Promoting Patient Dignity in Healthcare

Humans have an intrinsic need for dignity as a basic element of well-being. Yet, the concept of dignity can be somewhat nebulous, and its defining features can vary across societies, cultures, and individuals.

In the context of healthcare, dignity often is defined as a multifaceted approach to patient interactions that involves the elements of respect, autonomy, empowerment, safety, communication, privacy, acceptance, inclusion, acknowledgment, fairness, and more.(1)

The very nature of healthcare, however, can generate feelings that starkly contrast with the pillars of dignity. During healthcare encounters, patients might feel exposed, vulnerable, judged, anxious, and frightened. Further, in the busy healthcare environment, the principles that promote dignity — such as compassion, empathy, and attentiveness — can suffer because of time limitations and a greater focus on goals and improvements that are more easily defined and measured.

Despite these barriers, treating patients with dignity is an essential element of patient-centered care and patient engagement and satisfaction. Even small gestures or modest changes can have a meaningful effect on a person’s sense of dignity. This article discusses eight areas in which healthcare providers can promote patient dignity and reinforce patient-centered care as part of everyday practice.

1. Organizational Culture

Promote a culture of dignity in your organization by showing patients and colleagues respect, compassion, empathy, and kindness. Recognize and respect each person’s individuality, and encourage other practitioners and staff members in your practice to do the same. Review your organization’s patient bill of rights to ensure it includes language that supports dignified and respectful care, and consider how your organization can raise awareness about improving patient dignity through training, patient feedback, periodic reminders, and other methods.

2. Common Courtesy

Remember common courtesies in your daily interactions with patients, such as greeting patients, introducing yourself to new patients, asking how patients are feeling, and making direct eye contact during discussions.

During initial encounters, ask patients how they would prefer that you address them. Some patients might prefer their first names or nicknames, while others want to use titles and surnames. Additionally, some patients’ preferred names and pronouns may differ from what is listed in their patient records. Making an assumption about how to address a patient might lead to feelings of disrespect, especially in relation to cultural or generational differences.

Additionally, take stock of your attitude and demeanor when interacting with patients to ensure that personal or external factors (e.g., tiredness, stress, and staff or technology interruptions) don’t influence how patients perceive your feelings about them.

3. Privacy and Confidentiality

Respect patients’ privacy and confidentiality is imperative to building trust and promoting patient dignity. Make sure patients are aware of your organization’s commitment to safeguarding their protected health information, and take steps to ensure that privacy is maintained during patient encounters in the office – for example, do not discuss patients’ personal information in open areas, and lower your voice when communicating sensitive information. Actual or perceived lapses in privacy and confidentiality can trigger feelings of disrespect and erode the provider-patient relationship.

4. Decency and Modesty

Patients have varying definitions of decency and modesty, so it’s prudent to gauge these feelings and respond appropriately. Some general strategies for respecting patients’ modesty include:

• Knocking on exam room doors and asking permission before entering
• Using curtains in exam rooms to block the view from hallways and to provide a greater sense of privacy
• Leaving the room when patients disrobe
• Offering drapes or gowns that fasten to help patients feel less exposed
• Securing patients’ gowns or providing them with an additional cover if you’re planning to transfer them to another room

Additionally, ask for consent before physically examining or treating patients. Explain to patients what you’re doing as you’re doing it, and encourage them to speak up if they are uncomfortable or in pain. Acknowledging their feelings and providing support might help alleviate feelings of vulnerability.

5. Autonomy

Autonomy is a fundamental aspect of dignity and includes dimensions such as having choice, giving choice, making decisions, being able to make decisions, competence, rights, needs, and independence.(2) Autonomy also is an underlying principle of informed consent, a legal and ethical process that recognizes individuals’ rights to make decisions about their healthcare.

When providing patients with treatment options and recommendations, be vigilant about engaging patients in discussions about the risks and benefits of care and respecting patients’ rights related to choice and decision-making, including their right to refuse care.

