How to maintain patient dignity in nursing

Laura M. Cascella, MA, CPHRM

Humans have an intrinsic need for dignity as a basic element of well-being. Yet, the concept of dignity can be somewhat nebulous and its defining features can vary across societies, cultures, and individuals.

In the context of healthcare, dignity often is defined as a multifaceted approach to patient interactions that involves the elements of respect, autonomy, empowerment, safety, communication, privacy, acceptance, acknowledgment, fairness, and more.1

The very nature of healthcare, however, can generate feelings that starkly contrast with the pillars of dignity. During healthcare encounters, patients might feel exposed, vulnerable, judged, anxious, and frightened. Further, in the busy healthcare environment, the principles that promote dignity — such as compassion, empathy, and attentiveness — can suffer because of time limitations and greater focus on goals and improvements that are more easily defined and measured.

Despite these barriers, treating patients with dignity is an essential element of patient-centered care, engagement, and satisfaction. Even small gestures or modest changes can have a meaningful effect on a person's sense of dignity. This article discusses eight areas in which healthcare providers can promote patient dignity and reinforce patient-centered care as part of everyday practice.

Promote a culture of dignity in your organization by showing patients and colleagues respect, compassion, empathy, and kindness. Recognize and respect each person's individuality, and encourage other practitioners and staff members in your practice to do the same. Consider how your organization can raise awareness about improving patient dignity through training, patient feedback, periodic reminders, and other methods.

Remember common courtesies in your daily interactions with patients, such as greeting patients, introducing yourself (if appropriate), asking how the patient is feeling, and making direct eye contact during discussions.

During initial encounters, ask patients how they would prefer that you address them. Some patients might prefer their first names or nicknames, while others want to use titles and surnames. Making an assumption about how to address a patient might lead to feelings of disrespect, especially in relation to cultural or generational differences.

Additionally, take stock of your attitude and demeanor when interacting with patients to ensure that personal or external factors (e.g., tiredness, stress, and staff or technology interruptions) don't influence how patients perceive your feelings about them.

Respect patients' privacy and confidentiality by taking steps to (a) ensure privacy during office visits (e.g., not discussing patients' personal information in open areas and lowering your voice when communicating personal information), and (b) safeguard patients' protected health information. Actual or perceived lapses in privacy and confidentiality can trigger feelings of disregard and diminish patients' trust.

Patients have varying definitions of decency and modesty, so it's prudent to gauge these feelings and respond appropriately. Some general strategies for respecting patients' modesty include:

• Knocking on exam room doors and asking permission before entering
• Using curtains in exam rooms to block the view from hallways and to provide a greater sense of privacy
• Offering drapes or gowns that fasten to help patients feel less exposed
• Securing patients' gowns or providing them with an additional cover if you're planning to transfer them to another room

Additionally, ask for consent before physically examining or treating patients. Explain to patients what you're doing as you're doing it, and encourage them to speak up if they are uncomfortable or in pain. Acknowledging their feelings and providing support might help alleviate feelings of vulnerability.

Autonomy is a fundamental aspect of dignity, and includes dimensions such as having choice, giving choice, making decisions, being able to make decisions, competence, rights, needs, and independence.2 Autonomy also is an underlying principle of informed consent, a legal and ethical process that recognizes individuals' rights to make decisions about their healthcare.

When providing patients with treatment options and recommendations, be vigilant about engaging patients in discussions about the risks and benefits of care and respecting patients' rights related to choice and decision-making, including their right to refuse care.

Without a doubt, communication is central to how patients perceive they are treated during healthcare encounters. Both verbal and nonverbal communication must be considered when developing strategies to promote patient dignity.

Effective verbal communication can help reinforce dignity by supporting a culture of safety, creating a successful provider–patient partnership, and engaging patients in shared responsibility for their care.

When conversing with patients, be cognizant about not interrupting or rushing them. Doing so can imply lack of respect for the individual or general disinterest in what the patient is trying to communicate. Limiting external interruptions also can help minimize frustrations and make patients feel like they are a priority.

