Perception of Dignity by Nurses and Patients - Essay Example

? Nurses’ and Patients’ Perceptions of Dignity Introduction This essay will provide an indepth analysis of the study of nurses’ and patients’ perceptions of dignity based on interviews by Ken Walsh and Inge Kowanko (2002) on real experiences of participants in the hospital. It will analyse how the research was conducted with respect to research design, sampling, and ethical considerations. Walsh and Kowanko (2002) considered their study a phenomenological study aimed at: knowing patients’ and nurses’ perceptions of dignity; formulating a definition of dignity based on the experience of the chosen sample; and, identifying ‘nursing practices which maintain or compromise patient dignity’ (Walsh & Kowanko 2002, p. 143). Method or Design Phenomenological research is a science that deals with describing, interpreting and understanding human experiences of individuals, particularly patients and nurses. In this research, nurses were asked to tell their experiences with patients whose dignity was maintained or compromised. Patients were also asked about their hospital experiences in which their dignity was maintained or compromised. The whole process was done through unstructured interviews which lasted for about half an hour, and audiotaped by the researchers. The unstructured interview is used to motivate the participants to relate their stories at their convenient time. In arranging for interviews, the researcher informs the participants about the aim of the interview, the time frame, and the method it will be conducted whether audio-taped or video-taped. The participant have to be informed that the results of the interviews will be transcribed and that some of the answers will appear in articles, but the identity of the respondents will not be revealed. An unstructured interview is considered retrospective as the participants tell about their experiences about the subject being investigated. (Morse 2001) Unstructured interviews were used to explore and gather experiential narrative material and done in such a way that the researcher and the participants were like conversing with each other. The participants were not asked about their opinion on dignity but on their experiences wherein their dignity was maintained or compromised. After the interviews, the text was interpreted and analysed using ‘an interpretative hermeneutic approach,’ whereby themes were used and assigned on the participants’ responses. Out of the interpretations, the researchers drew their conclusions on the meaning of dignity and the circumstances where dignity was maintained or compromised. Sampling Sampling or recruitment of participants was done by way of posting notices in wards of a large hospital, which meant participants were asked to volunteer on the proposed study. Five patients and four nurses responded to the call and gave their informed consent. The sampling done in the study was not representative of the population of patients and nurses in that large metropolitan hospital mentioned in the study. Posting notices in wards do not draw the desired number of participants for a sample and does not generate a general opinion of the nurses and patients. However, the researchers were sure that the participants they intended to question possessed the desired information and that they were willing to answer the questions. Moreover, researchers should always try to obtain a sample that is representative of the population of interest. (Fraenkel & Wallen 2006, p. 402) There are other ways of drawing a sample, like random sampling, stratified random sampling, and cluster sampling. A simple random sample provides opportunity for every member of the population to have ‘an equal and independent chance of being selected,’ and ‘the larger a random sample is in size, the more likely it is to represent the population’ (Fraenkel & Wallen 2006, p. 95). This was not done in the research. What the researchers should have done was to ask permission of the owners or administrators of the hospital for the research to be conducted on a larger scale. A table of random numbers, which is ‘an extremely large list of numbers that has no order or pattern’ (Fraenkel & Wallen 2006, p. 95), could have been produced for the nurses and patients of the hospital. If, for example, there were 2,000 patients and 1,000 nurses in the hospital, the researchers could have obtained 200 patients and 100 nurses as members of the sample. What the researchers did in this current study was not a scientific approach in obtaining a sample for a large hospital. The researchers could have also expanded their search for participants by posting notices not just in wards but other places of the hospital. Ethical considerations could be observed by writing letters to the hospital administration, obtaining their permission and the permission from prospective participants. There are also instances wherein, based on previous knowledge of a population and the specific purpose of the research, researchers use personal judgement to select a sample. Researchers perceive they can use their knowledge of the population to judge whether or not a particular sample will be representative. (Fraenkel & Wallen 2006) Ethical consideration Ethics refers to morality, so that when we talk of ethical consideration in research we refer to morality in research. In this current study, we try to ask if the research done on nurses and patients was ethical. Was interviewing the nurses and patients on their perceptions of dignity done in an ethical manner? (Babbie 2011, p. 66) The research was done in an appropriate manner as the article stated that institutional ethics approval was granted to the researchers and the participants gave their informed consent before the start of the research. In researches involving human subjects and to be conducted in a university or institution, the research must be approved by an institutional review board (IRB) and must state whether the research will be conducted by a single researcher or a group of researchers, and whether the research will be financed by government or private funds. (Fraenkel & Wallen 2006) The identity of participants, the nurses and patients, remained confidential. Their responses to the questions were coded, meaning only their answers were known and not their identities. Findings of the study The authors set the tune of the study on the first part of the paper, the introduction that included the background. The purpose was clearly stated and explained. The authors provided an explanation of the results of the interviews by identifying the themes based on the responses of the participants. These themes are: privacy of the body, private space, consideration of emotions, giving time, the patient as a person, the body as object, showing respect, giving control and advocacy. Each theme was explained and the actual interview