Don’t forget to manage your patients’ dignity


Just before I induced anesthesia, he said, “Doc, I want to apologize beforehand. I am incontinent due to a previous surgery so I might wet the sheets.”

I told him not to worry and that we understood and that “these things do happen.” His response has stuck with me: “Doc, but there is still some shame.”

I nodded, told him not to worry since he was going to get a catheter anyway, and started pre-oxygenating him.

I thought about his words all day.

He was right.

We who work in the hospital setting expect our patients to check their feelings of shame at the door. What we fail to remember is that this feeling of shame is linked to a very major intrinsic human value called dignity. Loss of dignity for most people results in a lot of consternation, and yet, we expect our patients to check theirs at the door.

Dignity is seen as the right to being seen as worthy — to being respected and valued. It comes from the Latin word “dignitas,” meaning “worthiness.” It is a very powerful human need to be treated with dignity and respect. It is also appreciated when one carries himself or herself with dignity.

The hospital can absolutely rob one of his or her dignity. From gowns that expose the backside to the total lack of privacy, there is a constant assault on patients’ dignity, leading to shame. Now that is oftentimes a factor of the helplessness that illness and even age brings. That may make one incontinent, bringing on the shame of wearing diapers or even getting cleaned like a little child. Then are the necessary exams and treatments that can be invasive and demeaning. Pain always hovers around the corner, making patients helpless and dependent. It is also not uncommon to have doctors barge into patients’ rooms and not even introduce themselves. The whole stay at a hospital is enveloped in fear, and this just worsens the “de-dignification” process.

So besides the shame, does it really matter if patients lose their dignity for a few days?

Of course, it does, and yet, in a lot of hospitals the world over, the sick are not allowed the dignity they deserve.

Maintaining patient dignity has been shown to improve outcomes. In surveys done by the World Health Organization (WHO) in 41 countries, dignity was the second most important care attribute participants picked — only “promptness of care” was more highly rated.

Dignity matters and helping our patients maintain theirs should be high up on the list of every doctor and nurse.

The first step is to create awareness among all doctors and nurses about the importance of our patients’ dignity. Turnock and his group showed in a 2001 study that “awareness among the staff and nurses of the factors that promote patient dignity prompts all personnel to better maintain the personal dignity of patients.”

Then comes the environment that we create for the patients. The human element is important. A listening ear, empathy, and kindness can go a long way. The physical bit needs to be appropriate too. Gowns that reveal the backside of patients are not always necessary. A Canadian study from 2014 showed that although 56 percent of the patients could wear pants without causing a medical problem, only 25 percent of these patients actually did or were allowed to. Privacy is also of importance.

The physical environment segues into the importance of meeting the needs of patients. Of course, some demands may be outlandish, and in today’s environment of nurse shortages, not all demands can be met.

So that is where a third important point comes in — communication.

Not only is that important in dealing with patient needs, but it helps in discussing the illness they have, necessary tests, treatment options, prognosis, and even discharge instructions.

Lastly, is the importance of involving patients’ families.

The solutions listed above are in no way exhaustive. I have just listed a few more common ways of dealing with the problem.

In the “Nicomachean Ethics,” Aristotle wrote: “The ideal man bears the accidents of life with dignity and grace, making the best of circumstances.” It would be great if all our patients were like the Aristotelian ideal person, but as life would have it, they are not. Thus, it is up to us to help them maintain their sojourn with us with dignity and grace.

Nana Dadzie Ghansah is a cardiac anesthesiologist.

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