Patients’ perception of dignity in Iranian general hospital settings

Abstract

Background:

Dignified care is one of the main objectives of holistic care. Furthermore, paying attention to dignity as one of the fundamental rights of patients is extremely important. However, in many cases, the dignity of hospitalized patients is not considered. Dignity is an abstract concept, and comprehensive studies of the dignity of Iranian patients hospitalized in general hospital settings are limited.

Objective:

The aim of this study was to explore the concept of dignity from the perspective of patients hospitalized in general hospital settings in Iran.

Research design:

This study takes a qualitative approach. Data were gathered using individual, semi-structured interviews. Qualitative content analysis was the method used to analyse and interpret the data. The criteria suggested by Guba and Lincoln were used ensure the trustworthiness of the study.

Participants and research context:

A total of 14 hospitalized patients in general hospital settings in Shiraz participated in this study.

Ethical considerations:

The Research Ethics Committee of the Shiraz University of Medical Sciences approved the protocol of the study and the ethical principles were followed throughout.

Findings:

The findings of this study revealed four main themes – ‘respectful atmosphere’, ‘patient privacy’, ‘preservation of authority’ and ‘receiving attention’ – and 10 categories.

Discussion:

Patients need to be hospitalized in a respectable environment in which their privacy is preserved and paid attention, providing them with sufficient authority in terms of medical decisions and their life-related issues. The dignity of hospitalized patients will be preserved under these conditions.

Conclusion:

Patients hospitalized in general hospital settings need to retain their dignity. This can contribute to the optimal therapeutic outcomes for them. Therefore, it is suggested that a cultural, professional and institutional background, in which all components of the patient’s dignity are protected and emphasized, should be provided.

Keywords

Dignity hospitalization Iran patient qualitative research

Introduction

Dignity is one of the fundamental human rights.¹ The word ‘dignity’ is derived from the Latin word ‘dignitus’, which means competence, and ‘dingus’, which means value.² Dignity takes different meanings across the world, the most important of which are value, sanctity, magnanimity, respect, gentility, humanity, position and dignity.³ Human dignity has been present in medical fields for a long period of time and it may be rooted in Socrates’ emphasis on the significance of respecting a patient’s dignity.⁴ Furthermore, dignity is highlighted as a core characteristic of nursing caring related to ontology.⁵ In this regard, Nightingale points out that we are responsible for respecting every single human being in the world in front of God.⁶ The means of dignity in nursing entails respecting the individual’s inherent worth and uniqueness while providing culturally competent care and protecting the privacy and confidentiality of patients.⁷ The word dignity has increasingly become a part of contemporary discussions of healthcare.⁸ This is because disease, inability, need, decreased power and authority, lack of privacy, medical cures and hospitalization can affect ones’ innate value. Limited human dignity can influence a client’s body, soul, morals and spirituality and can expose people to the danger of stress and discomfort.⁹ Thus, procedures that aim to maintain dignity can be considered not only as ethical indicators but can also work as effective elements to improve both the patients’ desire for cure and also the relations between the patient and the health professionals.¹⁰

Dignified care has been considered as one of the main objectives of comprehensive care.¹¹ In addition, preserving dignity is one of the moral responsibilities of caregivers in nursing care¹² and all nurses are expected to respect the dignity of patients when they are providing care.¹³ Many national and international nursing organizations consider observing the patients’ dignity as the basis of nursing care.^14
–16 In its declaration on the promotion of patients’ rights, the World Health Organization (WHO) stated that patients have the right to be treated with dignity and respect for their culture and values.¹⁷ The ‘risk of losing human dignity’ has also been cited by the North American Nursing Diagnosis Association as one of the most important diagnoses in nursing.¹⁸

Respecting people’s dignity increases their satisfaction with the services provided by the healthcare staff and, consequently, leads to a proper relationship between the client and the professionals, to feelings of security and to a shorter length of stay in hospital by reducing mental health problems and, thereby, lowering the costs and increasing the motivation of the healthcare professionals to provide better services.⁴

Although preserving the dignity of patients is a high priority and it is necessary to ensure high-quality healthcare,¹⁹ many studies around the world have demonstrated the risks associated with the loss of patients’ dignity in healthcare environments.^{13,20

–25} Similarly, the findings of research by Rehnsfeldt et al.,²⁶ carried out in Denmark, Sudan and Norway, revealed that the care services provided were based on a routine caring programme without consideration for the individual’s value and dignity.

