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Introduction
In a bid to examine how nurses can enhance knowledge in the nursing care practice, this paper explores the concept of dignity as discussed in the middle range theory. Although there is no conventional definition of what dignity entails, this conceptual analysis will review different article to show that dignity in healthcare is indispensable for positive patient outcomes. Dignity is defined as the capability of an individual to have self-control of his/her actions and environment without being influenced by the way s/he is treated by other people (Clark, 2010). Due to continued reformation and practice of dignity, nurses acquire substantial knowledge in both research and practice. However, understanding dignity is fundamental for nurses to establish how to integrate it into their practice. As a multifaceted concept, dignity is applied in this work to provide an analysis and a model to assist nurses to uphold it in practice and make conscious decisions on healthcare provision. The main objective of this analysis is to develop a model for nurses to use dignity as a tool for engaging patients to discover what is of critical essence to them as a means of laying standards of preferred practice.
Literature Review
Critical literature analysis serves as a guide to examining a particular concept. It is important to focus on this stage since it lowers the prejudice of the researcher coupled with elaborating the nature of a concept and application challenges. This review seeks to look into three scholarly articles to identify attributes, antecedents, and consequences of dignity in the nursing practice. In her work, Defining the concept of dignity and developing a model to promote its use in practice , Clark (2010) defines dignity as an all-round concept as it is both objective and subjective in nature. On being objective, Clark (2010) argues that dignity is the foundation of human rights, where it is viewed as an entitlement for every human being. As a subjective concept, Clark (2010) notes that dignity underscores how individuals feel about themselves coupled with how they expect to be treated by others or how others perceive and treat them. In the nursing practice, the latter applies as the concept of dignity is a social construct and it entails moral values and feelings depending on how nurses perceive and integrate it in practice. According to Clark (2010), taking care and respecting patients dignity should be the nurses priority. Conventionally, Clarks idea is to let nurses know how to promote dignity by understanding the models of the care practice. The main strengths of her work is that she acknowledges that training and policies should be in place to help nurses make conscious judgments in cases where clients may not be in a position to tell how they would prefer care to be administered.
The second review explores the article, Dignified death: Concept development involving nurses and doctors in Pediatric Intensive Care Units by Poles and Bousso. This case contributes to the national and nursing service in understanding and maintaining dignity in practice. The authors use a case of a dignified death of children in Brazils pediatric intensive care units (PICUs). In a bid to define dignity, nine nurses and seven physicians serving in PICUs were involved in detailed interviews. Dignified death was found to be a complex concept in terms of decision-making by medical teams or the involved families. However, this study creates an understanding and it improves reflection on decisions, values, and beliefs that nurses should hold concerning their actions in the end of life scenarios. Themes of compassion and care are highlighted as driving factors underlying the nurses decisions on dignified death (Poles & Bousso, 2011). In conceptual development, this work aimed at creating new ideas and knowledge in the area of end of life care. One limitation of the article is that the authors did not examine the possible threats that nurse interactions can pose to undermining the patients dignity. The strength of this study is that the authors incorporated nursing interactions and experiences to inspire patients and make them feel comfortable even in the end of life situations.
In the third article, Carers and their rights , Clements (2011) examines how the themes of patients attitude, staff response or behavior, and hospital setting influence dignity. The author highlights that the concerns of the caregivers should be first addressed so as to enable a good working environment. In return, this aspect improves their learning and relationship with clients, thus giving them an upper hand in understanding the essence of observing clients dignity. The author identifies that the clients needs and perception of dignity vary with emerging issues in the nursing practice, and thus the management should hold continued training programs for caregivers. Clements (2011) posits that dignity is associated with the patients wholeness and the will to live.
Dignity, as a nursing concept, has been widely used to serve various purposes concerning the situation at hand. For instance, the study of dignity among patients suffering from terminal illnesses identified that its loss results in negative effects such as stress and lack of the will to fight (Poles & Bousso, 2011). The three articles identify two major uses of the concept of dignity. First, as a concept, dignity is applied to enhance practice. By examining and contextualizing dignity, nurses can understand and promote this concept easily. For instance, the above literature review helps nurses to create awareness about observing dignity and acknowledging the patients situation when dignity is compromised. Secondly, as a concept, dignity is operationalized to explain its application in the nursing care practice. For example, the study by Poles and Bousso (2011) developed the concept of a dignified death to examine whether it is possible to promote dignity in the care practice. A child dying with dignity in a PICU is an intricate phenomenon whose definition needs clarity to avoid application in uncalled circumstances. The study sought to bring clarity to the concept in a bid to promote desired care, advice the childs family, as well as advance meaning through research on end of life care in the nursing practice.
