Preserving patient dignity in critical care units: A qualitative content analysis
-
Alireza Arman
,
Shahrzad Ghiyasvandian
,
Zahra Abbasi Dolatabadi
,
Meysam Khoshavi
,
Ali Yavari
,
Masoumeh Zakerimoghadam
Abstract
Background & Aim: Patient dignity is a fundamental aspect of human rights, particularly when individuals are most vulnerable. Although maintaining patient dignity seemed to be challenging in Critical Care Units due to the complexity of medical procedures and critical condition of patients, a paucity of evidence exists exploring dignity preservation in Critical Care Units as well as its requirements from the patients' perspective. Thus, we aimed to explore patients’ dignity in Critical Care Units and the requirements for its preservation.
Methods & Materials: This qualitative study was conducted on 20 patients selected from the Critical Care Units of Imam Khomeini Hospital, Tehran, Iran, through purposeful sampling. Data were collected via semi-structured interviews and were analyzed using Graneheim and Lundman’s conventional content analysis method. Interviews explored patients' experiences and expectations regarding dignity preservation.
Results: The analysis revealed three main categories and nine subcategories essential for preserving patient dignity in Critical Care Units: (1) Care Ethics: Informed Decision-Making, Respecting Patient Concerns, and realistic interaction; (2) Humanity Preservation: Empathetic Acceptance, Avoiding Objectification, and Maintaining Patient Privacy; and (3) Personalized Care: Identifying Needs Proactively, Adapting Care to Individual Conditions, and Ensuring Comfort and Well-being. Participants emphasized the importance of empathetic communication, respect for their personal values and preferences, and maintaining a clean, comfortable environment.
Conclusion: The findings highlight the necessity for healthcare professionals to engage in ethical care, foster empathetic patient interactions, and proactively address the unique needs of each patient to enhance dignity preservation in critical care settings.
1. Rezaei M, Seyedfatemi N, Najafi Ghezeljeh T. Challenges of implementing family-based dignity intervention. Nursing Practice Today. 2023;10(3):173–5. doi:10.18502/npt.v10i3.13426
2. Barclay L. In sickness and in dignity: A philosophical account of the meaning of dignity in health care. International Journal of Nursing Studies. 2016;61:136-41. https://doi.org/10.1016/j.ijnurstu.2016.06.010
3. Voigt DK-H, Lenz P, Friederichs H. Physicians' comprehension of the German Patients' Rights Act: A cross-sectional study. Health Policy. 2018;122(11):1249-54. https://doi.org/10.1016/j.healthpol.2018.08.017
4. Safavi F, Yousefi Z, Bavani SM, Khodadadi E. The relationship between nurses' ethical reasoning with the quality of nursing care. International Journal of Applied and Basic Medical Research. 2022;12(3):196-202. https://doi.org/10.4103/ijabmr.ijabmr_637_21
5. Atashzadeh-Shoorideh F, Mohtashami J, Farhadzadeh M, Sanaie N, Fathollah Zadeh E, Beykmirza R, Abdoljabari M. Humanitarian care: Facilitator of communication between the patients with cancer and nurses. Nursing Practice Today. 2020;8(1):70–8. doi:10.18502/npt.v8i1.4493
6. Khademi M, Mohammadi E, Vanaki Z. On the violation of hospitalized patients' rights: A qualitative study. Nursing Ethics. 2019;26(2):576-86. https://doi.org/10.1177/0969733017709334
7. Bidabadi FS, Yazdannik A, Zargham-Boroujeni A. Patient's dignity in intensive care unit: A critical ethnography. Nursing Ethics. 2019;26(3):738-52. https://doi.org/10.1177/0969733017720826
8. Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, et al. The practice of respect in the ICU. American Journal of Respiratory and Critical Care Medicine. 2018;197(11):1389-95. https://doi.org/10.1164/rccm.201708-1676CP
9. Mehdipour-Rabori R, Abbaszadeh A, Borhani F. Human dignity of patients with cardiovascular disease admitted to hospitals of Kerman, Iran, in 2015. Journal of Medical Ethics and History of Medicine. 2016;9:8.
