Baillie Lesley
London South Bank University, United Kingdom.
Int J Nurs Stud. 2009 Jan;46(1):23-36. doi: 10.1016/j.ijnurstu.2008.08.003. Epub 2008 Sep 14.
Nurses have a professional duty to respect patients' dignity. There is a dearth of research about patients' dignity in acute hospital settings.
The study investigated the meaning of patient dignity, threats to patients' dignity, and how patient dignity can be promoted, in acute hospital settings.
A qualitative, triangulated single case study design (one acute hospital), with embedded cases (one ward and its staff, and 24 patients).
The study was based on a 22-bedded surgical ward in an acute hospital in England.
Twenty-four patients, aged 34-92 years were purposively selected. There were 15 men and 9 women of varied socio-economic backgrounds. They could all communicate verbally and speak English. Twelve patients, who had stayed in the ward at least 2 days, were interviewed following discharge. The other 12 patients were observed and interviewed on the ward. The ward-based staff (26 registered nurses and healthcare assistants) were observed in practice. 13 were interviewed following observation. Six senior nurses were purposively selected for interviews.
The data were collected during 2005. The Local Research Ethics Committee gave approval. Unstructured interviews using topic guides were conducted with the 24 patients, 13 ward-based staff and 6 senior nurses. Twelve 4-h episodes of participant observation were conducted. The data were analysed thematically using the framework approach.
Patient dignity comprised feelings (feeling comfortable, in control and valued), physical presentation and behaviour. The environment, staff behaviour and patient factors impacted on patient dignity. Lack of environmental privacy threatened dignity. A conducive physical environment, dignity-promoting culture and other patients' support promoted dignity. Staff being curt, authoritarian and breaching privacy threatened dignity. Staff promoted dignity by providing privacy and interactions which made patients feel comfortable, in control and valued. Patients' impaired health and older age rendered them vulnerable to a loss of dignity. Patients promoted their own dignity through their attitudes (rationalisation, use of humour, acceptance), developing relationships with staff and retaining ability and control.
Patients are vulnerable to loss of dignity in hospital. Staff behaviour and the hospital environment can influence whether patients' dignity is lost or upheld.
护士负有尊重患者尊严的职业责任。关于急症医院环境中患者尊严的研究匮乏。
本研究调查了急症医院环境中患者尊严的含义、对患者尊严的威胁以及如何促进患者尊严。
一项定性的、采用三角互证法的单案例研究设计（一所急症医院），包含嵌入式案例（一个病房及其工作人员，以及24名患者）。
该研究基于英格兰一所急症医院的一个有22张床位的外科病房。
有目的地选取了24名年龄在34至92岁之间的患者。其中有15名男性和9名女性，社会经济背景各异。他们都能进行口头交流且会说英语。12名在病房至少住了2天的患者在出院后接受了访谈。另外12名患者在病房接受了观察和访谈。对病房工作人员（26名注册护士和医疗护理员）进行了实际观察。13名工作人员在观察后接受了访谈。有目的地选取了6名高级护士进行访谈。
数据收集于2005年。获得了当地研究伦理委员会的批准。使用主题指南对24名患者、13名病房工作人员和6名高级护士进行了非结构化访谈。进行了12次每次4小时的参与式观察。采用框架法对数据进行了主题分析。
患者尊严包括感受（感到舒适、能掌控局面和被重视）、外在形象和行为。环境、工作人员行为和患者自身因素会影响患者尊严。缺乏环境隐私会威胁尊严。宜人的物理环境、促进尊严的文化氛围以及其他患者的支持能提升尊严。工作人员态度生硬、专断独裁以及侵犯隐私会威胁尊严。工作人员通过提供隐私以及能让患者感到舒适、能掌控局面和被重视的互动来促进尊严。患者健康受损和年事已高使他们容易丧失尊严。患者通过自身态度（自我开解、运用幽默、坦然接受）、与工作人员建立关系以及保持自身能力和掌控力来维护自己的尊严。
患者在医院容易丧失尊严。工作人员的行为和医院环境会影响患者尊严是丧失还是得以维护。