answer was provided about that theme. Privacy of the body referred to the exposure of the body and the gaze of others. Nurses narrated that it was important to place a divider or screen so that the patient’s body could not be seen by others while the patient was being washed or treated. Protecting the patient from the gaze of other patients or people in the hospital is an example of maintenance of patient dignity. There were also other nurses or medical staff who would try to intrude on patient space without asking the patient’s permission, or they would try to interrupt during procedures. This is again an example of patient dignity being compromised. Space included shower cubicles and toilets. The theme about consideration of emotions referred to the need of space and privacy to express emotions and share with loved ones, such as family members and guests. Patients also need explanations about certain procedures, information or diagnoses so that they would not be surprised and nurses should help patients manage the emotional impact involved in such procedures or information. In bioethics, respect for persons is equal to patient autonomy. This was explained by The Belmont Report (as cited in Joffe et al., 2003, p. 103) which pointed out that “respect for persons … divides into two separate moral requirements: The requirement to acknowledge autonomy and the requirement to protect those with diminished autonomy”. Autonomy is synonymous with independence or the right of the patient to decide for himself/herself. Respect for autonomy is a subset of respect for persons (Childress as cited in Joffe et al., 2003, p. 103). Time is another important factor to patient dignity, as nurses should have time to explain to patients about certain procedures, or how to perform their duties without rush because by giving them time, the patients feel important and their dignity maintained. The next theme is the patient as a person. The nurses said that the patient should be seen as a person and not as an object or body alone. Patients have an innate right to be treated as a person. The nurses recognised this innate right of the patient. Studies have shown that patients need the feeling that their dignity is being respected and that nurses know that they have to respect their patient dignity as this is a part of their responsibility to their patients. Respect for dignity is a universal obligation. (Matiti, 2011, p. 1) People’s value must be emphasised regardless of their background and how they look. Ridgway (as cited in Matiti & Baillie, 2012, p. 50) indicated that care given in any setting that emphasises self-respect can refer to dignity. Respect is a significant part of the nursing profession. The International Council of Nurses (as cited in Matiti & Baillie, 2012, p. 51) state that nurses should respect human rights and other rights that pertain to culture, life’s choices, and dignity. The findings help identify the problems of patients and nurses and their perceptions of dignity. Dignity as identified by the nurses was associated with ‘respect, privacy, control, advocacy and time’ based on the results of the interviews. The patients also showed their opinion according to their experience of dignity as ‘respect, privacy, control, choice, humour and matter-of-factness’ (Walsh & Kowanko 2002, p. 143). When compared, the themes based on responses were almost similar, which meant the nurses and patients had almost the same perceptions of dignity. The themes drawn from the experiences of both nurses and patients should be reported and be a part of a study to improve healthcare. Respecting the dignity of patients is a part of the healing process. Patients should not feel that they are not part of the healing or treatment process. If this happens, healing is difficult to attain. An in-distress patient with cancer cannot have the strength to fight cancer. A cancer patient must be given the moral strength and this can be done only through encouragement and motivation. There were several instances that the nurses cited examples that the patient’s body must be respected to give him/her dignity. During death, the body must still be respected. One nurse participant said that covering the body with a plastic bag because the patient is already dead is degrading; it reduces the patient into a piece of meat. The nurses unanimously said that respect meant treating due regard to the patients’ personhood. One Aboriginal elder, narrated a nurse, requested that he be not seen undressed by females. Many nurses said that patients should be allowed to control their own destiny to and express their individuality as persons; an example is to let them participate in decision-making. Nurses also felt that they had the responsibility in maintaining patient dignity especially in situations when the patient could not do it for himself or herself or when they are too ill to do so. The paper stated the similarity of the answers of the nurses and patients with regard to their experience about dignity. This study has explained and provided concrete examples and real-life situations about the nurses’ and patients’ perceptions of dignity. But a question remains hanging in the air: if nurses and patients have almost the same perceptions about maintaining and compromising dignity, why do such situations continue to exist in hospitals and clinics? The paper suggests that more studies should be conducted on this subject. As a whole, the findings do not represent the perceptions of the nurses and patients in the large metropolitan hospital mentioned in the study but they still give us ideas about perceptions of nurses and patients. References Babbie, E 2011, The basics of social research, Wadsworth Cengage Learning, Belmont Learning. Fraenkel, J & Wallen, N 2006, How to design and evaluate research in education, 6th edn, The McGraw-Hill Companies, Inc., New York. Joffe, S, Manocchia, J, Weeks, C, & Cleary, P 2003, ‘What do patients value in their hospital care? An empirical perspective on autonomy centred bioethics’, Journal of Medical Ethics, vol. 29, pp. 103-108, viewed 12 June 2013, via JSTOR database. Matiti, M, 2011, “The importance of dignity in healthcare”, in M Matiti & L Baillie (eds), Dignity in healthcare: a practical approach for nurses and midwives, Radcliffe Publishing Ltd, London, pp. 3-8. Matiti, M & Baillie, L 2011, “The concept of dignity”, in M Matiti & L Baillie (eds), Dignity in healthcare: a practical approach for nurses and midwives, Radcliffe Publishing Ltd, London, pp. 9-23. Morse, J 2001, ‘Interviewing the ill’, in J Gubrium & J Hostein (eds), Handbook of interview research: context and method, Sage Publications, Inc., London, UK, pp. 317-330. Walsh, K & Kowanko, I 2002, ‘Nurses’ and patients’ perceptions of dignity’, International Journal of Nursing Practice, vol. 8, pp. 143-151, viewed 26 December 2013, via ProQuest & Allied Health Source database. Read More