Patient Dignity and Effects free essay sample

The fast-paced focus and limited time in emergency department make it difficult to attend to the holistic needs of the patient. Physical barriers of the equipment connected to the patient hinder the humanistic view of the patient and the necessary communication for ensuring dignified interactions. The dignity of patients is a major concern in healthcare, and every human being has the right to be treated with respect and dignity. More appreciation and better understanding of dignity is needed among nurses to improve the quality of care. According to Neno (2006), nurses need to continuously improve their skills and competencies to ensure that people are treated with dignity. Patients present to the hospital already vulnerable due to illness, and place their lives in the hands of healthcare professionals. On top of compromised health, hospitalization often creates feelings of loss of control, helplessness, loss of worth, and loss of autonomy. Nurses need to provide quality care, maintaining patients’ dignity, and promoting autonomy and self-worth by showing understanding and respect. Often, patients present confused or unresponsive, not comprehending the world around them. It would seem that such person does not have any dignity. Dignity has to be maintained in the care provided regardless of patient’s knowing or understanding of the place and moment in time. According to the Code of Ethics for Nurses: â€Å"The worth of the person is not affected by disease, disability, functional status, or proximity to death† (2001, p. 7). Purpose â€Å"Dignity means different things to different people† (Gallagher, 2004). Walsh (2002) noted that the concept of dignity is frequently cited in nursing literature, but only few studies attempt to define it. The myriad of available definitions and explanations does not benefit nursing and patient care in understanding dignity, and it is still a concept that evokes many thoughts. Concept analysis is a process to create a meaning of abstract concepts such as dignity. This paper uses concept analysis method of Walker and Avant (1995) to clarify the components of the dignity concept as it applies to nursing and patient care, so it can be better understood and utilized. Literature Definition Although nursing schools emphasize nurses’ obligation to promote and maintain patients’ dignity, no definitions or instructions are provided on how to promote such care or assess its outcomes. The dictionary definition of dignity states: â€Å"bearing, conduct, or speech indicative of self-respect or appreciation of the formality or gravity of an occasion or situation, nobility or elevation of character; worthiness, elevated rank, office, station† and â€Å"the quality or state of being worthy, honored, or esteemed† (Dictionary. om Unabridged, n. d. ). Another dictionary adds: â€Å"a sense of pride in oneself† (Compact Oxford English Dictionary, n. d. ). Not all of these descriptions of dignity apply to healthcare. The American Association of Colleges of Nursing defined dignity as â€Å"respect for the inherent worth and uniqueness of individuals and populations† (as cited by Jacelon Henneman, 2004). Gallagher (2004) s tated that dignity is equal for all human beings, but Haddock (1996) informed that: â€Å"humans are also unique, and have ‘personal’ dignity which only has personal meaning†. The author noted that dignity is connected to the self concept and self-esteem. She explained that self-esteem is the value we attach to ourselves as a result of our success in achieving goals, and it is also determined by the reaction of others. Further, it is noted that a person’s dignity is a reflection of personal choices, values, ideals, conduct, and lifestyle (Haddock, 1996). Similarly, Mairis (1994) suggested that dignity relates to one’s cognitive skills, feeling comfortable with one-self, and having control over one’s surroundings, behavior, and treatment by others. On the other hand, not all patients are capable of autonomous thinking and choice. Gallagher (2004) argued that those incompetent of making any decisions deserve to be treated with the same respect and dignity as every one else. People have dignity regardless of their level of competence, consciousness, autonomy, or capability of communicating. The author informed that dignity is equal for all, as it is a basic moral right that all people are worthy of from the moment of birth. Moreover, dignity is concerned with the acknowledgement of humanity in people, alive or dead. Gallagher (2004) stated that dignity can apply to a range of situations from patient’s autonomy and treatment choice, through older confused, incapable of decision making patients, to people who are dying, and the dignity of the bodies of those who died. Walsh (2002) also acknowledged that there is dignity in death, and dead people have to be treated with dignity. Similarly, Haddock (1996) noted that dignity can be restored to the deceased by staying with the body, and tidying the room to receive grieving relatives. Another study stated that humanity and dignity are acknowledged simply by spending time and being present with patients (Perry, 2005). Furthermore, Chochinov (as cited by Jacelon, Connelly, Brown, Proulx, and Vo, 2004) informed that in addition to pride, self-respect, quality of life, well being, hope and self-esteem, which all overlap with dignity, there is a distinctive feature in dignity an external component termed behavioral dignity. It specifies behavior that a person would engage in if one was dignified, and also how others could enhance a person’s dignity. It can be used to judge a patient’s behavior, as well as the actions taken by a nurse that affect dignity (Jacelon, Connelly, Brown, Proulx, and Vo, 2004). The literature made distinctions between having dignity, being