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Shojaei A, Raziani Y, Bernstein C, Asgari A, Alazmani‐Noodeh F, Arab M, Ranjbar H. The experiences of psychiatric patients, their caregivers and companions in upholding patient dignity during hospitalization: A qualitative study. Health Expect 2023; 26:1915-1922. [PMID: 37332144 PMCID: PMC10485317 DOI: 10.1111/hex.13799] [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: 02/19/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023] Open
Abstract
INTRODUCTION The quality of care and patient satisfaction is closely linked with dignity, which is a crucial component of therapy and care. However, there is very little study on dignity in the context of mental health care. Planning for ongoing patient care might benefit from an understanding of the notion of dignity by exploring the experiences of patients, caregivers and companions of patients who have a history of hospitalization in mental health institutions. To retain patients' dignity while they were being treated in mental wards, this study sought to understand the experiences of patients, caregivers and companions of patients. MATERIALS AND METHODS This investigation was qualitative. Semistructured interviews and focus groups were utilized to collect the data. The purposeful sampling method was employed for participant recruitment, which continued until data saturation. Two focus group discussions and 27 interviews were conducted. Participants included 8 patients, 2 patients' family members (companions), 3 psychologists, 4 nurses and 11 psychiatrists. Two focus group discussions were held with seven family members or companions of patients. Thematic analysis was used for data analysis. RESULTS The primary theme that emerged was the infringement of patients' dignity, through negative guardianship, dehumanization and violations of their rights. Subthemes included dehumanization, worthlessness and namelessness, patient rights violations and stripping patients of authority. CONCLUSION Our results suggest that, regardless of the severity of the illness, the nature of psychiatric illness significantly compromises patients' dignity. Mental health practitioners, due to their sense of guardianship, may unintentionally treat patients with mental health disorders, thus compromising the patient's dignity. PATIENT OR PUBLIC CONTRIBUTION The research team's experiences as a psychiatrist, doctor and nurse informed the study's objectives. Nurses and psychiatrists who work in the healthcare industry designed and conducted the study. The primary authors, who are healthcare providers, collected and analysed the required data. Furthermore, the entire study team contributed to the writing of the manuscript. Study participants were involved in the data collection and analysis.
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Affiliation(s)
- Amirahmad Shojaei
- Medical Ethics and History of Medicine Research Center, Department of Medical Ethics, School of MedicineTehran University of Medical SciencesTehranIran
| | - Yosra Raziani
- Department of NursingAl‐Mustaqbal University CollegeHillahBabylonIraq
| | - Colleen Bernstein
- Department of PsychologyUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Ali Asgari
- Infectious Diseases Research CenterAJA University of Medical SciencesTehranIran
| | - Farshid Alazmani‐Noodeh
- Critical Care Nursing Department, Faculty of NursingAJA University of Medical SciencesTehranIran
| | - Mohammadreza Arab
- Department of Surgery, School of MedicineBam University of Medical SciencesBamIran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research InstituteIran University of Medical SciencesTehranIran
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Lam LT, Chang HY, Natashia D, Lai WS, Yen M. Self-report instruments for measuring patient dignity: A psychometric systematic review. J Adv Nurs 2022; 78:3952-3973. [PMID: 36070196 DOI: 10.1111/jan.15436] [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: 04/22/2022] [Revised: 07/15/2022] [Accepted: 08/20/2022] [Indexed: 11/29/2022]
Abstract
AIMS To synthesize and evaluate the psychometric properties of self-report instruments that measure patient dignity. DESIGN A psychometric systematic review. DATA SOURCES A comprehensive search of studies published from inception until February 17, 2022, was performed using PubMed, Embase, CINAHL, Web of Science, and Scopus. REVIEW METHODS The methodological quality of the psychometric studies was evaluated following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. RESULTS Eleven self-report instruments that evaluate dignity were identified. For most instruments, psychometric properties, including reliability, cross-cultural validity, responsiveness, and measurement error, had not been adequately examined. The Patient Dignity Inventory (PDI), the Jacelon's Attributed Dignity Scale (JADS), and the Inpatient Dignity Scale (IPDS) had acceptable content validity, structure validity, and internal consistency to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. CONCLUSION The PDI, the JADS, and the IPDS are recommended for future clinical practice and research to measure dignity among adult patients under palliative care, community-dwelling older adults, and inpatients receiving daily care. Early identification of patients' dignity-related problems in nursing care can prevent negative health outcomes and help develop a timely intervention to promote patients' health and recovery. IMPACT Given that the psychometric properties of the existing self-report dignity instruments have not been systematically assessed, the present review utilized comprehensive methods according to COSMIN to evaluate and determine the most appropriate measure for research and practice. The PDI, the JADS, and the IPDS demonstrated satisfactory psychometric properties and are, thus, recommended for clinical and research applications. Nursing professionals can employ these instruments to assess and promptly identify dignity issues among both young and older adults in hospitals and communities.
