Dignity and health: a review

Attention to dignity is thriving in health. However, much of this recent discourse ignores the broader scholarship pertaining to dignity. The purpose of this review is to synthesize a wide range of multidisciplinary writing in order to put recent discussions of dignity and health into a broader context. The review explicates two main meanings of dignity-human dignity and social dignity, and looks at how these two ideas are used in the arenas of human rights, law, social justice, bioethics, and clinical care, and suggests some implications of these meanings and uses for health research and advocacy.     

The End-of-Life Phase of High-Grade Glioma Patients: Dying With Dignity?

Background.

In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient''s personal dignity. We aimed to (a) assess the proportion of HGG patients dying with dignity as perceived by their relatives and (b) identify disease and care factors correlated with dying with dignity in HGG patients.

Methods.

We approached relatives of a cohort of 155 deceased HGG patients for the study. Participants completed a questionnaire concerning the EOL phase of the patient, covering several subthemes: (a) symptoms and signs, (b) health-related quality of life, (c) decision making, (d) place and quality of EOL care, and (e) dying with dignity.

Results.

Relatives of 81 patients participated and 75% indicated that the patient died with dignity. These patients had fewer communication deficits, experienced fewer transitions between health care settings in the EOL phase, and more frequently died at their preferred place of death. Relatives were more satisfied with the physician providing EOL care and reported that the physician adequately explained treatment options. Multivariate analysis identified satisfaction with the physician, the ability to communicate, and the absence of transitions between settings as most predictive of a dignified death.

Conclusions.

Physicians caring for HGG patients in the EOL phase should timely focus on explaining possible treatment options, because patients experience communication deficits toward death. Physicians should strive to allow patients to die at their preferred place and avoid transitions during the last month of life.     

Back to basics—Essential nursing care in the ED: Part One

Emergency nurses are expected to work under pressure to many standards, guidelines and protocols related to patient care, and often in an advanced practice role. These expectations can sometimes take priority over basic nursing care once emergency/resuscitative intervention has occurred. However, posing the question ‘How would I want this patient to be cared for if they were my grandmother/father/child’ sets a benchmark for nursing practice [Fulbrook P, Grealy B. Essential nursing care of the critically ill patient. In: Elliot D, Aitken L, Cheboyer W, editors. ACCCN critical care nursing. Sydney: Elsevier; 2006]. How well patients are cared for has a direct effect on their sense of well-being and their recovery. Effective communication is essential to good nursing care and patient outcomes. The length of stay of the patient in the ED may be extended, and the use of “holding” wards while waiting for investigation results of patients for probable discharge necessitates the ED nurse to consider basic but essential aspects of nursing care that will be discussed. Other essential aspects of care such as psychosocial; including culture, pain management and infection control are beyond the scope of this paper.     

Dignity Therapy for older people in care homes: a qualitative study of the views of residents and recipients of ‘generativity’ documents

Aim. To report the findings of a study exploring the views and experiences of care home resident’s family on Dignity Therapy. Background. As the proportion of older people dying in care homes increases, it is important to enhance their dignity, reduce distress at the end‐of‐life, and provide bereavement support to their families. Pilot studies show that hospice patients and care home residents feel Dignity Therapy had or would help their families; however, there are no qualitative studies of their views. Design. Qualitative exploration. Methods. Qualitative interviews were conducted between January 2009–March 2010 with 14 family members of care home residents who had received Dignity Therapy. The Framework approach to qualitative analysis was used. Findings. Four categories are reported: views on the document: impact on residents; impact on family; and potential impact on care homes. While contact with the therapist provided much needed company for residents, Dignity Therapy helped residents reappraise aspects of their lives positively, while enjoying the opportunity to reminisce. Concerns focused on resident’s anxiety over document content. Memory problems and perceived lack of distress in some residents were viewed as factors affecting delivery and impact of Dignity Therapy. Family discovered new information and were prompted to discuss the content with them. For bereaved family members, documents provided comfort during their grief. If made available to carers, documents could enhance care delivery in homes. Conclusion. Family members felt Dignity Therapy had helped them and the residents. Findings suggest that Dignity Therapy may be useful for enhancing the end‐of‐life experience for residents and their families.     

