Perspectives about dignity during acute care for older people and their relatives: A qualitative study

Abstract

Aims and objectives: The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation. Background: Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings. Design: An interpretative descriptive method was used. Methods: A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub-acute care, and their relatives, were invited to participate. The study was undertaken in one sub-acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio-recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. Results: Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity. Conclusions: Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital. Relevance to clinical practice: Clinicians may benefit from systematic dignity-related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated.

Dignity and Predictors of Its Change Among Inpatients in Long-Term Care

“…Older people are at risk of loss of dignity during hospitalization ( Kerr et al, 2020 ). The need for hospitalization in long-term care (LTC) is a stressor that raises concerns among chronically ill older adults with limited self-sufficiency, regarding the loss of their personal dignity ( Albers et al, 2013 ).…”

Development and psychometric properties of the hospitalized elder abuse questionnaire (HEAQ): a mixed methods study

“…The questionnaire is scored based on a 5-point scale. Positively phrased items (3,4,7,(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) are awarded 5 points for the "always/ very much" response and 1 point for "never/ not at all". Whereas items (1,2,5,6,8,(21)(22)(23)(24)(25)(26)(27) are scored in reverse and awarded 5 points for "never/ very slow/ absolutely inappropriate" response and 1 point for "always/ very timely/ absolutely appropriate".…”

“…Maintaining patients’ respect and dignity are essential components of the Patients’ Rights Charter [ 11 ]. However, older patients are at a higher risk of patients’ rights violation in hospitals due to the nature of their illness, clinical environment, and the behavior of medical teams [ 12 ]. Those with a physical disability, dementia, or cognitive impairment require a higher level of care, but at the same time are in a higher risk of abuse because of their aggressive behavior due to disability or impairment [ 9 , 13 ].…”

Meanings of participation in care for older people after hip fracture surgery and nurses working in an orthopaedic ward

“…This can be understood as the older people feeling that they were in a safe environment and that asking questions would not be seen as questioning or distrusting the healthcare professionals. When patients feel safe to ask questions and raise concerns about care, their dignity is protected (Kerr et al, 2020 ). For the older people in this study, taking responsibility and asking questions can be understood as them feeling comfortable with the health care personnel.…”