"Nurses in every setting are in a wonderful position to promote patient dignity," said Ellen Coughlin, MA, MPA, RN, CHPH, vice president of patient and family services at Saint Barnabas Hospice and Palliative Care Center, West Orange, NJ, an affiliate of the Saint Barnabas Health Care System.
"Dignity means demonstrating patients have value; it's important to promote that dignity because powerless patients can be easily exploited, especially when they're vulnerable during times of illness."
Coughlin shared the story of a patient with end-stage AIDS who resisted all efforts to interact.
"A night nurse and aide would not give up, and they persisted in approaching him," she recalled. "That man came back later looking healthy and told us, 'I started taking my meds again because someone was nice to me, and I realize I matter.' This is what nurses can do to turn things around!"
Nurses who work with patients at the end of life can help identify and facilitate the person's wishes, Coughlin said.
"Palliative care and hospice nurses explore whether the patient has been given the whole story about his illness so he can make informed decisions about how he wants to live and then die with dignity," she said.
"Patients have such misconceptions about pain medications, thinking if they take morphine, they'll be zonked out and won't be able to talk with their family members."
Nurses can provide the education and support so patients can make the final decisions about what they want.
Professional Practice Model
Maria Ducharme, MS, RN, NE-BC, administrative director of patient care services at The Miriam Hospital, Providence, RI, described how the professional practice model for nursing at the Magnet-designated hospital incorporates aspects of patient dignity and empowerment in each of its five tenets: accountability/engagement; communication; control over professional practice environment; collaborative practice and continuity of care; and nurse autonomy.
The accountability/engagement tenet highlights the role of nurses as coordinators of compassionate, competent care, she said. "This tenet includes the advocacy, moral agency, and vigilant engagement required for holistic care of the patient."
The communication tenet reflects the RN's responsibility to effectively communicate with the multidisciplinary team, which includes the patient and family. The third tenet highlights collaborative practice with the RN responsible for ensuring continuity of care, addressing the diversity of each patient and recognizing differences in the provision of care for each patient.
Control over professional practice environment, the fourth tenet, defines the vehicles through which nurses institute change, have input, and exert power and control in issues affecting nursing and patient care. Finally, the fifth tenet, autonomy, affirms nurses are empowered to make individual and independent clinical decisions for their patients in a nonpunitive environment.
Julie Hamann, MS, RN, staff nurse in the ICU/IMCU at Swedish Covenant Hospital, Chicago, believes the Planetree model of patient-centered care, which emphasizes human beings caring for other human beings and creating a healing environment, contributes to patient dignity.
"We're one of the most culturally diverse hospitals in the city and the country, and by incorporating patient-focused care into everything we do, within every nursing unit, we meet the needs of patients from every culture," Hamann said. "And the care is always patient-centered. If the patients' medical decisions are going in a different direction than what the family wants, we always advocate for the patients to help them maintain control and dignity during their stay with us."
Knowledge is power, Hamann added. "We always tell our patients as much as we possibly can, saying, 'This is what's going to happen, and here's what you may experience,'" she said. "When my patient was intubated this morning, of all the people in the room, she looked to me to inform and support her. She did that because, as her nurse, I've explained everything to her and she knew I would continue that pattern."
When patients come first, everyone wins, Hamann explained.
"Patient-centered care actually makes nursing care easier and more effective; once the patient trusts you, anything going forward is much less difficult," she said. "This nice working relationship makes patients and families very happy, so our satisfaction surveys are among the top 10 percent in the country for Planetree facilities."