treated with dignity, and giving dignity to others (Fenton Mitchell, 2002). Individual’s dignity is affected by the treatment received from others, and it is reflected when the nurse values and respects the patient. According to Haddock (1996), in order to maintain or promote patient’s dignity, the nurse has to first possess dignity, and treat patients as worthy and important when they are most vulnerable. Listening, caring, and attending to others’ needs all portray the giving of dignity. Critical Attributes Critical attributes are the defining characteristics of the concept, that allow to decide which phenomena are examples of the concept. Possessing dignity It is a characteristic of: being human, having positive self-esteem, feeling worthy, belief in oneself, self-respect, self-preservation, feeling that one’s beliefs, values, and identity are respected by others. Maintenance and promotion of patients’ dignity Valuing others alive or dead, appreciating similarities and differences in others, respecting patient’s identity and preferences, ensuring patient’s privacy, providing information, being attentive to patient’s needs. Empirical Referents The concept of dignity is an abstract concept difficult to understand. Its nature involves relations between people, therefore no single measure would identify if dignity is present (Haddock, 1996). Gallagher (2004) mentioned that dignity can only be measured by knowing what this term means to the patient. Measurement can be obtained from statements and reports of patient’s perspective. To ascertain if one possesses dignity, self-esteem could be measured using a scale, or patient satisfaction questionnaires could provide more insight. Also, as stated by Coventry (2006), observations of nurse/patient interactions and their behaviors could suggest the presence or absence of dignity. Nurse’s care with dignity can be observed for attentiveness, awareness, engagement, and an active defense of the patient. Mairis (1994) noted that dignity is difficult to measure, but common situations and patient’s behavior or report of feelings also give insight. She suggested that physiological changes such as temperature could be possible measurements/empirical referents of loss of dignity. Her example, blushing a symptom of embarrassment, causes skin temp to increase, indicating possible loss of dignity. Model Case Mr. T. , a 90 year old man presented to emergency department (ED) accompanied by his wife. He reported feeling progressively weaker over the last several days, complained of dark/black diarrhea, and vomiting coffee ground-like substance. Mr. T. appeared pale, weak, could hardly talk, and seemed very exhausted. The nurse introduced herself to the couple upon entering the room, listened to the story, and explained each step of her assessment as she performed it. Then, she informed the couple about the tests and procedures that could identify the cause of his symptoms, and about measures to relieve them. The couple verbalized understanding, and asked questions, which were clearly answered by the nurse. During Mr. T. ’s stay in ED, the nurse frequently checked on him, making sure he’s comfortable, pain free, and without further compromise to his health. During the day the nurse had to draw Mr. T. ’s blood, insert an NG tube, administer blood transfusion, and several medications to ease the pain and nausea. She clearly informed the patient before each procedure making sure he understands them, respected the patient’s privacy every time he had to use the bedpan for his diarrhea, and listened to all the complaints and worries of the couple. Before his transfer to ICU, Mr. T. thanked the nurse for the excellent care he received, and stated that he felt ‘like a king’. The model case presents all critical attributes. The nurse promoted the dignity of the patient by being present, giving information, privacy, and by attentive listening, compassion, and sensitivity to let the patient and his wife know that she saw him as more than a disease, and truly cared. This allowed Mr. T. to feel unique and important. He felt respected, had control over the situation although he was so weak, and was able to maintain his worth and self-esteem. Similarly, the nurse was sensitive to the patient’s vulnerability, and although the patient’s condition was critical and required rapid interventions, she managed to maintain his dignity. Contrary Case Mrs. B. , an 85 year old lady presented to emergency department (ED) from her nursing home, brought in by an ambulance. She was confused and febrile, unable to walk or stand, but able to verbalize feelings of pain or discomfort. Immediately on her arrival to ED, two nurses and two patient care technicians (PCT) started undressing her. When Mrs. B. was completely naked, one of the nurses started the assessment listening to her lungs, and pressing on her abdomen, while the other nurse yelled: â€Å"Gertrude! Do you know where you are!? Then, one of the PCTs covered the patient with a hospital gown, started to connect cardiac monitor electrodes on her, while the other one applied the blood pressure cuff. At the same time one of the nurses kept tightening a tourniquet on the other arm of Mrs. B. , repeatedly poking her trying to insert an IV catheter. As if this wasn’t enough, the other nurse spread the patient’s legs apart, and attempted to insert a Foley ca theter in her bladder. During all these procedures Mrs. B. begged: â€Å"stop! ouch! I want to go home! Take me home! † The nurse’s response was: â€Å"just stay still! repeatedly. Among themselves, the staff were laughing and discussing the weekend events of their private lives. Then, ignoring the patient’s cries, they turned Mrs. B. on one side, and inserted a thermometer into her rectum, while commenting on the bed sore on her sacrum: â€Å"oh, this is disgusting, look