The D Factor: How Respect for Dignity Can Make Health Care Better
2/26/2014, 3 p.m.
Dignity is one of those things we don't think much about until it’s gone.
In the hospital, for instance: Ever hear the saying about hospitalizations, "Check your dignity at the door"? It refers to those gowns that barely cover your tush. The abrupt 3 a.m. wakeups to take vital signs. Strangers' group discussions of your most intimate bodily functions.
Being able to hang onto your sense of dignity directly affects quality of life, researchers say. And this is especially true in care settings of all types, including at home.
What is Dignity, Anyway?
Dignity is defined in different ways. Mainly, it refers to the state or quality of being worthy of honor and respect.
"Dignity is a basic human right," says Qiaohong Guo, a PhD candidate at the University of Massachusetts, Amherst, who opened a panel of experts discussing dignity at the Geronological Society of America's annual meeting last fall. "You have dignity by virtue of being human." (This is sometimes called "intrinsic dignity.")
In terms of care, researchers focus on what's called "attributed dignity." This measure, developed by Cynthia Jacelon, PhD, RN, refers to how much value people perceive that they have and how much respect and worth they feel that others show them. Dignity is deeper than self-esteem or feeling good about yourself; it's self-value, she says, valuing yourself and feeling valued by others.
"Dignity is like the air — as long as it's good quality and available, you don't notice it. It's only when there's not enough air or a bad smell in the air that you notice it and it becomes important," explains Jacelon, also of UMass Amherst.
How Dignity Affects Care
Over the past decade or so, there's been growing interest in the role of dignity in care settings, Jacelon says. Of special interest to researchers: Dignity in health care, in end-of-life care, and in the care of people with impaired mental capacity, such as Alzheimer's or coma.
Jacelon’s research has shown that some kinds of function are improved when people feel they are being treated respectfully and in ways that maintain their dignity. "It's a powerful idea," she says.
People who feel disrespected can react in a variety of ways that makes care more difficult. They may become depressed or anxious, or may respond with aggression or resistance.
A 2013 study in Nursing Ethics defined one of the foundations of dignity-preserving dementia care as "advocating the person's autonomy and integrity." This means having compassion for the person, confirming his or her worthiness and sense of self, and creating a "humane and purposeful environment."
At the end of life, people deserve to have a peaceful environment, relief from symptoms, dignified treatment and care, privacy, and autonomy, among other factors, says Guo, who is studying how family caregivers maintain dignity during the dying process. The Five Wishes living will program is one of many efforts to encourage advance conversations about one's preferences for these aspects of care, among others.
What "Dignified Care" Looks Like
"Dignified care," Guo says, "is care that respects, maintains, promotes and recovers a patient's dignity."