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Affiliation(s)
- Le Trinh Lam
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Hsin-Yi Chang
- International Doctoral Program in Nursing, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Dhea Natashia
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department Medical Surgical Nursing, Faculty of Nursing, Universitas Muhammadiyah Jakarta, Jakarta, Indonesia
| | - Wei-Shu Lai
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Miaofen Yen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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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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Plunkett R, O'Callaghan AK, Kelly BD. Dignity, coercion and involuntary psychiatric care: a study of involuntary and voluntary psychiatry inpatients in Dublin. Int J Psychiatry Clin Pract 2022; 26:269-276. [PMID: 35001768 DOI: 10.1080/13651501.2021.2022162] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVES There is a paucity of research about psychiatric inpatients' experience of dignity. Most of the limited literature on this topic is qualitative. Our study provides quantitative data about self-rated dignity among involuntary and voluntary psychiatry inpatients. We explore relationships between perceived dignity and legal status, coercion, level of insight, diagnosis, and therapeutic alliance, among other parameters. METHODS We recruited 107 participants aged 18 years or over from two inpatient psychiatric units in Dublin, Ireland over a 30-month period. Interviews consisted of structured, validated assessment tools. Demographic and clinical data were obtained from patient charts. RESULTS Patient Dignity Inventory (PDI) score was non-normally distributed (skewed to the right), with a median score of 63.0 out of 125 (inter-quartile range: 40.0-80.0). On multi-variable testing, lower self-rated dignity was associated with higher perceived coercion, better insight and more negative symptoms. There was no association between dignity and gender, employment status, marital status, ethnicity, age, admission status, diagnosis, working alliance, positive symptoms or cognition. CONCLUSIONS Lack of dignity is linked with perceived coercion and negative symptoms, and is seen in patients with better insight. These links merit further study if we are to understand patient dignity in a more nuanced and useful way.KEYPOINTSWe interviewed psychiatric inpatients using the Patient Dignity Inventory and other structured assessment tools.There was no significant difference between voluntary and involuntary patient groups' self-rated dignity.Less self-rated dignity was seen in patients with higher levels of perceived coercion.Patients with better insight reported lower dignity.Dignity scores were not significantly associated with age, gender, ethnicity, diagnosis or length of stay in hospital.
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Affiliation(s)
- R Plunkett
- Psychological Medicine Service, St. James' Hospital, Dublin 8, Ireland.,School of Medicine, Trinity College, Dublin University, Dublin 2, Ireland
| | - A K O'Callaghan
- School of Medicine, Trinity College, Dublin University, Dublin 2, Ireland
| | - B D Kelly
- Psychological Medicine Service, St. James' Hospital, Dublin 8, Ireland.,Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, Ireland
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Mergler BD, Goldshore MA, Shea JA, Lane-Fall MB, Hadler RA. The Patient Dignity Inventory and Dignity-Related Distress among the Critically Ill. J Pain Symptom Manage 2022; 63:359-365. [PMID: 34890727 DOI: 10.1016/j.jpainsymman.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022]
Abstract
CONTEXT Critical illness confers a significant risk of psychological distress, both during and after intensive care unit (ICU) admission. The Patient Dignity Inventory is a 25-item instrument initially designed to measure psychosocial, existential and symptom-related distress in terminally ill patients. OBJECTIVES This study was conducted to validate the inventory as a means of identifying distress in inpatient critical care settings. METHODS Single-center prospective cohort study of adult patients admitted to one of five ICUs within the University of Pennsylvania Health System for greater than 48 hours from January 2019 to February 2020. Patients completed the inventory in addition to the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-seven questionnaires. RESULTS The tool's internal structure was assessed via principal components analysis. 155 participants consented, completed the surveys and were included for analysis. Scores on the inventory showed evidence of internal consistency when used in critical care settings (Cronbach's α=0.95). Moreover, principal components analysis elucidated four themes prevalent in critically-ill patients: Illness-related Concerns, Interactions with Others, Peace of Mind and Dependency. Construct validity was assessed through correlational analysis with depression and anxiety questionnaires. Scores on the inventory appear to be valid for assessing dignity-related psychological concerns in the critical care setting although there is overlap among components and with anxiety and depression scores. CONCLUSIONS This study demonstrates that the inventory can be used to assess patient distress in critical care settings. Further research may elucidate the role of dignity-based interventions in treating and preventing post-intensive care psychological symptoms.
