Patient's Dignity in the Hospital Environment - Report Example

Introduction With growing number of aged patients requiring hospitalization, issues regarding their comfortable stay in the hospital as well as quality of life have emerged and are being actively researched. The present article describes the results obtained after a focussed qualitative research for investigating the issue of dignity in older patients, how they themselves feel about it, in a post scenario questionnaire based analysis after hospitalization (Webster & Bryan, 2008). Although modern medicine has achieved great advances in the diagnosis and treatment of disease which have yielded greater life expectancy, the situation has become more complicated due to the dearth of time and over reliance on technology for healthcare delivery. In the process, the humane angle is sometimes neglected which can have serious consequences on patient compliance as well as the quality of life post treatment. The situation in case of older people is worse. With growing number of their population in society and the fact that most of the older people are either single or have nobody to care for them, it becomes imperative to address the issues pertaining to their dignity in the hospital environment as well as in the social setting. The idea of evidence based clinical diagnosis and practice has emerged and achieved a prominent place in the last few decades to address many of the problems encountered in the hospital setting (Knottnerus & Buntinx, 2009). Past experiences, clinical trials and the surmounting medical literature has churned out stupendous amount of knowledge about diagnosis and the most appropriate treatment modalities for various diseases which are impossible to store within the confines of the human brain. However, the recent advances in information and communication technology have placed a means to access the most pertinent information in a matter of minutes, if not seconds. Making a decision about the most appropriate diagnostic procedure and treatment modality to be adopted should therefore be backed by thorough research and investigation providing a strong basis for the approach to be used in the peculiar situations confronting one in a clinical setting. This allows for the right decision to be taken at the right moment with full justification and forms the basis for evidence based practice. Health care organizations all over the world are making endeavours to facilitate information transfer from literature to practice in order to ensure evidence based practice (Pipe et al, 2005). The issues of handling patients and providing encouragement and comfort during their stay in the hospital as well as in the recuperative stage at home too have clearly defined guidelines which need to e followed rigorously in order to make health services truly effective in their purpose. This assumes a higher significance in older patients, who maybe unable to communicate effectively with the hospital staff, both due to the generational gap as well as the lack of physical and cognitive functions which might have ebbed with age. The Question/Aim/Objective The need for establishing perception and understanding for patient dignity among nursing staff has always been felt (Matiti & Trorey, 2004). To explore this issue, in an incisive, qualitative study, the authors have looked into the issue of dignity in older patients by conducting a patient interview based analysis after discharge from a single district hospital in England (Webster & Bryan, 2008). The need for such an analysis has been built upon by the authors by citing the focus of the ‘National Service Framework for Older People’ to address issues of dignity in older patients whose number has significantly increased in England as well as other developed countries during the last few decades. Any patient who needs hospitalization is naturally distressed and compromised in one or the other way and has to depend on the nursing as well as other staff for basic bodily functions, as well as being subject to manipulation due to medical procedures which can impact their personal dignity at any age. Issues on patient dignity have been studied for all ages to find means and methods to maintain it during hospitalization (Baillie, 2009). Staff behaviour and the hospital environment have important bearings on this aspect. The issue acquires special considerations in older patients due to their vulnerability and chances of not being communicated with adequately. Moreover, gerontological nursing has always been the most unattractive career options to students of nursing (Brown et al, 2007). A need for the development of core skills necessary for handling has always been felt due to the recent endeavours to address issues of dignity in handling older patients (Sturdy, 2010). Endeavours have been made to study the communication patterns and their impact on patient dignity in older people in many hospitals around Europe (Woolhead et al, 2005). Design/Methodology Although the study was conducted on what appears as a stark paucity in sample size, the emphasis on an accurate analysis of the qualitative and abstract feelings of patients as regards the issues related to personal dignity, done in great detail, negates the inadequacy of sample size. In this study, an approach has been employed to shortlist older patients to review their views about issues concerning patient dignity after an unplanned admission to the hospital and subsequent discharge (Webster & Bryan, 2008). Sample Size/Subjects/Participants After due approval from the local research ethic committee and defining appropriate inclusion criteria, twenty one patients were initially identified out of which ten actually participated in the survey. Although the sample size appears dismally small, it was adequate according to the descriptive qualitative approach employed. The actual number of participants who satisfied the criteria and fully complied with the protocol was ten, which was considered an adequate sample size according to the criteria for a descriptive qualitative approach as defined by Morse and Field (Webster & Bryan, 2008). All patients fell within an age range of 73-83 years which satisfied one aspect of the inclusion criteria. Patients were from both sexes and with different occupational backgrounds. The actual interviews were conducted in an amiable setting after setting the appropriate preamble and a pre structured prompt approach was used to achieve uniformity in analysis of the responses. Data Collection Methods The ten participants who actually participated according to the predetermined criteria were interviewed at home by a nurse researcher. Semi-structured interviews lasting 45 minutes to one hour were conducted in which by making use of prompts derived from the ‘Essence of Care’ benchmarks as established by the department of health. Data