing human nature and uniqueness in reducing self-dehumanization and other-dehumanization of SEN students, as well as their associated negative consequences.

DISCUSSION

The study fills a research gap by examining dehumanization in SEN students, applying dyadic modeling, and identifying potential solutions to ameliorate dehumanization and its negative consequences. The findings will contribute to the advancement of the dual model of dehumanization, increase public awareness and support for SEN students in inclusive education, and promote changes in school practice and family support. The 24-month study in Hong Kong schools is expected to provide significant insights into inclusive education in school and community settings.

A qualitative inquiry of communication based barriers to the diagnosis of pediatric cancer: Perceptions of primarily Spanish-speaking caregivers

BACKGROUND

Primarily Spanish-speaking cancer patients and caregivers often experience non-congruence with healthcare providers about beliefs, values, and knowledge of cancer. Our goal was to describe how communication related to the diagnosis of cancer was influenced by culture and language among primarily Spanish-speaking caregivers of pediatric cancer patients.

METHODS

Caregivers participated in three focus groups about their experiences with their child's diagnosis, communication issues, and understanding of their child's diagnosis and treatment plan. Focus groups were audio recorded, transcribed, and qualitatively analyzed using interpretive description.

RESULTS

Three themes emerged: 1) Negative experiences and barriers during the cancer diagnosis and treatment, 2) Miscommunication and system complexity, and 3) Language barriers throughout the diagnostic process. Due to barriers and negative experiences, some caregivers reported that their child's diagnosis was delayed, that providers sometimes used dehumanizing language, and that they were confused about diagnostic testing and treatment.

CONCLUSION

Cultural and linguistic disparities in pediatric oncology must be systematically addressed at the provider, clinic, and system level.

PRACTICE IMPLICATIONS

High-quality cancer care delivered by oncologists and cancer care teams should include cultural humility when discussing the cancer diagnosis and prognosis.

Transformation of Clinical Nursing Practice Following a Caring-based Educational Intervention: A Qualitative Perspective

Introduction

Hemodialysis (HD) patients experience numerous physical and psychological symptoms on a daily basis. These symptoms have a heavy impact on their quality of life, which is a key indicator of their survival in the short term. Numerous empirical studies have shown that the quality of the nurse-patient relationship (NPR) is essential in promoting positive outcomes for patients. When patients receive caring, their autonomy and independence grows, their sense of hope increases, their quality of life improves, and their sense of satisfaction with nursing care received rises. Inversely, the presence of dehumanizing practices in hemodialysis settings can contribute to delay healing for patients. In light of the importance of the quality of the relationship between nurses and HD patients and of the benefits to be had from a quality relationship, an educational intervention based on Watson's Theory of Human Caring was delivered to HD nurses.

Objective

The purpose of this study was to explore qualitatively the perceptions of nurses working with HD patients in French-speaking Switzerland regarding changes to their clinical practice after receiving an educational intervention intended to reinforce caring attitudes and behaviors towards patients.

Methods

The method used was that of consensual qualitative research (CQR). Sixteen semi-structured interviews were conducted with hemodialysis nurses post-intervention.

Results

The results evidence a transformation of clinical nursing practice illustrated by three core ideas: (1) caring practice was reinforced; (2) new practices emerged; and (3) some limitations appeared.

Conclusion

In these times of global pandemic where the issue of the humanization of nursing care is front and center, this professional development activity helped reinforce caring-based practice. This practice needs to be developed within the various care units in order to guarantee and promote quality of care and patient safety.

Dehumanization: trends, insights, and challenges

Despite our many differences, one superordinate category we all belong to is 'humans'. To strip away or overlook others' humanity, then, is to mark them as 'other' and, typically, 'less than'. We review growing evidence revealing how and why we subtly disregard the humanity of those around us. We then highlight new research suggesting that we continue to blatantly dehumanize certain groups, overtly likening them to animals, with important implications for intergroup hostility. We discuss advances in understanding the experience of being dehumanized and novel interventions to mitigate dehumanization, address the conceptual boundaries of dehumanization, and consider recent accounts challenging the importance of dehumanization and its role in intergroup violence. Finally, we present an agenda of outstanding questions to propel dehumanization research forward.