at her back†¦Ã¢â‚¬  In the contrary case none of the critical attributes of dignity are present. The patient’s dignity was compromised not only by her severely debilitated state, but also by the staff’s failure to recognize and respect her as a unique human being. Mrs. B. was treated like an object, dependent on others, or as if she was absent. She experienced physical invasion, inadequate communication, loss of control, and was treated in a manner that did not make her feel or look as an important human being, of equal value to others. Antecedents Antecedents are events that must occur before the concept (Walker Avant, 1995). (Jacelon, Connelly, Brown, Proulx, Vo, 2004) stated that dignity is a learned behavior, and learning about dignity is an antecedent to behaving with dignity. Attitudes, values and beliefs which are learned throughout life, as well as life experiences develop one’s dignity (Mairis, 1994). To become vulnerable to losing dignity patient must be in a position to need care; have compromised health, become disabled, powerless, and dependent on health care professionals to restore his or her health. Also, being removed from one’s familiar environment, routines, and roles when entering hospital may predispose individual’s loss of control and identity, which lead to loss of dignity. Furthermore, to provide dignified care nurses must develop own integrity and dignity, responsibility, accountability, and obligations to the patients. Lack of time, the pressure of work, and nurse’s lack of interpersonal skills result in loss of dignified care. Consequences Consequences are those events that occur as a result of the concept (Walker Avant, 1995). A positive consequence of the presence of dignity is secured patient’s autonomy, and his or her feelings of value, worth, pride, and confidence. As a result, there is a positive effect on patient’s behavior, health, compliance, and self-esteem. On the other hand, losing dignity may continue to generate powerful emotions for a long time (Gallagher, 2004). When dignity is lost patients feel distressed, embarrassed, shameful, humiliated, foolish, angry, anxious, and degraded (Mairis, 1994). The result of lack of dignity can also be demonstrated by loss of self-control, the patient may become rude, mean, belligerent, and complaining. Moreover, a positive consequence of dignified care for the nurse is enhanced own dignity, a therapeutic relationship with the patient, and job satisfaction. When patient’s dignity is compromised, the nurse may experience the same emotions as the patient: anger, anxiety, and stress. Research for Practice Dignity has been a concept in nursing practice that is often overlooked by nurses. It is often a challenge to promote patient’s dignity while performing critical care interventions in emergency department. Among the most vulnerable to loss of dignity are older people. They are often perceived as having little worth, and being a drain on others. The negative attitudes towards this population result in neglect of their needs. Nurses should consistently ask the questions: â€Å"How can I make this patient feel better about being here? What are his or her wishes and values? Does this patient have control over the situation? Is this patient satisfied with the care received? † Also, patients with mental status changes, in a coma, or disabled may not seem to behave with dignity, but through compassionate care, recognizing living and experiencing human being, the nurse can enhance their dignity. Every patient’s needs and feelings should be considered. Nurses need to recognize that whatever the patient’s behavior, help and support from the nurse will satisfy and promote dignity of every patient, which in return will increase job satisfaction of the nurse. Further research should focus on strategies to minimize the occurrences of loss of dignity during critical care interventions. One of the studies reported that nurses were most likely to stay in the profession if they perceived they provided care that was of an acceptable quality, and were usually satisfied with their careers (Perry, 2005). Conclusion The ambiguity of the human dignity concept makes it difficult to construct an exhaustive definition. This paper concentrated on understanding patient’s dignity from the nurse’s perspective, and the effects of nursing care on its maintenance. Dignity arises in every nurse-patient encounter and there are many opportunities for dignity promotion. It is maintained depending on how the nurse acts toward the patient. The smallest actions can make a huge difference in the way a person feels. Nurses need to remember the person inside the patient (Haddock, 1996), give more thought to how they assess and communicate with the patient, and work in partnership with him or her. Authoritative nurses performing care they believe is best without discussing it with the patient do not provide dignified care. Patients have the right to refuse the care provided to them and nurses have to respect that. This can be a difficult experience for the nurse, especially when the patient’s decisions are not what the nurse would consider to be the best choice. Nurse’s interactions with the patient have a tremendous effect on the patient’s dignity, therefore they need to be constantly aware of patients’ needs, consider their emotions, give privacy, information, and compassionate care. Haddock (1996) stated that: â€Å"the most powerful tool a nurse possesses to maintain and promote dignity is herself/himself†. References Code of ethics for nurses with interpretive statements. (2001). Washington, DC: American Nurses Association. Compact Oxford English dictionary. (n. d. ). Retrieved October 11, 2006, from: http://www. askoxford. om/concise_oed/dignity? view=uk Coventry, M. L. 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