Thought Piece: Patient's Dignity

Thought Piece: the dignity of patients in a hospital setting - what is the balance of care?

It occurred to me recently that Medicine, or modern medicine at the very least has evolved to a stage where intervention quite literally can make the difference between life and death, perpetuating life where it otherwise might have ended.

But do we actually think about what perpetuating that life really entails?

A patient who is intubated and ventilated is kept alive by a machine that breathes for them, sustained by high flow oxygen, intravenous fluids and vasopressors and other medication to support the circulatory system. But the underlying means of achieving this is often forgotten - an endotracheal tube in the airway, multiple arterial and venous lines placed about the body, catheters and ng tubes for feeding and monitoring among other things.

When one considers the "common" demographics of such patients in such settings, we typically get either the very old (and implicitly frail) or the very young, who are also inherently very ill.

The ICU is a place meant to preserve life, being admitted there comes with a (partial) guarantee that one will leave it, meaning it is a place where the utmost is done to maintain life- but at what cost?

https://doi.org/10.1111/jocn.16286

This is a paper published in the Journal of Clinical Nursing that is aptly titled: Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives. Meant to gauge what the patients actually think about hospital care.

Because after all, maintaining dignity is an essential component of dignified and holistic care, and patients overall wellbeing. Honouring their wishes should be at the heart of all decision making.

The study followed four key themes:

Effective nurse–patient communication, Maintaining patients’ privacy, Respectful and compassionate care provision and Providing quality and safe care.

What they found was that: dignity was preserved when patients were treated with respect and compassion, provided privacy, and had close family members involved in physical care.

Barriers to dignity included: inadequate information about their health condition, poor communication by the nurses, lack of autonomy, poorly designed healthcare infrastructure and inadequate privacy.

So what can be done to improve this?

Suggestions include: Nurses must treat older patients with respect, educate them about the health condition, involve them in care decisions, and identify their preferences regarding provision of hygiene needs, particularly in consideration of religious and cultural beliefs, including involvement of family members.

The interview process included questions like:

Which raised a discussion on themes such as:

Something as simple as compassion, inclusiveness and being forthright can go a long way to improving the quality of care a patient receives, and improve the standard of their hospital admission, excluding the medical aspect of treatment and monitoring.