10. Nyholm L, Koskinen CA. Understanding and safeguarding patient dignity in intensive care. Nursing Ethics. 2017;24(4):408-18. https://doi.org/10.1177/0969733015605669
11. Jacobson N. Dignity and health: A review. Social Science & Medicine. 2007;64(2):292-302. https://doi.org/10.1016/j.socscimed.2006.08.039
12. America CoQoHCi. Crossing the quality chasm: A new health system for the 21st century. National Academies Press; 2001.
13. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105-12. https://doi.org/10.1016/j.nedt.2003.10.001
14. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins; 2010.
15. Cheraghi MA, Manookian A, Nasrabadi AN. Human dignity in religion-embedded cross-cultural nursing. Nursing Ethics. 2014;21(8):916-28. https://doi.org/10.1177/0969733014521095
16. Angel S, Frederiksen KN. Challenges in achieving patient participation: A review of how patient participation is addressed in empirical studies. International Journal of Nursing Studies. 2015;52(9):1525-38. https://doi.org/10.1016/j.ijnurstu.2015.04.008
17. Fumis RRL, Ranzani OT, Martins PS, Schettino G. Emotional disorders in pairs of patients and their family members during and after ICU stay. PLoS One. 2015;10(1):e0115332. https://doi.org/10.1371/journal.pone.0115332
18. Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): An overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Review of Neurotherapeutics. 2021;21(10):1159-77. https://doi.org/10.1080/14737175.2021.1981289
19. Gay EB, Pronovost PJ, Bassett RD, Nelson JE. The intensive care unit family meeting: Making it happen. Journal of Critical Care. 2009;24(4):629.e1-12. https://doi.org/10.1016/j.jcrc.2008.10.003
20. Ussher JM, Parton C, Perz J. Need for information, honesty and respect: Patient perspectives on health care professionals' communication about cancer and fertility. Reproductive Health. 2018;15:1-12.
https://doi.org/10.1186/s12978-017-0441-z
21. Ozaras G, Abaan S. Investigation of the trust status of the nurse-patient relationship. Nursing Ethics. 2018;25(5):628-39. https://doi.org/10.1177/0969733016664971
22. Zafarnia N, Abbaszadeh A, Borhani F, Ebadi A, Nakhaee N. Moral competency: Meta-competence of nursing care. Electronic Physician. 2017;9(6):4553-61. https://doi.org/10.19082/4553
23. Fuseini AG, Rawson H, Ley L, Kerr D. Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives. Journal of Clinical Nursing. 2023;32(7-8):1286-1302. https://doi.org/10.1111/jocn.16286
24. Bagherian S, Sharif F, Zarshenas L, Torabizadeh C, Abbaszadeh A, Izadpanahi P. Cancer patients' perspectives on dignity in care. Nursing Ethics. 2020;27(1):127-40. https://doi.org/10.1177/0969733019845126
25. Sharifi N, Adib-Hajbaghery M, Najafi M. Cultural competence in nursing: A concept analysis. International Journal of Nursing Studies. 2019;99:103386. https://doi.org/10.1016/j.ijnurstu.2019.103386
26. Norouzinia R, Aghabarari M, Shiri M, Karimi M, Samami E. Communication barriers perceived by nurses and patients. Global Journal of Health Science. 2015;8(6):65-74. https://doi.org/10.5539/gjhs.v8n6p65
27. Fountouki A, Andrades Sanchez M, Theofanidis D. Paternalism vs patient empowerment: Nursing challenges from Spain and Greece. International Journal of Caring Sciences. 2020;13(3):2288-93.
28. Brower RG. Consequences of bed rest. Critical Care Medicine. 2009;37(10 Suppl):S422-8. https://doi.org/10.1097/CCM.0b013e3181b6e30a
29. Rachel H, Chiara C, Robert K, Francesco S. Spiritual care in nursing: An overview of the measures used to assess spiritual care provision and related factors amongst nurses. Acta Bio Medica Atenei Parmensis. 2019;90(Suppl 4):44-50.
