Every human individual has his own unique beliefs, attitude, values and preferences. To achieve patient- centered care, a nurse needs to recognize and respect patient’s individuality, dignity and diversity. The maintenance of patient dignity is an important element of nursing care and is highly valued by patient. The International Council of Nurses also reflects the significance of patient dignity. According to the ICN Revised Code of Ethics (2012) it is a nurses’ responsibility to respect human rights including the right to dignity, to life and to treat patient with respect. In addition, the sole aim of a nurse-patient relationship is the betterment of the patient which could be achieved by giving dignified care. In other words, dignity is an important factor which a nurse needs to consider while providing holistic care.
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The reason for selecting this topic is that mental health is the most neglected field in Pakistan. In socio cultural context, it has been observed that psychiatric patients are one of the most socially excluded groups (Qasim, 2012). In our society, there are many stigmas attached to it. This leaves great impact on patient’s mental health, thus interfering in holistic care. Since it is a nurses’ professional duty to promote patients’ dignity therefore, it is important to highlight undignified practice issues and analyze it critically. This paper will discuss importance of dignity in psychiatric ward setting, related threats and how it can be promoted.
During my clinical rotation at Karwan_e_Hayaat, a 32 years old male patient admitted with the diagnosis of schizophrenia was continuously irritating the patients and nursing students present in the hall. After many warnings, staff held the patient forcefully and slapped him in front of everyone. Upon investigation of the event, patient verbalized that he felt very embarrassed. Next day, he was asked to share his concerns with the staff but he refused. According to him, staff responded rudely when he shared his concerns with them.
After encountering this scenario, I couldn’t stop thinking about it. I wondered how a staff could behave so roughly with a patient. Doesn’t he consider its impact on the patient? I realized that such humiliating and undignified behavior towards the patient made him feel embarrassed. This not only lowered his self esteem, but also shattered his trust upon the staff.
Dignity is referred to a special dimension of value. The term “dignity” is derived from the Latin word “dignus” meaning worthy. According to Oxford English Dictionary (2002) it is “the state or quality of being worthy of honor or respect”. Patient dignity is the feeling of being valued and comfortable psychologically.
According to the Nordenfelt (2004) there are four types of dignity which includes merit, moral status, personal identity and Menschenwurde. Firstly, merit is a type of dignity which is related to the social status ascribed by the people due to their position in a society. For example doctor, nurse etc who are recognized by the people. Psychiatric patients are mostly excluded from their role in a society and they may experience loss of dignity. Secondly, moral status entails person’s moral integrity and autonomy. If a person is able to live according to his moral values, the individual will feel a sense of dignity. Thirdly, personal identity is related to the self-respect and individual’s identity as a person. This is most relevant in the context of older people. It can be violated by physical interference and emotional or psychological insult such as humiliation. Lastly, Menschenwurde is an intrinsic dignity which all human beings have at a same degree. It cannot be lost as long as human exist. In nursing practice, importance of acknowledging worth of human regardless of human condition is particularly related to the concept of Menschenwurde. Morover, dignity of identity helps in providing individualized care (Gallagher et al, 2008).
Dignified care has significant impact on health and recovery of the patient. Patient feels comfortable when he is happy, relaxed, and free from anxiety when he knows that his privacy is not invaded without invitation. If a patient feels in control, only then he will be confident and able to cope. Lack of dignified care affects negatively on psychological health of the patient. It can lead to stress, aggression, anxiety, embarrassment and social isolation. This can delay their recovery and may lead to further complication. In case scenario it is also evident that the patient felt embarrassed when he was slapped and forcefully taken to his room. According to literature, staff behavior is one out of three factors which threatens patient dignity (Baille, 2009).
According to the Patient Dignity Model (Baillie, 2009) staff behavior, hospital environment and patient factor affect patient’s dignity. It portrays that the patient has central place in this model. The hospital environment and staff behavior surround patient which can promote or threaten their dignity. This model is divided into upper and lower halves. The upper half of the model shows why patient is vulnerable to loss of dignity while the lower half shows how these factors promote patient dignity regardless of their vulnerability.
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There are many factors in hospital which violate patient dignity. Lack of privacy, inadequate physical and human resources and dehumanizing ward culture increases patient vulnerability. Lack of privacy with regards to physical environment, mixed-sex environment and bodily exposure has emerged as an important factor that leads to loss of dignity. Other factors may include overcrowding of patient in a ward, less staffing or staff workload and unhygienic environment. In addition, staff behavior also has significant impact on patient dignity as they are the people who interact with them mostly. There are two ways by which staff can threatens dignity: staff communication and breaching privacy. Curtness, lack of kindness and courtesy in interaction lead to undignified care. Authoritarianism, controlling and not respecting request in interactions are also threat to dignity. Moreover, Patient’s intrinsic factor also affects dignity. Impaired health and older age are two major factors which make patient vulnerable to loss of dignity. Impaired health status leads to dependency in personal care which impacts negatively on patients’ psychological health. (Baillie, 2007)
Therefore, modifying hospital environment and improving staff behavior can promote dignity. A nurse should play an important role in modifying both factors. A nurse should provide an environment that comprises of well-maintained, clean, safe and conducive environment as it makes patient comfortable. Environmental privacy should be maintained. Social interaction with other patient should be encouraged as this helps patient to share his feeling and understand other patient as well, which impacts positively on the patient’s self-esteem.
Furthermore, staff behavior also plays an important role in promoting dignity. They can promote dignity by providing privacy and therapeutic interactions. Providing environmental, bodily and auditory privacy is found helpful in promoting dignity. Auditory privacy refers to confidentiality of patient’s diagnosis and treatment. Therapeutic communication makes patients feel comfortable, in control and valued. Use of reassurance, humor, friendliness and professionalism helps patient to feel comfortable. Professionalism portrays competence and efficiency which makes patient feel contented and safe. Moreover, patients feel in control when they are provided with information, explanation, independence and choices. Interaction which shows consideration, concern, helpfulness, politeness and respect as an individual, makes patient feel valued (Baillie & Gallagher, 2011).
In conclusion, a patient is vulnerable to loss of dignity. It can be threatened by various factors. Individual staff behavior particularly has strong influence on patients’ mental health which is evident in case scenario. Therefore, it is recommended to take special care when it comes to patient’s dignity. Pertinent steps in hospital settings can be taken to promote dignity. This not only improves nurse-client relationship, but will also promote therapeutic relationship, thus speeding up patients’ recovery. Therefore, as a nursing student it is important for us to understand the importance of dignity as this will help us to provide holistic care.
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