Attributes are terms or expressions, which are commonly utilized by researchers to elaborate on the features of a concept. Therefore, attributes that describe dignity are identified in the process of concept analysis. The concept analysis entails reviewing the three articles to identify the properties of dignity discussed in at least two articles. The attributes identified include control. A study about dignified death indicates that patients especially when acutely ill lose control. Clark (2010) claims that the patients ability to exert control may promote or threaten dignity. Control entails both patients feelings and behavior regarding self and others. Caregivers assume the responsibility of taking over control and deciding with decency the best care to offer in a bid to instill confidence to the patient and the family. In addition, nurses have the mandate to take control and restore dignity to patients who may feel that illnesses have compromised their dignity due to dependency. The second attribute is privacy for patients. As retaliated in the three articles, privacy is closely inseparable with dignity especially when handling patient health documents. If nurses fail to uphold the patients desired level of privacy, then dignity is threatened. In cases when nurses are compelled to share the patients health details, practice ethics should be observed (Clements, 2011).
A model case presents an ideal dignity in the nursing care such as the one presented by Clements (2011) whereby caregivers are governed by self-control and nursing ethics to preserve the dignity of the elderly. Poles and Bousso (2011) present another case where the attributes of control, privacy, involvement, sensitivity, listening, and showing responsibility are magnified in the PICU. These aspects demonstrate that dignity is upheld and it can be sustained in clinical practice.
Borderline cases may underscore an alternative use of the concept of dignity, for instance, the application of privacy to enhance dignity. In some cases, nurses will show inconsistency since they are compelled to alter the patients privacy during medicine administration. Related cases in the concept of dignity may involve the attributes of compassion and intimate care. For example, in their study, Poles and Bousso (2011) claim that nurses should show compassion and intimate care to children even during the end of life moments. Both attributes provide a close aspect to help nurses in promoting dignity.
As elaborated by Clements (2011), the themes of the hospital environment, the patients attitudes, and staff behavior prompt the call to uphold dignity. Research on dignified death reveals that decisions made by healthcare teams during end of life situations are uninformed. The nurses lack of information and capacity to build confidence to the family of the sick child and create a healing environment requires a lasting solution. In establishing a solution, the cry for dignity arose. The main consequence developed is successful coping. The established hospital culture and friendly conceptualization of dignity results in a favorable environment for both nurses and clients. For example, the study by Clark (2010) advances subjective dignity, as nurses have to create interpersonal relationship with patients. Consequently, this relationship creates a sense of social welfare, which is necessary to generate a healing environment.
The availability of several descriptions of dignity and examples to illustrate the application of dignity in the nursing practice literature presents a case of empirical referent. The manifestation of dignity within the literature shows consistent definitions and claims pertaining dignity in the nursing care. According to Clements (2011), for caregivers to show dignity, they should first receive it. This aspect creates the challenge of dealing with the pressures of promoting dignity within nursing and social care sectors by ensuring that nurses have the best environs to give back dignified care (Clements, 2011). The second empirical referent stands out in the study by Poles and Bousso. Families seek health care for their children in the PICU with high expectations of dignified service. The study shows the commitment of caregivers to ensure a healing environment by promoting dignity.
Conclusion
Promoting dignity requires continued educational programs to bolster the nurses professional skills, which are required to solve challenging situations. The studies have indicated that upholding dignity is dependent on both the individuals behavior and their relationship with others.
References
Clark, J. (2010). Defining the concept of dignity and developing a model to promote its use in practice. Nursing Times, 106(20), 694-709.
Clements, L. (2011). Carers and their rights: The law relating to carers. London, UK: Carers UK.
Poles, K., & Bousso, R. (2011). Dignified Death: Concept development involving nurses and doctors in pediatric intensive care units. Journal of nursing ethics, 18(5), 694-709.
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