30. Chiang YC, Lee HC, Chu TL, Han CY, Hsiao YC. The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring. Nursing Outlook. 2016;64(3):215-24. https://doi.org/10.1016/j.outlook.2015.11.012
31. Baldacchino D. Spiritual care education of health care professionals. MDPI; 2015. https://doi.org/10.3390/rel6020594
32. Mujallad A, Taylor EJ. Modesty among Muslim women: Implications for nursing care. MedSurg Nursing. 2016;25(3):169-74.
33. Almutairi KM. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Medical Journal. 2015;36(4):425-9. https://doi.org/10.15537/smj.2015.4.10133
34. Bäck E, Wikblad K. Privacy in hospital. Journal of Advanced Nursing. 1998;27(5):940-5. https://doi.org/10.1046/j.1365-2648.1998.t01-1-00576.x
35. Costa DGd, Moura GMSSd, Pasin SS, Costa FGd, Magalhães AMMd. Patient experience in co-production of care: Perceptions about patient safety protocols. Revista Latino-Americana de Enfermagem. 2020;28:e3272. https://doi.org/10.1590/1518-8345.3352.3272
36. Allen C, Glasziou P, Del Mar C. Bed rest: A potentially harmful treatment needing more careful evaluation. The Lancet. 1999;354(9186):1229-33. https://doi.org/10.1016/S0140-6736(98)10063-6
37. Molina-Mula J, Gallo-Estrada J. Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health. 2020;17(3):835. https://doi.org/10.3390/ijerph17030835
38. Gezginci E, Goktas S, Orhan BN. The effects of environmental stressors in intensive care unit on anxiety and depression. Nursing in Critical Care. 2022;27(1):113-9. https://doi.org/10.1111/nicc.12553
39. Turner-Cobb J, Smith P, Ramchandani P, Begen F, Padkin A. The acute psychobiological impact of the intensive care experience on relatives. Psychology, Health & Medicine. 2016;21(1):20-6. https://doi.org/10.1080/13548506.2014.997763
40. Van Paasschen J, Walker SC, Phillips N, Downing PE, Tipper SP. The effect of personal grooming on self‐perceived body image. International Journal of Cosmetic Science. 2015;37(1):108-15. https://doi.org/10.1111/ics.12176
41. Hsu T, Ryherd E, Waye KP, Ackerman J. Noise pollution in hospitals: Impact on patients. Journal of Communication in Healthcare. 2012;19(7):301-9.
2. Barclay L. In sickness and in dignity: A philosophical account of the meaning of dignity in health care. International Journal of Nursing Studies. 2016;61:136-41. https://doi.org/10.1016/j.ijnurstu.2016.06.010
3. Voigt DK-H, Lenz P, Friederichs H. Physicians' comprehension of the German Patients' Rights Act: A cross-sectional study. Health Policy. 2018;122(11):1249-54. https://doi.org/10.1016/j.healthpol.2018.08.017
4. Safavi F, Yousefi Z, Bavani SM, Khodadadi E. The relationship between nurses' ethical reasoning with the quality of nursing care. International Journal of Applied and Basic Medical Research. 2022;12(3):196-202. https://doi.org/10.4103/ijabmr.ijabmr_637_21
5. Atashzadeh-Shoorideh F, Mohtashami J, Farhadzadeh M, Sanaie N, Fathollah Zadeh E, Beykmirza R, Abdoljabari M. Humanitarian care: Facilitator of communication between the patients with cancer and nurses. Nursing Practice Today. 2020;8(1):70–8. doi:10.18502/npt.v8i1.4493
6. Khademi M, Mohammadi E, Vanaki Z. On the violation of hospitalized patients' rights: A qualitative study. Nursing Ethics. 2019;26(2):576-86. https://doi.org/10.1177/0969733017709334
7. Bidabadi FS, Yazdannik A, Zargham-Boroujeni A. Patient's dignity in intensive care unit: A critical ethnography. Nursing Ethics. 2019;26(3):738-52. https://doi.org/10.1177/0969733017720826
8. Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, et al. The practice of respect in the ICU. American Journal of Respiratory and Critical Care Medicine. 2018;197(11):1389-95. https://doi.org/10.1164/rccm.201708-1676CP
9. Mehdipour-Rabori R, Abbaszadeh A, Borhani F. Human dignity of patients with cardiovascular disease admitted to hospitals of Kerman, Iran, in 2015. Journal of Medical Ethics and History of Medicine. 2016;9:8.
