Dignity in Healthcare

A Practical Approach for Nurses and Midwives

Milika Ruth Matiti, Lesley Bailey

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781000377637
• Edition: 1
• Topic: Medizin
• Subtopic: Krankenpflege

Dignity in the care of patients and clients of all ages, whether in hospital or community settings, is an area of increasing national and international importance and concern. However, a comprehensive, accessible resource for nurses and midwives on the theory and practice of dignity in care has until now been lacking. Dignity in Healthcare provides a practical approach, underpinned by up-to-date theory, to this crucial issue for those providing care to people in all stages of life, including those with mental illnesses or learning disabilities. Care in areas such as maternity, community, palliative and acute care and others is explored in depth. Approaches to education and practice development for promoting dignity in care are also outlined clearly and accessibly, with each chapter combining an evidence-based theoretical underpinning with practical application through scenarios. Pre-registration nursing and midwifery students and their teachers will find this book essential reading, but it will also be of interest to practising nurses, midwives and other health professionals seeking clear insights into the principle of care that is central to all healthcare professions.

SECTION 1

Dignity in healthcare: setting the scene

CHAPTER 1

The importance of dignity in healthcare

Milika Ruth Matiti

INTRODUCTION

The concept of dignity is not new. Many scholars have written on the subject and there seems to be a global consensus that dignity is an important concept to every individual in every society. Dignity is imbedded in Article 1 of the United Nations General Assembly Declaration of 1948, reiterated in 1996 by the United Nations International Bill of Rights, which states that all human beings are born free and equal in dignity and rights (United Nations, 1996). Dignity is reflected in Article 3 of the United Kingdom’s (UK) Human Rights Act (1998), which states that ‘no one shall be subjected to torture or inhuman or degrading treatment or punishment’; this article applies across society, including healthcare. The 1994 Amsterdam Declaration on the promotion of patients’ rights recognises dignity as one of the main rights for patients (World Health Organization [WHO], 1994), regardless of nationality, race, tribe, creed, colour, age, sex, politics, social and educational status, cultural background or the nature of their health problems.

This first chapter highlights the importance of patient and client dignity in healthcare settings, drawing on patients’ and healthcare professionals’ viewpoints.

DIGNITY IN HEALTHCARE: PATIENTS’ AND HEALTHCARE PROFESSIONALS’ VIEWS

Worldwide empirical evidence confirms that, for a positive healthcare experience, patients and clients need to feel that their dignity is upheld and that healthcare professionals (most studies are from nurses’ perspectives) also view dignity as important for patients and as a valuable part of their professional practice. Confirming the universality of dignity, these studies have been conducted in a range of specialties and some of these are presented next.

Patients in varied hospital settings have identified that dignity is important to them: in maternity care (Lai and Levy, 2002), medical and surgical wards (Matiti, 2002) and for older people in hospital (Jacelon, 2003). Joffe et al (2003) surveyed 27 414 patients following their discharge from acute care in the United States of America (USA) to identify how involvement in decisions, confidence and trust in care providers, and treatment with respect and dignity, influenced patients’ evaluations of their hospital care. They found that perceptions of respectful, dignified treatment correlated most closely with high satisfaction with the hospital stay, thus indicating that patients who perceive that they are treated with dignity are happier with their overall hospital experience. In the USA, a survey by Beach et al (2005) of 6722 adults found that involving patients in decisions and treating them with dignity and respect were associated with positive outcomes. Recently, in Norway, a qualitative study using semi-structured interviews with 12 older people who had had strokes found that being treated with dignity and respect was a core factor contributing to the patients’ satisfaction with their rehabilitation (Mangset et al, 2008). This main factor was further subdivided into: being treated with humanity, being acknowledged as individuals, having their autonomy respected, having confidence and trust in professionals and dialogue and exchange of information.

In terminal care, a number of research studies have identified dignity as one of the most important issues, from patients’, relatives’ and/or staff perspectives (Payne et al, 1996; Keegan et al, 2001; Miettinen et al, 2001; Vohra et al, 2004; Volker et al, 2004; Touhy et al, 2005; Aspinal et al, 2006). Chochinov et al’s (2002a) study of dignity with terminally ill patients indicated that patients viewed loss of dignity very negatively. In a further study, the same authors (Chochinov et al, 2002b) indicated a link between loss of dignity and various negative effects, such as psychological and symptom distress, heightened dependency needs and loss of will to live. In critical care settings, nurses stated that facilitating dying with dignity is important in end-of-life care (Kirchhoff et al, 2000; Beckstrand et al, 2006).

In several other studies, the importance of being treated with dignity has also emerged. Holland et al (1997) interviewed 21 patients about their recollections of their stay in the intensive therapy unit (ITU). Participants stated that it was easier to cope with the stress of ITU if nurses treated them with respect and dignity. In a further ITU-based study, Engström and Söderberg (2004) studied the experiences of seven ITU patients’ partners, who all stressed that it was important that staff showed respect for the patient’s dignity. Clegg (2003) explored perceptions of culturally sensitive care with older South Asian patients who were being cared for in two community hospitals. ‘Demonstrating respect’ emerged as a core category, with ‘Retaining dignity’ being a subcategory. The results indicated that promoting dignity was necessary for cultural sensitivity and involved preserving humanity and self-respect in the hospital setting.