According to several studies, dignity is a complex concept that is difficult to define due to its multidimensional nature.²⁵ Although many efforts have been made to define the concept of dignity and its related factors, these remain complex and obscure.²⁷ Since it is impossible to respect dignity without clarifying the concept²¹ and because human dignity is one of the important concerns of healthcare system,²⁸ considerable emphasis has been placed on the need for more research to identify dignity in different wards of the hospital.²⁵ Most of the qualitative studies that have been conducted around the world have considered the dignity of particular groups of patients^{28

–35} and the results of these studies cannot be generalized to other patients. Therefore, studying the dignity of hospitalized patients in the setting of a general hospital can be highly beneficial. Furthermore, because the physical environment, the organizational culture and the attitudes and behaviour of the personnel may have an effect on dignity,³⁶ it would appear that conducting further studies in different societies and cultures may contribute to illustrating the different aspects of this concept and the factors that are related to maintaining patients’ dignity and providing care services that are based on it. Thus, in considering the importance of maintaining and improving patients’ dignity in the healthcare system and the necessity to explore dignity in the setting of the general hospital and within different social-cultural contexts, the purpose of this study is to explore the concept of dignity from the perspective of Iranian patients hospitalized in general hospital settings.

Methodology

Design

In this study, the researchers sought to explore the dignity of hospitalized patients through the expression and description of the patients themselves. Since the qualitative method is based on the views of individuals and the meaning of a phenomenon is determined through the examination of components that make up the whole,³⁷ a qualitative approach was utilized in this study.

Participants and setting

The inclusion criteria in this study were Iranian nationality, the ability to speak and understand Persian, being hospitalized for at least 24 h, between the ages of 18 and 60 years, no acute mental or physical disabilities and being able to provide rich and sufficient information in the field of study. The sampling of this study was purposeful. There was an attempt to gather a sample with maximum diversity, covering a wide range of patients in terms of age, sex, disease, marital status and so on. A total of 14 patients participated in this study and these were selected from five hospital wards in two educational hospitals affiliated to Shiraz University of Medical Sciences.

Data collection

Data collection was carried out from November 2016 to July 2017. In this study, data were gathered using the method of individual interviews. For this purpose, 14 in-depth, semi-structured interviews were conducted with 14 hospitalized patients. The interviews were conducted face-to-face in a private environment with the consent and willingness of the participants, along with a field note recording.

The beginning of the interview was loosely structured and focused on the following main questions: ‘What is dignity in your opinion?’ ‘What is dignified care in your view?’ ‘Under what circumstances will your dignity be endangered during your stay in hospital?’ The questions that followed were based on the interviewees’ responses to these questions. Where necessary, follow-up questions were used to increase the clarity of information.

There was an attempt to align the interview process with the main purpose of the study. Each interview lasted for approximately 45–60 min. The interviews were audio recorded after obtaining the patients’ permission. The interviews were listened to several times immediately after each interview and then transcribed. Data analysis was carried out after each interview and the next interview was then scheduled. These interviews continued until data saturation was reached. Saturation is achieved when a new category does not appear and the categories reach saturation in terms of their features and dimensions.³⁸

Data analysis

The conventional content analysis method of Graneheim and Lundman³⁹ method was used to analyse the data. This method is usually used when the available theory or research literature on a subject is limited. Inductive category development was used in this study. This means that rather than using preconceived categories, the categories emerged from the data. The researchers also immersed themselves in the data in order to generate new insights.⁴⁰

The data were simultaneously analysed using content analysis so that every text was first studied several times for the purpose of immersion in the data and to obtain insights and a sense of the whole. Categories of meaning were then identified based on the purpose and questions of the study. Next, hints and important topics in the text were extracted in the form of open codes while taking the explicit and hidden content of meaning categories into account. These codes were classified according to broader categories based on differences and similarities (data reduction to describe the phenomenon and to achieve greater comprehension) and the abstraction process continued until the themes were extracted.³⁹

Study rigour

The Guba and Lincoln⁴¹ criteria were used to ensure the trustworthiness of this study. The credibility of the findings was provided through prolonged contact with the participants and continued engagement with the data during all steps of the study (8 months). Furthermore, independent analyses conducted by each member of the research team and team analyses improved the credibility of the research. Moreover, the coding process was assessed by two qualitative researchers (PhD nursing faculty members) who did not engage in the study process. To validate dependability and conformability, the researchers used detailed descriptions of the study, such as evidence and examples, so that readers would be able to authenticate the findings. The transferability of the findings was assured by (a) including precise instances and quotes from the participants that provide readers with the possibility of comparing them with those in similar situations and (b) including a range of participants based on different contextual information in the study, for example, by choosing participants suffering from different medical problems and from both sexes.

Ethical considerations

Individuals fulfilling the criteria for entry into the study were identified after obtaining permission from the Research Ethics Committee of the University of Medical Sciences in Shiraz (No. IR.SUMS.REC.1395.S872) and informed consent was obtained after providing verbal and written explanations. The participants were assured that the conversations would remain confidential. Participants were informed that they could withdraw from the study at any stage and they were assured that their lack of participation or withdrawal would have no consequences for them.

Results

Interviews were conducted with 14 patients hospitalized in different educational public hospitals. The patients participating in this study consisted of nine females and five males. The individual characteristics of the participants are presented in Table 1.