10. Nyholm L, Koskinen CA. Understanding and safeguarding patient dignity in intensive care. Nursing Ethics. 2017;24(4):408-18. https://doi.org/10.1177/0969733015605669
11. Jacobson N. Dignity and health: A review. Social Science & Medicine. 2007;64(2):292-302. https://doi.org/10.1016/j.socscimed.2006.08.039
12. America CoQoHCi. Crossing the quality chasm: A new health system for the 21st century. National Academies Press; 2001.
13. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2):105-12. https://doi.org/10.1016/j.nedt.2003.10.001
14. Polit DF, Beck CT. Essentials of nursing research: Appraising evidence for nursing practice. Lippincott Williams & Wilkins; 2010.
15. Cheraghi MA, Manookian A, Nasrabadi AN. Human dignity in religion-embedded cross-cultural nursing. Nursing Ethics. 2014;21(8):916-28. https://doi.org/10.1177/0969733014521095
16. Angel S, Frederiksen KN. Challenges in achieving patient participation: A review of how patient participation is addressed in empirical studies. International Journal of Nursing Studies. 2015;52(9):1525-38. https://doi.org/10.1016/j.ijnurstu.2015.04.008
17. Fumis RRL, Ranzani OT, Martins PS, Schettino G. Emotional disorders in pairs of patients and their family members during and after ICU stay. PLoS One. 2015;10(1):e0115332. https://doi.org/10.1371/journal.pone.0115332
18. Ramnarain D, Aupers E, den Oudsten B, Oldenbeuving A, de Vries J, Pouwels S. Post Intensive Care Syndrome (PICS): An overview of the definition, etiology, risk factors, and possible counseling and treatment strategies. Expert Review of Neurotherapeutics. 2021;21(10):1159-77. https://doi.org/10.1080/14737175.2021.1981289
19. Gay EB, Pronovost PJ, Bassett RD, Nelson JE. The intensive care unit family meeting: Making it happen. Journal of Critical Care. 2009;24(4):629.e1-12. https://doi.org/10.1016/j.jcrc.2008.10.003
20. Ussher JM, Parton C, Perz J. Need for information, honesty and respect: Patient perspectives on health care professionals' communication about cancer and fertility. Reproductive Health. 2018;15:1-12.
https://doi.org/10.1186/s12978-017-0441-z
21. Ozaras G, Abaan S. Investigation of the trust status of the nurse-patient relationship. Nursing Ethics. 2018;25(5):628-39. https://doi.org/10.1177/0969733016664971
22. Zafarnia N, Abbaszadeh A, Borhani F, Ebadi A, Nakhaee N. Moral competency: Meta-competence of nursing care. Electronic Physician. 2017;9(6):4553-61. https://doi.org/10.19082/4553
23. Fuseini AG, Rawson H, Ley L, Kerr D. Patient dignity and dignified care: A qualitative description of hospitalised older adults perspectives. Journal of Clinical Nursing. 2023;32(7-8):1286-1302. https://doi.org/10.1111/jocn.16286
24. Bagherian S, Sharif F, Zarshenas L, Torabizadeh C, Abbaszadeh A, Izadpanahi P. Cancer patients' perspectives on dignity in care. Nursing Ethics. 2020;27(1):127-40. https://doi.org/10.1177/0969733019845126
25. Sharifi N, Adib-Hajbaghery M, Najafi M. Cultural competence in nursing: A concept analysis. International Journal of Nursing Studies. 2019;99:103386. https://doi.org/10.1016/j.ijnurstu.2019.103386
26. Norouzinia R, Aghabarari M, Shiri M, Karimi M, Samami E. Communication barriers perceived by nurses and patients. Global Journal of Health Science. 2015;8(6):65-74. https://doi.org/10.5539/gjhs.v8n6p65
27. Fountouki A, Andrades Sanchez M, Theofanidis D. Paternalism vs patient empowerment: Nursing challenges from Spain and Greece. International Journal of Caring Sciences. 2020;13(3):2288-93.