Analysis and Results Data obtained was transcribed and the transcripts coded to extract the most pertinent information according to the method of Colaizzi (Webster & Bryan, 2008). Collection of data and its analysis in this study are meticulously carried out and have yielded pertinent information about how patients felt during their respective stays in the hospital with many generalizations and a few exceptions. Although the authors themselves feel that the analysis cannot be generalized for all patients due to the small sample size, it serves to provide pertinent indicators to the approach to be followed while attending to such patients in future. The vital aspects relating to dignity which emerged after this study were, the concern about privacy of the body among patients, the need for effective and personal communication by the attending staff, not being made an object of ridicule in personal conversations amongst staff, the need for cleanliness initiatives among attending staff while switching between patients, allowance of more independence and access to facilities during stay in hospital and the absence of any insinuation of them being considered a spent force by the younger staff. More effective communication with patients and due respect of age were identified as other two vital aspects related to patient dignity. Ethical Considerations Approvals from the local research Ethics committee as well as the University Ethic committee were obtained and the patients were informed well in advance about the intent of the study to encourage participation. More detailed information was communicated to the patients subsequently before conducting the actual interviews. The interviews were conducted by building a congenial environment for true responses by setting the patients at ease. Conclusions and Implications for Practice It has already been established that the relationships between staff and older patients have vital implications on personalized and dignified care during hospital stay (Bridges et al, 2009). The study has served to provide vital clues to the awareness of older patients about the importance they place on personal dignity, especially when they have adequate awareness and control over their cognitive functions. Their observations within the hospital about the ignobility of much older patients within the hospital precincts, who have compromised physical and cognitive abilities, reveal their fear of getting into the same situation in later years of their life. Their need for being appropriately pre informed about the procedures to be carried out during their stay, not being considered as just objects to be subjected to such procedures and being fully aware of the comments among the attending staff reveal the true feelings they experience which may be missed or ignored by the untrained young staff. Nursing as well attending staff therefore needs to be made aware and properly trained to handle such cases with utmost care. Older patients are increasing in number and require frequent hospitalizations due to one factor or the other due to their frail nature and medical emergencies from time to time. Hospital environment and behaviour of the staff should be more congenial to make them feel at home and not be offended in any manner. Such patients come from myriad backgrounds and may have contributed intellectually as well as in their professional capacities during youth and can get easily hurt if they are subjected to any form of dignity within the hospital premises. The nursing staffs are in close contact of such patients and need to understand the implications and effects of their behaviour as well as actions while dealing with such patients. A toothpick approach needs to be employed in actual practice so as not to affect the personal dignity of all patients, more so of older patients. Appendix: Synopsis In a well directed and planned study, Webster & Bryan, 2008 have laid bare the issues pertaining to dignity among older patients directly from the proverbial horse’s mouth. Carefully selected patients were identified from a single district hospital and after due ethical approval and informed consent, subjected to a scientifically designed questionnaire in the form of an interview which yielded pertinent data which was transcribed and coded to give appropriate outcomes. The analysis of the obtained data revealed that older patients were highly aware of the indignities they suffer during hospitalization. Personal privacy during procedures, effective and appropriate communication by the attending staff, not being considered as helpless individuals and provision of scope for availability of facilities within easy access were the identified key areas responsible for preservation of dignity within the hospital. Their awareness serves to elicit a vital awakening call to the medical, nursing and other professionals working within a hospital setting to be more careful while carrying out procedures on patients, talking amongst themselves as well as while communicating with patients. This will ensure the actual and true application of the latest endeavours for ensuring dignity of the prevalent high numbers of older patients. Reference List Baillie, L 2009, Patient dignity in an acute hospital setting: A case study, International Journal of Nursing Studies 46, 23–37 Bridges, J, Flatley, M & Meyer, J 2009, Older people’s and relatives’ experiences in acute care settings: Systematic review and synthesis of qualitative studies, Review Article, International Journal of Nursing Studies 47, 89–107 Brown, J, Nolan, M, Davies, S et al 2007, Transforming students’ views of gerontological nursing: Realising the potential of ‘enriched’ environments of learning and care: A multi-method longitudinal study, International Journal of Nursing Studies 45, 1214–1232 Knottnerus, J A & Buntinx, F 2009, The Evidence Base of Clinical Diagnosis, Theory and methods of diagnostic research, Second Edition, John Wiley & Sons Ltd, West Sussex, UK, Preface, pp. xi-xiii Matiti, M R & Trorey, G 2004, Perceptual adjustment levels: patients’ perception of their dignity in the hospital setting, International Journal of Nursing Studies 41, 735–744 Pipe, T B, Wellik, K E, Buchda, V L et al 2005, Implementing Evidence-Based Nursing Practice , online article accessed January 15, 2009 at: http://www.medscape.com/viewarticle/514532 Sturdy, D 2010, Best practice for older people in acute care settings, Editorial, International Journal of Nursing Studies 47, 1–2 Webster, C & Bryan, K 2008, Older people’s views of dignity and how it can be promoted in a hospital environment, Journal of Clinical Nursing, 18, 1784–1792 Woolhead, G, Tadd, W, Boix-Ferrer, J A et al 2005, ‘‘Tu’’ or ‘‘Vous?’’ A European qualitative study of dignity and communication with older people in health and social care settings, Patient Education and Counseling 61, 363–371 Read More