Worldwide, healthcare professions have agreed that promoting patient or client dignity is a core element of their practice and this is also evidenced by empirical studies. Kelly’s (1991) study aimed to examine what English nursing undergraduates internalised as professional values. The 12 students interviewed perceived two concepts as central to their professional values: ‘Respect for patients’ and ‘Caring about little things’; these both link with patient dignity. Fagermoen (1997) surveyed Norwegian nurses (n = 731) with varying experience about their underlying values and found that human dignity was the core value, with all other values either arising from it or being aimed at preserving it. In Yonge and Molzahn’s (2002) study, 18 registered nurses from varied settings in Canada gave examples of going to great lengths to preserve patients’ dignity in situations in which they were vulnerable, demonstrating the importance these nurses placed on dignity. In Australia, Johnstone et al (2004) surveyed 398 nurses regarding ethical concerns encountered in practice. Protecting patients’ rights and human dignity was a frequently cited ethical concern, which could indicate high staff awareness of dignity as an ethical issue. Perry (2005) conducted an internet-based study, accessing a self-selected, international sample of nurses (n = approximately 200) who were asked to share a story related to career satisfaction. Nurses who were satisfied with their careers believed that they provided quality care; defending patients’ dignity was one of the four core values that emerged.

From a professional perspective, international bodies of different professional groups acknowledge that patient and client dignity is important and they have adopted the notion of dignity in their professional charters and policies; here are some examples. The European Region of the World Confederation for Physical Therapy (2003) urges physiotherapists to promote patient dignity at all times in their practice. In terms of midwifery, one of the perinatal principles of the WHO is that care should respect the privacy, dignity and confidentiality of women (Chalmers et al, 2001). The International Council of Nurses’ Code of Ethics for Nurses (2006) affirms that inherent in nursing is respect for human rights, including cultural rights, the right to die and to choice, and the right to dignity and to be treated with respect. In the UK, under the duties of a doctor registered with the General Medical Council (GMC), doctors are expected to treat patients as individuals and respect their dignity (GMC, 2006). The General Pharmaceutical Council (2010) expects pharmacists to respect the dignity of clients and patients. The Occupational Therapy Association of South Africa (2005) asserts the expectation that occupational therapists should promote patient dignity. These global examples signify that different professions recognise the importance of patient or client dignity.

From these discussions, then, there is a widely shared view among patients and healthcare professionals that dignity is important in healthcare practice. However, while legislation and different professions urge healthcare workers to respect the dignity of patients and clients, the practicalities of promoting dignity for individuals in different situations and diverse settings have not been clearly articulated. There is evidence from different healthcare settings and drawing on patients’ and healthcare workers’ perspectives that the notion of dignity is neither clearly understood nor appropriately or consistently applied in practice (Porkony, 1989; Street, 2001; Matiti, 2002; Enes, 2003; Jacelon, 2003; Reed et al, 2003; Matthews and Callister, 2004; Calnan and Tadd, 2005; Baillie, 2007).

Dignity in care is influenced by multiple and interconnecting influences and, furthermore, the concept is abstract and difficult to define and is consequently not adequately understood, contributing to a lack of clarity about what kind of caring activities preserve dignity in practice (Anderberg et al, 2007). Therefore, there is a need to help healthcare workers in practice to identify practical ways of promoting patient and client dignity.

CONCLUSION

This introductory chapter has emphasised the importance of dignity from patients’ and professionals’ perspectives. The book contributors address the central issues in the current debate on the concept of dignity in healthcare. We hope that the work of the authors in this book will inspire you and help you to further develop your practice as a healthcare worker or student, to better promote the dignity of patients and clients in healthcare practice. We hope this book will be useful to everyone who reads it in their day-to-day practice. At the end of each chapter, authors have provided an extensive reference list which will be very useful for readers to further explore the dignity field.

ACKNOWLEDGEMENTS

I would like to thank Dr Henry Matiti and Professor Jack Mapanje for their valuable comments while writing this chapter.

REFERENCES

Anderberg P, Lepp M, Berglund A, Segesten K (2007) Preserving dignity in caring for older adults: a concept analysis. Journal of Advanced Nursing 59(6): 635–43.

Aspinal F, Hughes R, Dunckley M, Addington-Hall J (2006) What is important to measure in the last months and weeks of life? A ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Dedication
• Tribute to Paul Wainwright
• Foreword
• Preface
• About the editors
• Contributors
• Acknowledgements
• Abbreviations
• Section 1 Dignity in healthcare: setting the scene
• Section 2 Dignity in different healthcare settings
• Index