Imperial College NHS Healthcare Trust, St Mary's Hospital, London, UK.
Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
J Clin Nurs. 2018 Oct;27(19-20):3706-3718. doi: 10.1111/jocn.14490. Epub 2018 Aug 13.
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.
To develop tools for measuring patient dignity in acute hospitals.
A large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 years or above.
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).
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).
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.
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。
开发用于衡量急性医院患者尊严的工具。
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。
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）。
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）。
我们已经开发了一种简单的尊严调查和观察格式。总体而言，大多数患者通过电子方式报告他们在医院接受了有尊严的护理。然而，观察发现，很大比例的互动被归类为中性/基本护理，虽然不会主动降低尊严，但也不会增强尊严。有机会使这些互动更加积极。