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Affiliation(s)
- Blake D Mergler
- Department of Anesthesiology and Critical Care (B.D.M., M.B.L.F.), University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Matthew A Goldshore
- Department of Surgery (M.A.G.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Judy A Shea
- Department of Medicine (J.A.S.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghan B Lane-Fall
- Department of Anesthesiology and Critical Care (B.D.M., M.B.L.F.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel A Hadler
- Department of Anesthesia (R.A.H.), University of Iowa, Iowa City, Iowa, USA
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Abstract
OBJECTIVE The aim of this study was to investigate the validity and reliability of the Patient Dignity Inventory (PDI) in the Turkish society, which was developed to evaluate dignity-related distress in palliative care patients. METHODS One hundred and twenty-seven adults with advanced cancer hospitalized in several clinics of two university hospitals were included in the study. The patients whose Palliative Performance Scale score was at least 40% were recruited to study. The data were collected with a patient demographic form, the Turkish version of Hospital Anxiety and Depression Scale (HADS-TR), and the Turkish version of the PDI (PDI-TR). The PDI-TR was finalized and back-translated after translating into Turkish and obtaining 10 expert opinions. Exploratory and confirmatory factor analysis, internal consistency, concurrent validity, and test-retest reliability analysis were performed. RESULTS The Cronbach's α coefficient of PDI-TR was 0.94. Factor analysis resulted in a five-factor solution, and all items were loaded on factors. Factors were labeled as symptom distress, existential distress, self-confidence, dependency, and supportive care needs and accounted for 68.70% of the overall variance. The model's normed fit index, comparative fit index, and X2/SD were found between acceptable range (0.90, 0.93, and 2.64, respectively). A positive and strong correlation was found between subdimension scores of HADS-TR and the total score of PDI-TR (r = 0.70 for anxiety subdimension; r = 0.73 for depression subdimension). The test-retest reliability was conducted with 32 patients within the sample two weeks after the first application, and no significant difference was found between the two application scores as the result of paired-sample t-test (p > 0.05). An intraclass correlation coefficient of test-retest reliability was r = 0.855. SIGNIFICANCE OF RESULTS PDI-TR was found to be a valid and reliable tool in palliative care patients in Turkish society.
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Tehranineshat B, Rakhshan M, Torabizadeh C, Fararouei M. Patient Dignity in Iranian Clinical Care Settings as Perceived by Physicians, Caregivers, and Patients. J Multidiscip Healthc 2020; 13:923-933. [PMID: 32982269 PMCID: PMC7502381 DOI: 10.2147/jmdh.s258962] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction All over the world, healthcare team members are recommended to respect patients’ human dignity. However, the dignity of hospitalized patients is not preserved in many cases. Due to the abstract, complex, and cultural nature of the concept of human dignity, further studies are required to precisely determine the different aspects of this concept. Purpose The aim of the present study was to explore the experiences and perceptions of physicians, nurses, family caregivers, and hospitalized patients with regard to patient dignity in Iranian clinical setting. Materials and Methods This is a qualitative, exploratory study in which physicians, nurses, family caregivers, and patients were recruited from 2 educational hospitals located in an urban area in Iran from April 2016 to February 2017 using the purposive sampling method (n = 24). Data were collected through individual interviews and subsequently analyzed using conventional content analysis in the software MAXQDA 2007, VERBIO`. Results Three major themes emerged from analyses of the data obtained from the interviews: a peaceful environment, respect, and comprehensive support. Conclusion From the participants’ point of view, in order for their dignity to be preserved, patients need to be hospitalized in a peaceful environment in which they are treated with empathy, they receive comprehensive support, and the care settings are managed properly. Furthermore, it is important to respect patient’s values and beliefs, to provide unbiased care and treatment, and to maintain patient’s autonomy in order to maintain hospitalized patients’ dignity.
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Affiliation(s)
- Banafsheh Tehranineshat
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahnaz Rakhshan
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Camellia Torabizadeh
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
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