Effects of an educational intervention to strengthen humanistic practice on haemodialysis nurses' caring attitudes and behaviours and quality of working life: a cluster randomised controlled trial

Background

Nurses are trained to establish a trusting relationship with patients to create an environment promoting patients’ quality of life. However, in tech-heavy care settings, such as haemodialysis units, dehumanising practices may emerge and take root for various reasons to the potential detriment of both patients and nurses. For patients, this may lead to a deterioration of quality of life and, ultimately, of health status. For nurses, it may cause a deterioration of the work environment and, in turn, of quality of working life. Based on Watson’s Theory of Human Caring, we developed a brief educational intervention for haemodialysis nurses to strengthen their humanistic practice in the aim of improving the nurse-patient relationship and nurse quality of working life.. The intervention was tested by way of an experimental design.

Methods

One hundred and one haemodialysis nurses, recruited in ten hospitals in French-speaking Switzerland, were randomised into an experimental group that received the intervention and a control group. The nurse-patient relationship was measured with the Caring Nurse-Patient Interaction Scale (EIIP-70) and nurse quality of life at work was measured with the Quality of Work Life Questionnaire at four time points: pre-intervention, intervention completion, and six-month and one-year follow-ups. Random intercept regression analysis was used to evaluate change over time in the two variables under study.

Results

The intervention appeared to reinforce nurse attitudes and behaviours geared to a more humanistic practice. The effect seemed to fade over time but, 1 year post-intervention, six dimensions of the nurse-patient relationship (hope, sensibility, helping relationship, expression of emotions, problem solving, teaching) scored above baseline. Nurse quality of working life, too, seemed positively impacted. The cultural dimension of nurse quality of working life, that is, the degree to which everyday work activities attune with personal and cultural values, seemed positively impacted, as well, with improvement stable throughout the year following the intervention.

Conclusions

Results support a positive effect of the intervention over both the short term and the medium-to-long term. A brief intervention of the sort may constitute an effective means to improve the nurse-patient relationship by preventing or reducing dehumanising practices.

Trial registration

NCT03283891.

Classism in pain assessment and management: the mediating role of female patient dehumanization and perceived life hardship

ABSTRACT

Compared with racism and sexism, classism in pain assessment and management practices (PAMPs) has been less investigated, and its mediating mechanisms are still unknown. Drawing on a social psychological model of dehumanization, this research aimed to test (1) the effect of patient socioeconomic status (SES; a proxy of social class) on PAMPs and (2) whether patient dehumanization and perceived life hardship mediated these effects. Two online experimental studies were conducted, in which patient SES was manipulated (low vs high) within-subjects. One-hundred sixty-two female medical students (study 1) and 105 female nurses (study 2) were presented with vignettes/images depicting 2 cases of women with chronic low-back pain, followed by videos of them performing a pain-inducing movement. Participants reported on patient dehumanization, perceived life hardship, and PAMPs. The low SES patient was perceived as less pain sensitive (medical students alone) but more disabled, credible, and her pain more attributed to psychological causes (by nurses alone). Medical students recommended less nonpharmacological treatments but prescribed slightly stronger medication. Medical students were less willing to provide individualized care to the low SES patient, whereas nurses showed the opposite pattern. Patient mechanistic dehumanization mediated SES effects on pain disability (medical students alone). Perceived life hardship mediated SES effects on pain disability, credibility (nurses alone), and intentions of providing individualized care (nurses alone). These finding bear novel contributions to the fields of pain, health service research, and social psychology and have important implications to the development of more effective future interventions to reduce classism in PAMPs.

