Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.
Int J Nurs Stud. 2013 Aug;50(8):1080-9. doi: 10.1016/j.ijnurstu.2012.12.014. Epub 2013 Jan 8.
While knowledge on factors affecting personal dignity of patients nearing death is quite substantial, far less is known about how patients living with a serious disease understand dignity.
To develop a conceptual model of dignity that illuminates the process by which serious illness can undermine patients' dignity, and that is applicable to a wide patient population.
Qualitative interview study.
34 patients with either cancer, early stage dementia, or a severe chronic illness were selected from an extensive cohort study into advance directives.
In-depth interviews were carried out exploring the experiences of seriously ill patients with regard to their personal dignity. The interview transcripts were analyzed using thematic analysis and a conceptual model was constructed based on the resulting themes.
We developed a two-step dignity model of illness. According to this model, illness related conditions do not affect patients' dignity directly but indirectly by affecting the way patients perceive themselves. We identified three components shaping self-perception: (a) the individual self: the subjective experiences and internally held qualities of the patient; (b) the relational self: the self within reciprocal interaction with others; and, (c) the societal self: the self as a social object in the eyes of others.
The merits of the model are two-folded. First, it offers an organizing framework for further research into patients' dignity. Secondly, the model can serve to facilitate care for seriously ill patients in practice by providing insight into illness and dignity at the level of the individual patient where intervention can be effectively targeted.
虽然人们对影响临近死亡患者个人尊严的因素有了相当多的了解，但对于患有严重疾病的患者如何理解尊严，人们知之甚少。
制定一个尊严的概念模型，阐明严重疾病破坏患者尊严的过程，并且适用于广泛的患者群体。
定性访谈研究。
从一项广泛的预先指令队列研究中选择了 34 名患有癌症、早期痴呆症或严重慢性疾病的患者。
进行深入访谈，探讨重病患者在个人尊严方面的经历。对访谈记录进行主题分析，并根据得出的主题构建概念模型。
我们提出了一个两步的疾病尊严模型。根据该模型，疾病相关状况不会直接影响患者的尊严，而是通过影响患者对自己的看法间接影响。我们确定了塑造自我认知的三个组成部分：（a）个体自我：患者的主观体验和内在品质；（b）关系自我：在与他人的相互作用中自我；以及，（c）社会自我：他人眼中的社会客体自我。
该模型有两个优点。首先，它为进一步研究患者尊严提供了一个组织框架。其次，该模型可以为严重疾病患者的护理提供参考，深入了解患者个人层面的疾病和尊严，从而可以有效地针对具体患者进行干预。