28. Brower RG. Consequences of bed rest. Critical Care Medicine. 2009;37(10 Suppl):S422-8. https://doi.org/10.1097/CCM.0b013e3181b6e30a
29. Rachel H, Chiara C, Robert K, Francesco S. Spiritual care in nursing: An overview of the measures used to assess spiritual care provision and related factors amongst nurses. Acta Bio Medica Atenei Parmensis. 2019;90(Suppl 4):44-50.
30. Chiang YC, Lee HC, Chu TL, Han CY, Hsiao YC. The impact of nurses' spiritual health on their attitudes toward spiritual care, professional commitment, and caring. Nursing Outlook. 2016;64(3):215-24. https://doi.org/10.1016/j.outlook.2015.11.012
31. Baldacchino D. Spiritual care education of health care professionals. MDPI; 2015. https://doi.org/10.3390/rel6020594
32. Mujallad A, Taylor EJ. Modesty among Muslim women: Implications for nursing care. MedSurg Nursing. 2016;25(3):169-74.
33. Almutairi KM. Culture and language differences as a barrier to provision of quality care by the health workforce in Saudi Arabia. Saudi Medical Journal. 2015;36(4):425-9. https://doi.org/10.15537/smj.2015.4.10133
34. Bäck E, Wikblad K. Privacy in hospital. Journal of Advanced Nursing. 1998;27(5):940-5. https://doi.org/10.1046/j.1365-2648.1998.t01-1-00576.x
35. Costa DGd, Moura GMSSd, Pasin SS, Costa FGd, Magalhães AMMd. Patient experience in co-production of care: Perceptions about patient safety protocols. Revista Latino-Americana de Enfermagem. 2020;28:e3272. https://doi.org/10.1590/1518-8345.3352.3272
36. Allen C, Glasziou P, Del Mar C. Bed rest: A potentially harmful treatment needing more careful evaluation. The Lancet. 1999;354(9186):1229-33. https://doi.org/10.1016/S0140-6736(98)10063-6
37. Molina-Mula J, Gallo-Estrada J. Impact of nurse-patient relationship on quality of care and patient autonomy in decision-making. International Journal of Environmental Research and Public Health. 2020;17(3):835. https://doi.org/10.3390/ijerph17030835
38. Gezginci E, Goktas S, Orhan BN. The effects of environmental stressors in intensive care unit on anxiety and depression. Nursing in Critical Care. 2022;27(1):113-9. https://doi.org/10.1111/nicc.12553
39. Turner-Cobb J, Smith P, Ramchandani P, Begen F, Padkin A. The acute psychobiological impact of the intensive care experience on relatives. Psychology, Health & Medicine. 2016;21(1):20-6. https://doi.org/10.1080/13548506.2014.997763
40. Van Paasschen J, Walker SC, Phillips N, Downing PE, Tipper SP. The effect of personal grooming on self‐perceived body image. International Journal of Cosmetic Science. 2015;37(1):108-15. https://doi.org/10.1111/ics.12176
41. Hsu T, Ryherd E, Waye KP, Ackerman J. Noise pollution in hospitals: Impact on patients. Journal of Communication in Healthcare. 2012;19(7):301-9.
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| dignity; professional-patient relations; patients; intensive care units | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Arman A, Ghiyasvandian S, Abbasi Dolatabadi Z, Khoshavi M, Yavari A, Zakerimoghadam M. Preserving patient dignity in critical care units: A qualitative content analysis. NPT. 2025;:X-X.