Speak clearly and use words that patients will understand, but avoid using a tone that might be perceived as demeaning, patronizing, or dismissive. Also, be mindful about avoiding language that implies stereotypes based on age, culture, gender, sexual orientation, and so on. Even if these statements are well intentioned or unintentional, they might be perceived as offensive or derisive. Carefully consider your wording and whether it is appropriate for the individual and the situation.

Considering that the majority of daily communication is nonverbal, it is no surprise that this aspect of communication has a significant impact on human interactions. Positive nonverbal communication is a powerful tool for connecting with patients in a constructive way and reinforcing mutual understanding and respect.

Developing situational awareness of your nonverbal communication — such as facial expressions, gestures, and body language — can help you recognize its potential to either alienate or engage patients and develop strategies for reassuring patients in nonverbal ways.

Cultural competence is a distinguishing feature of patient-centered care and a vital component of communicating well with patients and promoting dignity. Providing culturally competent care requires developing an awareness of how patients' cultural beliefs and values can affect their perception of healthcare interactions and understanding of healthcare information. Further, it's important to consider how cultural influences might contribute to how patients define the various aspects of dignity, such as respect, self-worth, pride, modesty, and autonomy.

Although the day-to-day activities and tasks that occur in healthcare practices, clinics, and hospitals often are routine for people who work in these settings, they might be overwhelming for patients. Additionally, healthcare encounters don't occur in a vacuum, and the emotions they evoke can intermingle with patients' other personal and professional stressors.

During patient interactions, give pause to consider how patients are responding to diagnoses, treatment recommendations, and outcomes. Acknowledging patients' emotions and responding with empathy, understanding, and compassion can greatly influence patients' overall experience and help them feel respected and comforted.

Resources

Endnotes

1 Adib-Hajbaghery, M., & Aghajani, M. (2015, March). Patients dignity in nursing. Nursing and Midwifery Studies, 4(1), e22809. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4377527/; Finn, N. (2015, June). The role of dignity in healthcare. Society for Participatory Medicine. Retrieved from https://participatorymedicine.org/epatients/2015/06/the-role-of-dignity-in-health-care.html

2 Adib-Hajbaghery, et al., Patients dignity in nursing.

If people feel their identity and value as a human being is not respected, this can stop them from enjoying life and living comfortably during a period of care.

There are 8 factors related to dignity identified by the Social Care Institute for Excellence:

• Choice and control.
• Communication.
• Eating and nutritional care.
• Pain management.
• Personal hygiene.
• Practical assistance.
• Privacy.
• Social inclusion.

Methods for upholding dignity are usually small, seemingly inconsequential things, but to a person who has resigned the majority of their independence to a stranger, they mean the world.

Our Dignity in Care Training will give you a strong awareness of how to uphold dignity in a care setting. This knowledge will enable you to care for patients of all ages and from all walks of life in a way that makes them feel secure, comfortable, and, most importantly, valued and respected.

Let’s take a look at 9 examples, all of which derive from the dignity factors listed above.

1. Let people choose their own clothing.

There is nothing more stifling to a person’s identity than having to wear clothes that are not ‘them’. People have a strong sense of what style of clothing suits their personality and personal preferences, so to denying them the ability to choose is harmful to their dignity.

However, this doesn’t mean you can’t assist them. With their approval you can help them dress, but let them pick what to wear. This includes the physical act of choosing. Unless they ask you to, don’t lay out an outfit for them just for the sake of speed. Give them time to select their own from the wardrobe.

2. Involve them in decisions relating to their care.

You might think it’s more straight forward to simply go ahead with decisions about changes to the way people receive care, rather than try explain it to them. But that is harmful to a person’s dignity: it makes them feel disconnected and undervalued. Their lack of control over the situation is dehumanising; they’ll feel like they’re just an object over which you have complete authority.

People appreciate being included as it gives them the sense that their opinion and preferences are respected. Therefore, be sure to involve them in any and all discussions that affect their care. This includes decisions about their medication (e.g. which type to take and how to take it), day-to-day changes (e.g. new staff or changes to the home’s layout), and meal plans (this includes dietary requirements and preferences).