6. Communication

Without a doubt, communication shapes how patients perceive they are treated during healthcare encounters. Both verbal and nonverbal communication must be considered when developing strategies to promote patient dignity.

Verbal Communication

Effective verbal communication can help reinforce dignity by supporting a culture of safety, creating a successful provider—patient partnership, and engaging patients in shared responsibility for their care.

When conversing with patients, be cognizant about not interrupting or rushing them. Doing so can imply lack of respect for the individual or general disinterest in what the patient is trying to communicate. Limiting external interruptions also can help minimize frustrations and make patients feel like they are a priority.

Speak clearly and use words that patients will understand, but avoid using a tone that might be perceived as demeaning, patronizing, or dismissive. Also, be mindful about avoiding language that implies stereotypes based on age, culture, gender, sexual orientation, and so on. Even if these statements are well intentioned or unintentional, they might be perceived as offensive or derisive. Carefully consider your wording and whether it is appropriate for the individual and the situation.

Nonverbal Communication

Considering that the majority of daily communication is nonverbal, it is no surprise that this aspect of communication has a significant impact on human interactions. Positive nonverbal communication is a powerful tool for connecting with patients in a constructive way and reinforcing mutual understanding and respect.

Developing situational awareness of your nonverbal communication — such as facial expressions, gestures, and body language — can help you recognize its potential to either alienate or engage patients. This awareness also can help you develop strategies for reassuring patients in nonverbal ways.

7. Cultural Competence

Cultural competence is a distinguishing feature of patient-centered care and a vital component of communicating well with patients and promoting dignity. Providing culturally competent care requires developing an awareness of how patients’ cultural beliefs and values can affect their perception of healthcare interactions and understanding of healthcare information. Further, it’s important to consider how cultural influences might contribute to how patients define the various aspects of dignity, such as respect, self-worth, pride, modesty, and autonomy.

8. Empathy, Understanding, and Compassion

Although the day-to-day activities and tasks that occur in healthcare practices, clinics, and hospitals often are routine for people who work in these settings, they might be overwhelming for patients. Additionally, healthcare encounters don’t occur in a vacuum, and the emotions they evoke can intermingle with patients’ other personal and professional stressors.

During patient interactions, give pause to consider how patients are responding to diagnoses, treatment recommendations, and outcomes. Acknowledging patients’ emotions and responding with empathy, understanding, and compassion can greatly influence patients’ overall experience and help them feel respected and comforted.

In Summary

The concept of patient dignity encompasses many elements and requires a multifaceted approach to patient interactions. Healthcare leaders, providers, and staff members should consider various factors that support a dignified care environment — such as culture, courtesy, privacy, modesty, autonomy, communication, cultural competence, and compassion — and determine whether they have opportunities to improve the delivery of high-quality, patient-centered care.

Resources

For more information about communicating well with patients and delivering respectful care, see the following MedPro resources:

• Addressing Cultural Competence as an Element of Health Literacy and Patient-Centered Care (ChiroPreferred by MedPro Group)
• Communicating Effectively With Patients to Improve Quality and Safety (ChiroPreferred by MedPro Group)
• Dignity in Care Toolkit (Dignity in Care)
• Patient Advocacy: Preserving Human Dignity (The Sentinel Watch)
• Preserving People’s Dignity (Royal College of Nursing)
• The ABCDs of Dignity in Care (Dignity in Care)
• To Prevent Patient Harm, Practice Respect and Deliver Dignity (Institute for Healthcare Improvement)

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1. Adib-Hajbaghery, M., & Aghajani, M. (2015, March). Patients dignity in nursing. Nursing and Midwifery Studies, 4(1), e22809. Retrieved from www.ncbi.nlm.nih.gov/pmc/articles/PMC4377527/; Finn, N. (2015, June). The role of dignity in healthcare. Society for Participatory Medicine. Retrieved from https://participatorymedicine.org/epatients/2015/06/the-role-of-dignity-in-health-care.html
2. Adib-Hajbaghery, et al., Patients dignity in nursing.