Patient dignity in nursing : a phemomenological study

This research is concerned with patient dignity in nursing. It proposes the
introduction of the concept of Perceptual Adjustment Level (PAL) in order to resolve
the problem of the definition of patient dignity and its maintenance within nursing
care. The aims of the study are to identify how patients and nurses perceive patient
dignity, to investigate the extent to which patient dignity is maintained and to identify
nursing care activities in maintaining patient dignity. The implications of the findings
of this study for nursing education and the development of policy on clinical practice
are also examined.

The literature review revealed a paucity of research on patient dignity. There
was no clear definition of dignity that could be understood by both nurses and patients
during their day to day interaction. Little was known of the maintenance of patient
dignity and its influencing factors. A qualitative methodology utilising a
phenomenological approach was used. A total of 102 patients and 94 nurses from
medical and surgical wards in three hospitals within the United Kingdom were
interviewed using semi-structured interview techniques.

Although neither patients nor nurses specifically defined patient dignity, they
came up with similar categories in terms of how they perceived patient dignity:
privacy, respect, communication, the need for information, involvement in care,
independence, patients' choice, form of address, decency and confidentiality. Control
was only mentioned by patients. Although there was congruence between how the
patients and nurses described patient dignity, it emerged that nurses tended to operate
on different levels from how patients perceived the maintenance of their dignity.
While nurses utilised primarily their own perception of dignity to maintain patient
dignity, it was discovered that hospitalised patients went through a process of
adjustment of their notion of dignity and came to a level they could accept. As a
result a new concept termed Perceptual Adjustment Level (PAL) is proposed. Patients
felt dignified if events matched with this level. This research has, therefore, proposed
a tentative definition of patient dignity as the fulfilment of patients' expectations or
needs in terms of values within each patient's perceptual adjustment level taking into
account the hospital environment.

The need for assessing patients to discover their perceptual adjustment level
has been highlighted. A number of patients were satisfied with how their dignity was
maintained but a significant number were not. Ways of improving the maintenance of
patient dignity have also been proposed. In order to maintain patient dignity, nurses
should consider six questions: "what?" signifies the needs of dignity which should be
met. "Why?" highlights the importance of full explanations of the purpose of tasks
carried out on patients, and whether it matters to the patient. "Who?" relates to who is
going to perform the task on her or him? "Where?" considers whether privacy will be
ensured when the tasks will be done and "how?" sensitively the tasks will be done? It
is also important to make the patient aware "when?" tasks will be carried out. The
main factors that influenced the maintenance of patient dignity are revealed and
implications for nursing practice, management, education and research are discussed.