The Model In Detail
Since 1995, a Winnipeg-based research team and their international collaborators have been exploring the importance of patient dignity. Their findings show that a patient’s sense of dignity can have a profound impact on patient well-being and satisfaction with the health care system – and one of the biggest factors is the way patients are treated by health care providers.
This section outlines:
- The model of major dignity influencers
- Tools developed by the research team to support the Dignity approach in the health care workplace
The Dignity Model
The team’s initial research has been distilled into the Dignity Model, which shows three major categories of factors that affect the patient’s sense of dignity:
- Illness-Related Issues: How the illness itself affects personal feelings of dignity
- Dignity-Conserving Repertoire: How a patient’s own perspectives and practices can impact their sense of dignity
- Social Dignity Inventory: How the quality of interactions with others can enhance or detract from one’s sense of dignity
|Category||Themes and Sub-themes|
Physical distress: Pain, discomfort
Psychological distress: Medical uncertainty, anxiety
LEVEL OF INDEPENDENCE
Functional capacity: Ability to perform normal daily tasks
Cognitive acuity: Ability to think clearly, reason, remember
The Person’s Perspectives and Practices
(The Dignity-Conserving Repertoire)
HOW THE PERSON PERCEIVES THE SITUATION
Autonomy/control: Do I feel in control?
Acceptance: Am I at peace with what is happening?
Maintenance of pride: Do I take pride in myself?
Hopefulness: Do I look forward to anything?
Role preservation: Have I lost my place in life?
Continued sense of self: Am I the same person I used to be?
Resilience/fighting spirit: Do I have the will to go on?
Generativity/legacy: What will I leave behind?
WHAT THE PERSON DOES TO EASE THE SITUATION
Living in the moment: Not dwelling on the medical concern
Maintaining normalcy: Sticking to a routine
Seeking spiritual comfort: Finding solace in spiritual or religious practices
The Person’s Perspectives and
Interactions with Others
(The Social Dignity Inventory)
Care tenor: Being treated with respect and kindness
Privacy boundaries: Feeling control over privacy
Social support: Ability to draw support from friends and family
Burden to others: Worry about how others are affected
Aftermath concerns: Concerns about those left behind
Studies of cancer patients show illness may affect sense of dignity because of concerns about independence and distressing symptoms.
Level of independence
Illness can reduce a person’s sense of independence in two ways:
- Cognitive: Not being able to think clearly – because of either the illness or drug therapy
- Functional: Inability to perform the tasks of daily living
Illness symptoms can cause two forms of distress:
- Physical: The strong link between pain, depression and anxiety is well-documented. Patients often say that intense, prolonged pain can make them feel that personal dignity has been lost and life is no longer worth living.
- Psychological: Uncertainty about one’s health status, treatment and what the future will bring can cause enormous fear and anxiety – which in turn threatens the patient’s sense of dignity. The two main forms of psychological distress are uncertainty about one’s health status, and death anxiety – worry or fear regarding the process or anticipation of death and dying.
The Dignity-Conserving Repertoire
Even when facing serious illness and death, many people maintain their sense of dignity through their own personal perspectives and practices. This intuitive protection of “self” can be encouraged by the way we provide care.
A personal sense of dignity is often based on long-held notions of what makes people “themselves.” With advancing illness, people can keep this sense of self intact by holding onto perspectives such as:
- Autonomy and sense of control
- Acceptance of what is happening
- Hopefulness about something in the future
- Continuing to identify with their self-defined roles (for example, spouse, parent, teacher, contributing citizen)
- An enduring belief that they are worthy of respect
- Resilience and fighting spirit
- Feeling that they are leaving a legacy
People can use personal approaches and techniques to bring dignity to their lives while ill:
- Living in the moment (focusing on immediate issues or tasks instead of worrying about the future)
- Maintaining routines (which helps people manage day-to-day challenges)
- Seeking spiritual comfort (finding solace in a religious or spiritual belief system)
The Social Dignity Inventory
How patients believe they are seen by others can have a powerful influence on their sense of dignity.
Patients’ preferences in these areas are as dynamic and individual as their own life experiences. It’s important to allow the patient to define what is most significant for him or her. Studies point to five major factors:
- Privacy boundaries
- Social support
- Care tenor
- Burden to others
- Aftermath concerns
Having a support network of family and friends influences feelings of dignity and comfort.
Dying patients may worry about how their death may cause suffering for those who are left behind. They may be concerned about parenting and finances, for example.
Burden to others
Chronically ill or dying patients can become very distressed if they feel they are becoming a burden to caregivers.
People who work in health care can affirm a patient’s sense of value and dignity by paying careful attention to the tone of care. The more the patient’s value can be affirmed, the more likely the patient’s sense of dignity will be upheld.
Loss of privacy is a difficult transition for most people who rely on others for care or support, whether they are still living in their own home, with a family member or in a care facility. Privacy boundaries are individual, but most people feel their dignity is encroached when they rely on others for bathing and toileting.
Dignity Tools for Researchers
The Dignity Model is the basis for practical tools to support people who work in health care:.
Initial trials suggest Dignity Therapy offers many advantages over other supportive approaches:
The Patient Dignity Question (PDQ)
The key question everyone working in health care should consider when interacting with patients
The Patient Dignity Inventory (PDI)
Covers 25 potential concerns that should be regularly evaluated by health care providers
Dignity Therapy for dying patients
A model for individualized psychotherapy, developed and piloted by the team and intended for people near end of life a successful online platform.