尊严护理服务模式的构建及其在晚期癌症患者中的应用

目的：构建适合我国晚期癌症患者的尊严护理服务模式,以期增强晚期癌症患者的尊严水平,提升其生命意义,为晚期癌症患者的临终关怀及实现善终提供参考依据。方法：通过Delphi专家函询法构建尊严护理服务模式,并选取2017年3月至6月入住天津市某三甲专科医院的晚期癌症患者50例作为对照组,给予常规护理;选取2018年同期入住该医院的晚期癌症患者50例作为干预组,给予尊严护理服务模式。干预前后比较两组患者的尊严水平、生命意义及生活质量的变化。结果：干预后干预组患者尊严评分、生命意义及生活质量均明显优于对照组,差异具有统计学意义（Ｐ＜0.05）。结论：尊严护理服务模式能够有效增强晚期癌症患者的尊严水平,提升患者生命意义,改善其生活质量。     

家庭尊严干预在老年轻度认知障碍患者主要照顾者中的应用

目的 探讨家庭尊严干预对老年轻度认知障碍患者主要照顾者照顾负担及负性情绪的影响。方法 便利选取80对老年轻度认知障碍患者及其主要照顾者,按出院单双日分为实验组和对照组各40对。实验组在实施常规心理护理的基础上增加家庭尊严干预,对照组实施常规心理护理。应用照顾者负担量表、医院焦虑抑郁量表、Herth希望指数量表评价干预效果。结果 干预后实验组主要照顾者的照顾负担评分和焦虑抑郁评分明显低于对照组,希望指数评分明显高于对照组,差异有统计学意义（P<0.05）。结论 家庭尊严干预能够明显减轻老年轻度认知障碍患者主要照顾者的照顾负担,有效缓解其负性情绪,提高其希望水平。     

双维分级管理对中晚期乳腺癌病人尊严水平、生命态度及生命质量的影响

目的 探讨双维分级管理对中晚期乳腺癌病人的尊严水平、生命态度及生命质量的影响。方法 选择2020年7月1日至2021年6月30日西安交通大学第一附属医院收治的中晚期乳腺癌病人124例为研究对象,采用随机数字表法分为观察组和对照组,每组各62例病人,对照组根据疾病严重程度进行分级护理,观察组在分级护理基础上根据马斯洛人类需要层级理论进行双维分级管理及护理。在进行干预3个月后,比较两组病人的尊严水平、生命态度及生活质量指标等情况。结果 在对124例中晚期乳腺癌病人进行干预的过程中,观察组中途退出2例病人,对照组中途退出3例病人,最终纳入统计分析的病例数为119例,其中观察组60例、对照组59例。干预3个月后,观察组病人尊严感得分（43.18±4.90）分与对照组（48.55±4.21）分相比差异有统计学意义（t=6.41,P<0.05）;观察组病人自然接受评分（18.74±3.21）分与对照组（15.44±2.54）分相比差异有统计学意义（t=6.21,P<0.05）;观察组病人生命质量测定量表（QLQ-C30）指标（63.77±8.14）分与对照组（58.42±7.30）分比...     

Promoting Resident Autonomy to Maintain Quality of Life

In response to the COVID-19 pandemic, Canadian governments and healthcare organizations implemented restrictions on continuing care residents. From an ethical lens, governments and healthcare organizations were focused on preventing harm through promoting beneficence and non-maleficence; however, this was at the expense of resident autonomy. The rights of continuing care residents were stripped away when they were not given the opportunity to make informed decisions regarding their care and day-to-day life. Governments and healthcare organizations denied them the dignity to experience the positive outcomes that result from risk-taking based on their personal values and preferences. In an attempt to prevent resident harm from COVID-19 cases and deaths, governments and continuing care facilities forced residents into isolation. This negatively affected residents’ quality of life in the form of physical, mental, and cognitive health deterioration. Moving forward, governments and healthcare organizations need to take the time to engage residents in decision-making and policy development that affects their care, treatment, and support system. Governments and healthcare organizations must promote and safeguard resident autonomy to maintain quality of life.