Emergency department overcrowding as a threat to patient dignity

Mah, Rick

doi:10.1017/s1481803500011428

Cited by 18 publications

(11 citation statements)

References 26 publications

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“…This need is especially pertinent to acute hospital settings [ 8 , 9 ], as endorsed by the Amsterdam declaration on the promotion of patients’ rights [ 10 ], which declared that “Patients have the right to be treated with dignity, which should be rendered with respect for their culture and values” [ 11 ]. Dignity in the caring process contains the values of “autonomy, truth, justice, and responsibility to human rights” [ 12 ] and is demonstrated by “attentiveness, awareness, personal respect, engagement, fraternity and an active defense of the patient” [ 13 , 14 ]. Baillie asserted that preserving human dignity is integral to the caring mission of nursing [ 9 ] and she recognized that health problems may threaten dignity (thereby leading to ‘indignity’).…”

Section: Introductionmentioning

confidence: 99%

Patients’ perception of dignity in an Italian general hospital: a cross-sectional analysis

Ferri

Muzzalupo

Lorenzo

2015

BMC Health Serv Res

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BackgroundDignity is related to a patient’s respect, privacy, information and autonomy. Maintaining dignity is defined as ethical goal of care. Although the importance of dignity has been widely recognized, there is limited research that investigates if dignity is really maintained in clinical practice and few studies have been conducted in acute hospital settings with adults across the age range. The aim of the study was to explore inpatients’ perception of dignity in an hospital setting.MethodsThis descriptive cross-sectional study was carried out in 10 medical and surgical wards of a General Hospital in Modena (Italy). We collected a purposive sample of 100 patients by selecting 10 participants from each ward who met following criteria: hospitalized for more than three days, at least 18 years old, not mentally ill, willing to participate and able to speak Italian. We developed a 15-item anonymous questionnaire divided into three sections: “physical privacy”, “information and autonomy”, “nurse-patients respectful interaction”.ResultsThe percentages of positive (preserved dignity perception) were more frequent than negative (not preserved dignity perception) and no answers with a statistically significantly difference among the three sections (Pearson chi2 = 150.41, p < 0.0001). The frequency of positive or negative answers was statistically significantly related to the preservation of dignity according to the following questions (p < 0.005, multivariate logistic regression): “privacy to use the bathroom” and “respectful interaction”, as protective factors and “maintaining of body privacy”, “involvement in the care process”, “correct communication” as risk factors.ConclusionsDignity was quite but not completely maintained according to the standards expected by patients. According to patients’ views, privacy of the body during medical procedures and respectful nurse-patient interactions were preserved more than information and verbal communication. Listening to patients’ views on the specific factors they consider useful to maintaining their dignity can help in this process. Recognizing and focusing on these factors will help professionals to establish practical measures for preserving and promoting patients' dignity and providing more dignified care. Dignity should be extensively and systematically pursued as other important clinical goals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0704-8) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Patients’ perception of dignity in an Italian general hospital: a cross-sectional analysis

Ferri

Muzzalupo

Lorenzo

2015

BMC Health Serv Res

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“…For those patients wishing to remain in the EDH, reasons included having faster access to physicians and nurses, familiarity with the ED, and ability to witness the excitement of acute care in the ED of other patients. These patients did not seem to mind the inconveniences of EDH care that many would find a threat to patient dignity [13]. It is somewhat surprising in our study and the aforementioned studies that a substantial proportion of admitted patients did not mind EDH boarding.…”

Section: Discussionmentioning

confidence: 56%

Patients Prefer Boarding in Inpatient Hallways: Correlation with the National Emergency Department Overcrowding Score

Richards

Ozery

Notash

et al. 2011

Emergency Medicine International

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Objective. The boarding of patients in Emergency Department (ED) hallways when no inpatient beds are available is a major cause of ED crowding. One solution is to board admitted patients in an inpatient rather than ED hallway. We surveyed patients to determine their preference and correlated their responses to real-time National Emergency Department Overcrowding Score (NEDOCS). Methods. This was a survey of admitted patients in the ED of an urban university level I trauma center serving a community of 5 million about their personal preferences regarding boarding. Real-time NEDOCS was calculated at the time each survey was conducted. Results. 99 total surveys were completed during October 2010, 42 (42%) patients preferred to be boarded in an inpatient hallway, 33 (33%) preferred the ED hallway, and 24 (24%) had no preference. Mean (±SD) NEDOCS (range 0-200) was 136 ± 46 for patients preferring inpatient boarding, 112 ± 39 for ED boarding, and 119 ± 43 without preference. Male patients preferred inpatient hallway boarding significantly more than females. Preference for inpatient boarding was associated with a significantly higher NEDOCS. Conclusions. In this survey study, patients prefer inpatient hallway boarding when the hospital is at or above capacity. Males prefer inpatient hallway boarding more than females. The preference for inpatient hallway boarding increases as the ED becomes more crowded.

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“…Crowding, which is highly related to boarding, threatens the human right to health and the right to be free from degrading treatment 16. Our study provides multiple examples on how patients feel undignified—forgotten, hungry because they are not fed and unclean because there are no showers.…”

Section: Discussionmentioning

confidence: 91%

“…Studies have shown that boarding is associated with longer hospital length of stay (LOS), delays in receiving care, medical errors, adverse events and mortality 8 10–15. Boarding is also a threat to patient dignity 16. A variety of initiatives have been employed to address boarding such as full capacity protocols and a limit on ED LOS to 4 h as implemented in the UK 17.…”

Section: Introductionmentioning

confidence: 99%