3. Address the person properly.

Another crucial part of a person’s identity is their name – they are how we identify one another. Therefore, making assumptions about which title or name a person would like to be addressed by – even if you think your assumption is the polite choice – is disrespectful to their identity, which in turn damages dignity.

This is particularly important for the elderly, many of whom have certain expectations about how people should refer to them. So always ask a patient how they’d like to be addressed. Similarly, address them with a polite, amiable voice and don’t adopt a patronising tone. They’re adults, not children.

4. Make food look and taste nice.

For people in care – as for many people – mealtimes are the highlight of the day. Nothing is more disheartening than having a lousy lunch. Imagine being presented with an unappetising plate of food – both in terms of look and taste – every day for weeks, months, maybe even years on end.

As mentioned earlier, involve people when creating meal plans – they can offer suggestions, including their favourite dishes. Make sure kitchen staff are skilled at cooking, receive fresh, quality ingredients, and make the effort to ensure food is well-presented.

5. Respect personal space and possessions.

You are caregiver and care resident, not mother and child. Just because you’re in charge of their care, it does not mean you can barge into their personal space without asking for permission. Respecting residents’ privacy in a care home is of utmost importance: being in such close quarters with strangers can already feel claustrophobic without your lack of consideration.

So unless they are incapable of giving permission or it’s an emergency, always knock or ask to come in before entering a person’s room.

Likewise, don’t move or rifle through people’s personal belongings without permission.Even when cleaning, remember to respect their positions and space -ask them if it’s okay for you to move their items while you clean. The simple act of asking makes people feel respected and more open to giving you permission, and instils trust. Be sure to put everything back where it was when you’re done.

6. Handle hygiene activities sensitively.

You may be used to seeing people’s unclothed bodies every day, but the patient will not be used to revealing theirs so frequently. If you need to assist a person with bathing and dressing/undressing, you must handle the situation with tact. Understand that they will be self-conscious and very self-aware when undressed.

Above all, you must ask for consent before you engage in any activities involving their body. Explain what you’re doing as you’re doing it and engage in conversation to make the situation less uncomfortable – having a chat will reduce how hyperaware they are about their body. If they don’t want to talk, ask if they’d like you to put on some music or the TV for background noise.

7. Promote social activities.

Being in a care home can leave a person feeling shut off from the outside world. Particularly for those who have an extroverted personality, this can be extremely stifling and damaging to their identity and dignity. They may end up feeling like they are simply a task for caregivers to complete; like a burden.

Having a social life instils them with a sense of purpose and satisfaction, thus improving their quality of life. So you should take it upon yourself to create opportunities for people in your care to engage in social activities, whether it be inside or outside the premises. Contact with family, eating out with friends, or getting involved in local groups are all good examples. Also, encourage them to adopt hobbies and provide them with the means and equipment to do so, such as knitting or art supplies.

8. Know how to detect pain.

Treating pain in care homes can be tricky. Older people are more likely to experience pain but less likely to complain or want medication. This combination can leave the elderly in a great deal of pain which will distract them and hinder their ability to enjoy the remainder of their life.

Ideally you will be educated on how to identify signs of pain without being told. Restlessness, social isolation, and avoidance are just a few examples. Detecting pain is easier if the person is seen by the same caregiver regularly, since trends and changes in behaviour will be more apparent. It also enables you to build a relationship with the person, so they’ll feel more willing to telling you about any pain.

9. Have a friendly chat.

Your life as a caregiver probably feels very hectic, especially if you have to run back and forth between several people a day. But for a person in care, it could be quite boring or uneventful. You likely talk to dozens of people throughout the day – including other caregivers and service users – but depending on their circumstances, many residents in the care home might only talk to one person a day: you.

A five or ten minute chat will fulfil their craving for social interaction and lift their spirits. Let them lead the conversation if they want to, but don’t just nod along until you have an opportunity to leave. Really listen and interact with them; show interest in what they have to share. When you have to move on, let them know politely and reassure them that you’ll continue the chat next time. And be sure to do so.

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