开发用于衡量急性医院老年人尊严的工具。

Development of tools to measure dignity for older people in acute hospitals.

机构信息

Imperial College NHS Healthcare Trust, St Mary's Hospital, London, UK.

Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.

出版信息

J Clin Nurs. 2018 Oct;27(19-20):3706-3718. doi: 10.1111/jocn.14490. Epub 2018 Aug 13.

DOI:10.1111/jocn.14490

PMID:29679397

Abstract

BACKGROUND

Dignity is a concept that applies to all patients. Older patients can be particularly vulnerable to experiencing a loss of dignity in hospital. Previous tools developed to measure dignity have been aimed at palliative and end-of-life care. No tools for measuring dignity in acute hospital care have been reported.

OBJECTIVES

To develop tools for measuring patient dignity in acute hospitals.

SETTING

A large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 years or above.

METHODS

Three methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6-24); a format for nonparticipant observations; and individual face-to-face semi-structured patient and staff interviews (reported elsewhere).

RESULTS

A total of 5,693 surveys were completed. Mean score increased from 22.00 pre-intervention to 23.03 after intervention (p < 0.001). Staff-patient interactions (581) were recorded. Overall 41% of interactions (239) were positive, 39% (228) were neutral, and 20% (114) were negative. The positive interactions ranged from 17%-59% between wards. Quality of interaction was highest for allied health professionals (76% positive), lowest for domestic staff (22% positive) and pharmacists (29% positive), and intermediate for doctors, nurses, healthcare assistants and student nurses (40%-48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief)-63% (longer interactions) (F[2, 557] = 28.67, p < 0.001).

CONCLUSIONS

We have developed a simple format for a dignity survey and observations. Overall, most patients reported electronically that they received dignified care in hospital. However, observations identified a high percentage of interactions categorised as neutral/basic care, which, while not actively diminishing dignity, will not enhance dignity. There is an opportunity to make these interactions more positive.

摘要

背景

尊严是一个适用于所有患者的概念。老年患者在医院中尤其容易失去尊严。以前开发的用于衡量尊严的工具主要针对姑息治疗和临终关怀。在急性医院护理中，尚未报道用于衡量尊严的工具。

目的

开发用于衡量急性医院患者尊严的工具。

设置

英国一家大型急性医院。我们有目的地选择了 17 个病房，这些病房至少有 50%的患者年龄在 65 岁或以上。

方法

开发了三种与尊严相关的数据收集方法：电子患者尊严调查（可能的分数范围为 6-24）；非参与者观察格式；以及个人面对面的半结构化患者和工作人员访谈（另行报道）。

结果

共完成了 5693 次调查。干预前的平均得分为 22.00，干预后的平均得分为 23.03（p<0.001）。记录了 581 次员工与患者的互动。总体而言，41%的互动（239 次）是积极的，39%（228 次）是中性的，20%（114 次）是消极的。积极的互动范围在不同病房之间从 17%到 59%不等。与医生、护士、医疗助理和实习护士（40%-48%积极）相比，与药剂师（29%积极）和病房工作人员（22%积极）的互动质量最高，与辅助卫生专业人员（76%积极）的互动质量最低。互动时间的增加（从 25%（短暂）到 63%（较长互动））更有可能产生积极的互动（F[2, 557]=28.67，p<0.001）。