Nursing is more than delivering care; it involves patient advocacy as well. Because they have the most direct interaction with patients, nurses are in the ideal position to advocate for each one on an individual basis. The American Nurses Association (ANA) stresses the importance of patient advocacy in its Code of Ethics and lists three core values that form its basis: preserving human dignity, patient equality, and freedom from suffering. This three-part blog series will address each of these core values in turn.
Human dignity can be thought of as an individual’s sense of self-worth and self-respect. It can encompass many things, including the right to fill basic needs, like food, shelter, and personal safety. In the healthcare environment, human dignity is more focused on aspects of privacy, respect, and autonomy. Certain care episodes can be frightening for some patients, and exams and procedures often include elements that may erode human dignity. Patients are exposed and vulnerable, they’re poked and prodded, they’re questioned about intimate details, they’re subjected to the scrutiny of strangers. Part of nursing’s advocacy role is to preserve human dignity throughout the continuum of care.
Modesty is often important to a patient’s sense of dignity, particularly for those with cultural or ethnic beliefs surrounding body image. Simple acts like pulling a curtain closed, holding a gown together in the back, or offering a drape to the patient can show respect for the patient modesty. Lowering your voice when asking personal questions or relaying personal information can help to preserve patient privacy. Being sensitive to the patient’s demographic and special circumstances is critical to preserving human dignity. For example, geriatric patients often report that recent healthcare encounters have eroded their dignity.
Older patients may suffer a loss of dignity when healthcare providers hold stereotyped, negative assumptions about their ability to understand, remember, and act on information. So for older patients, the path to preserving human dignity involves respectful communication, even when it takes more time. You may have to explain a procedure step-by-step to someone with dementia every single time, rather than just doing it and frightening or rushing the patient. When a family member or caretaker is present, talking to that person exclusively and ignoring the elderly patient is a definite erosion of dignity. Older patients don’t want to be treated like children. Often it helps to get down to the patient’s level when he or she is in a bed or wheelchair, so you’re not “talking down to” someone.
Dignity may also be associated with autonomy among older patients. We recognize that people need to have some measure of control over what happens to their bodies, and over how their destinies unfold. This is one reason why we no longer routinely restrain patients to keep them in bed. Older patients, even those with some cognitive impairment, have a right to make choices, and to have their wishes honored. With all patients, but with older patients in particular, everything you do as a nurse has the power to either preserve and strengthen human dignity, or to undermine and diminish it.
As noted, time and inadequate staffing are probably the biggest barriers nurses face when it comes to preserving patient dignity. When you’re rushed, you may not take enough time to address each patient as an individual. Burnout may also hamper your efforts to be an effective patient advocate. It takes profession knowledge, dedication, and a clear ethical vision to see each and every patient as another human being, and to strive to keep that dignity intact.