Self-dehumanisation in severe alcohol use disorder: Links with self-stigma and environmental satisfaction

Metadehumanisation (i.e., the perception of being considered as less than human by others) is proposed to be widespread in stigmatised populations, such as people with severe alcohol use disorder (SAUD). However, the relations between metadehumanisation, self-dehumanisation (i.e., the self-perception of being less than human), and stigmatisation (i.e., the negative taint applied to some groups) remain unexplored. The aim of this research is thus to investigate the relations between these processes. Metadehumanisation, self-dehumanisation, self-stigma (and its subdimensions) and environmental satisfaction were assessed in 120 inpatients with SAUD and analysed in a mediational model. Stigma awareness was positively associated with metadehumanisation, whereas environmental satisfaction was negatively associated with metadehumanisation. Stigma's application to the self was associated with increased self-dehumanisation. Self-stigma and self-dehumanisation are closely intertwined phenomena. Self-dehumanisation seems to follow a multi-step process suggesting that some steps, such as dehumanisation awareness, are missing from current models of dehumanisation.

Social Symptoms of Parkinson's Disease

Parkinson's disease (PD) is typically well recognized by its characteristic motor symptoms (e.g., bradykinesia, rigidity, and tremor). The cognitive symptoms of PD are increasingly being acknowledged by clinicians and researchers alike. However, PD also involves a host of emotional and communicative changes which can cause major disruptions to social functioning. These incude problems producing emotional facial expressions (i.e., facial masking) and emotional speech (i.e., dysarthria), as well as difficulties recognizing the verbal and nonverbal emotional cues of others. These social symptoms of PD can result in severe negative social consequences, including stigma, dehumanization, and loneliness, which might affect quality of life to an even greater extent than more well-recognized motor or cognitive symptoms. It is, therefore, imperative that researchers and clinicans become aware of these potential social symptoms and their negative effects, in order to properly investigate and manage the socioemotional aspects of PD. This narrative review provides an examination of the current research surrounding some of the most common social symptoms of PD and their related social consequences and argues that proactively and adequately addressing these issues might improve disease outcomes.

Classism and dehumanization in chronic pain: A qualitative study of nurses' inferences about women of different socio-economic status

OBJECTIVES

Class-based dehumanization in health is poorly investigated. Beliefs about social class are often shared across cultures, with people of lower socio-economic status (SES) being typically dehumanized. This study specifically examined how nurses' perceptions of pain patients' SES were associated with (more or less) dehumanizing inferences about their pain and different treatment recommendations.

DESIGN

Sequential mixed methods including Similitude Analysis (statistical analysis of qualitative data) and a Thematic Analysis. Fifty female nurses watched short videos of two white women of different SES (low vs. middle) and similar levels of pain behaviours. Afterwards, nurses were asked to complete (1) a Free Association Task (associating characteristics and a profession to the women) and (2) a Story-Completion Task (writing a story describing women's lives, pain, and recommending treatments). Data were analysed with Similitude and Thematic Analysis.

RESULTS

The women's SES was recognized, linked to distinct professions, and associated with distinct inferences. The middle-SES woman was depicted with both Uniquely Human (e.g., autonomous) and Human Nature (e.g., communicative) traits, positive future prospects, and competence to self-manage pain. The low-SES woman was associated with Human Nature traits (hard-working) but denied Uniquely Human traits associated with competence; she was imagined as passive towards pain, with poor future prospects and referred to psychoeducation.

CONCLUSION

Findings reveal the role of class-based cultural belief systems in pain care, showing how nurses' recognition of low SES is associated with dehumanizing inferences and recommendations, which may contribute to reproducing pain care disparities. Theoretical implications of these findings for social and health psychology are drawn. Statement of contribution What is already known on the subject? • Psychosocial research on health and pain care disparities has paid more attention to the role of race/racism and gender/sexism than the role of social class/classism; Belief systems about social class are shared across cultures; people from lower SES are often dehumanized by being denied competence, civility, and self-determination; Class-based dehumanization may influence the relational and technical aspects of clinical encounters but little is still known about these processes. What does this study add? Drawing upon a mixed-methods approach, this study provides novel findings on class-based dehumanization inferences made by female nurses on female chronic pain patients; Nurses perceived the lower SES patient with fewer Uniquely Human traits, that is, less competent, with more pain-related disability, and recommended her more psychoeducation. Class-based dehumanization processes may contribute to reproducing pain care disparities and may prove to be important targets for intervention development.