An analysis of the concept dignity

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Summary

Dignity is a highly abstract, vague concept that is difficult to measure within the context of general nursing. Despite this, it is a central phenomenon to nursing and so it is crucial that health care workers have a clear depiction of dignity.

This concept analysis uses the framework established by Walker and Avant [Walker, L.O., Avant, K.C., 1995. Strategies for Theory Construction in Nursing, third ed., Appleton and Lange, Connecticut] in order to heighten knowledge and awareness of the concept dignity. This approach also ensures that the concept is not being used erroneously. Respect, autonomy, empowerment and communication have been identified within the literature as being the defining attributes of dignity. Within these, further attributes are defined, which explain the complex, ambiguous concept that it is. This concept analysis is important for areas where the maintenance of dignity may be unintentionally overlooked. This can be related to many Emergency Departments in various parts of the world, where patients are awaiting beds. This is prevalent and has been slowly worsening for more than a decade [Derlet, R.W., Richards, J.R., 2000. Overcrowding in the Nation’s emergency departments: complex causes and disturbing effects. Annals of Emergency Medicine 35 (1), 63–68; Schneider, S., Zwemer, F., Doniger, A., Dick, R., Czapranski, T., Davis, E., 2001. Rochester, New York: A decade of emergency department overcrowding. Academic Emergency Medicine 8, 1044–1050; Nairn, S., 2003. The politics of beds. Accident and Emergency Nursing 11, 68–74]. Commonly patients are nursed in a corridor, which does not lend itself to upholding the dignity, privacy and confidentiality of those patients [Ball, J., Dixon, M., Dolan, B., Holt, L., Wilkinson, R., 2000. Why are we waiting? Emergency Nurse 8 (1), 173–180]. However, patients’ dignity should be maintained at all times and health care workers need to recognise that they themselves need dignity in order to promote dignity in others.

Introduction

The concept of dignity is identified throughout the plethora of nursing literature and is acknowledged as being a core aspect of nursing care (Haddock, 1996, Fenton and Mitchell, 2002). Jacobs (2001) concurs with this and suggests that the central phenomenon of nursing is the respect of human dignity. An Bord Altranais (2000, p. 16) advocate that nurses should ‘Act to enhance the dignity and integrity of individuals/clients/groups/communities’.

The purpose of this concept analysis is to delineate the meaning of dignity within the nursing profession. The author endeavours to achieve this by using the framework outlined by Walker and Avant (1995) (see Table 1). Dignity is an ambiguous concept which will be clarified throughout this assignment through the process of analysis. Wills and McEwen (2002) suggest that concept analysis is important so that concepts can be reviewed with regard to their relevance in a particular context. The concept of dignity was chosen by the author, whose background is in emergency nursing, where there are an increasing number of admitted patients on trolleys; this has become prevalent and remains a topical issue. This difficult situation has meant that at times patients are nursed in corridors, where little control is exerted over situations and no privacy afforded. It is important to undertake this concept analysis in order to enhance understanding and highlight the importance of the concept within the nursing profession.

Section snippets

What are concepts?

Concepts are multifaceted, abstract representations of reality which can be acquired from an individual’s insight into phenomena (Chinn and Jacobs, 1978 in Nicoll, 1997; Fawcett, 1995). Concepts can also be perceived as complex ideas or categories that underpin theory construction and knowledge acquisition (Hardy, 1978 in Nicoll, 1997; Rodgers, 1989). McKenna (1997) suggests that if a concept is not clearly distinguished, its function within a given context may be questioned. In order to

Concept analysis

Concept analysis enables exploration of the meaning of a concept, which may have been observable in practice, research or theory (McKenna, 1997). Exploration can provide a clearer understanding of the attributes of a concept in order to generate nursing knowledge and therefore improve patient care (Morse, 1995, Paley, 1996). Concept analysis is also performed in order to clarify the attributes of the concept so as not to misinterpret it with other similar terms, this is also important to ensure

Literature review

Dignity is regarded as a central phenomenon in nursing (Jacobs, 2001). However, the concept has been described as a vague, ambiguous, highly abstract concept that is impossible to measure (Haddock, 1996, Shotton and Seedhouse, 1998, Chinn and Kramer, 1999, Fenton and Mitchell, 2002). Therefore, it is imperative that concept clarity is achieved for health care workers in order to ensure and enhance patients’ dignity. This is essential in emergency departments that have patients lying on trolleys

Alternative depictions of dignity

The Penguin Concise English Dictionary defines dignity as having four components ‘being worthy or esteemed, high rank or position, high opinion of oneself; self-esteem, stillness of manner; gravity’ (Allen, 2001, p. 239). Mairis (1994, p. 947) identifies that ‘the word ‘dignity’ is derived from the Latin word ‘dignus’ meaning worthy’.

The author identified that the concept of dignity has been contextualized in various non-nursing subjects. Some such examples include; art, literature, poetry,

Defining attributes

The defining attributes of a concept identify the characteristics that repeatedly occur throughout the literature. They also differentiate the concept from similar terms (Walker and Avant, 1995, McKenna, 1997). Throughout the literature, an abundance of attributes confer to the meaning of dignity, many authors concur with these attributes. The author has performed an in-depth review of the literature and has identified four main defining attributes each having characteristics to further define

Antecedents of dignity

Antecedents are incidents that precede the existence of the concept (McKenna, 1997). In order for a person to have dignity the following antecedents, as described within the literature, need to be present:

  • Possession of dignity within oneself, value for oneself and others, belief in oneself (Haddock, 1996).

  • To be in a circumstance, where a person feels competent and capable (Shotton and Seedhouse, 1998).

  • Human beings can be said to have dignity ethically and philosophically as a moral ideal or can

Consequences of dignity

Consequences are the outcomes that are present following the occurrences of the concept (McKenna, 1997). If dignity is maintained, a sense of empowerment and a positive self-image may exist (Mairis, 1994). For patients this is important due to the vulnerable position they are in when admitted to hospital. A person may feel important, valued and have a feeling of worth. Their self-esteem may increase and they may have more respect for themselves and for others (Haddock, 1996, Jacobs, 2001). In

Empirical referents

Empirical indicators are measures that can be taken in order to observe if the concept is present (Walker and Avant, 1995). Haddock (1996) highlights that the concept of dignity is abstract and therefore difficult to measure. However, research methodologies, for example qualitative interviews involving staff and patients, can lead to a deeper understanding of their perception of dignity and whether it is occurring in the clinical environment (Matiti and Sharman, 1999, Chochinov, 2002). Haddock

Implications for nursing practice

Walsh and Kowanko (2002) identify how nurses empathised with patients’ problems and treated them as individuals in order to maintain dignity. This is highlighted by Carper’s (1978) emphasis on the aesthetic pattern of knowing as an important aspect of nursing. She purports that nurses who become skilled in perceiving and empathising with the lives of others will endeavour to broaden their knowledge and understanding of perceived reality and therefore provide effective nursing care. However,

Conclusion

This concept analysis has aimed to improve knowledge and understanding of the concept dignity by using the framework constructed by Walker and Avant (1995). This has been performed within the context of general nursing and with reference to emergency nursing. Dignity is fundamental to the provision of effective nursing care. The literature suggests that nurses need to possess dignity in order to maintain it for patients, and that shared humanity is a vital component in nursing care. Dignity can

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