Table 1.

Individual social characteristics of the participants.

Participants	Sex	Age (years)	Marital status	Educational level	Job	Length of hospitalization (days)	Wards
P1	Female	28	Married	MSc.	Self-employed	8	Internal
P2	Female	52	Married	Primary school	Housewife	19	Internal
P3	Female	59	Married	Primary school	Retired	4	Surgery
P4	Female	50	Married	Diploma	Housewife	20	Internal
P5	Female	42	Married	Bachelor	Governmental	5	Orthopaedic
P6	Female	19	Single	High school	Housewife	7	Urology
P7	Male	30	Married	Diploma	Self-employed	12	Surgery
P8	Male	55	Single	MSc.	Governmental	16	Internal
P9	Male	58	Married	Diploma	Retired	20	Internal
P10	Male	44	Single	Primary school	Self-employed	30	Internal
P11	Female	32	Married	Bachelor	Governmental	5	Neurology
P12	Female	50	Married	Diploma	Housewife	6	Internal
P13	Male	28	Single	High School	Self-employed	3	Urology
P14	Female	24	Married	Bachelor	Housewife	6	Internal

Four main themes, including ‘respectful atmosphere’, ‘patient privacy’, ‘patient authority’ and ‘receiving attention’, and 10 categories were extracted from the data. Table 2 represents the themes and categories.

Table 2.

Themes and categories extracted from the content analysis.

Theme	Category
Respectful atmosphere	Respecting the patient Respecting other patients Respecting the patient’s companions Respecting the nurse
Patient’s privacy	Physical privacy Informational privacy
Patient’s authority	Patient’s decision-making on healthcare issues Self-control of life
Receiving attention	Presence for patient Meeting patients’ needs

Respectful atmosphere

The patients who participated in this study needed to be in a hospitalized environment where they would always be respectful of themselves and other people around them, including other patients, patient’s companions and nurses. This theme included four categories: respecting the patient, respecting other patients, respecting the patient’s companions and respecting the nurse.

One of the most important needs of the participating patients was to be respected by the healthcare staff in the process of providing care and therapy. In many cases, the patients considered the healthcare team’s respectful and ethical behaviour to be far more effective than the physical treatment they received to improve their condition:

In my opinion, such a respectful attitude and their (healthcare team) good ethics are more likely to affect me than their caring. (P11)

Also, respect from their loved ones had an impact on improving the patients’ morale:

I am glad that I see my family really respects me in every situation. (P4)

In addition, the participants wanted the healthcare team to respect other patients and their companions. In fact, the sense of dignity for them was not personalized and preserving the dignity of others who were in the same situation as their own or that of close relatives was also important to them:

When my daughter told the doctor that if my mother could not be cured here we would refer her to another hospital, the doctor responded with a tone: ‘You should not interfere with our work; you want to do it better’. I was very upset about the insulting way in which the doctor treated my daughter…(P3)

I’m so upset when I sometimes see patients being personally insulted. (P10)

The patients also mentioned that other patients and their companions needed to consider the dignity of the healthcare team:

Many patients or their companions insult the nurses for various reasons, such as lack of medication at the hospital…while it is not the fault of the nurses. It is wrong and we should respect them. (P9)

Patient’s privacy

The patients considered their physical and informational privacy as essential for internal peace and they tried to preserve it. The theme of patient’s privacy included two categories: patient’s physical privacy and their informational privacy.

Patients preferred to have their care needs performed by nurses of the same gender:

I feel comfortable with a female nurse, especially when it comes caring for some parts of my body that require me to be naked, so it’s easier when it is done by female nurses. (P5)

They also did not want to be exposed to people who did not play a direct role in their care or in the provision of healthcare services, especially other patients and companions of the opposite sex:

When the companions of my roommate patients are male or if visitors are constantly coming and going, I want my body to be covered because I do not want to be embarrassed. If it is necessary to do some dressing, these curtains must be pulled around so that nobody can see my body. (P1)

In addition, the participants did not publicly share their personal and private information and they talked about their private life issues only to some of the people who were very close to them:

I don’t like to tell anyone about my personal issues but I’m not having trouble sharing my life problems with my brother or mother. (P13)

Patient authority

Patient authority was another theme extracted in this study, which included the two categories of patient decision-making on healthcare issues and on self-control of life. In this study, the participation of the healthcare staff in the process of obtaining healthcare decisions was very important for the patients:

When, for example, we are told what to do and we can use our opinions, we will better accept the decisions and will have more readiness for that surgery or medication. (P5)

Patients also complained that they did not have enough freedom to carry out their routine tasks and activities when they were hospitalized:

When you are good, outdoors, you are free to do everything you want and to go wherever you want. You can plan for your life, but here it is not possible. You cannot do anything; you’re all in a state of disability…. (P8)

Receiving attention

To meet their needs, the patients participating in the study needed to feel the effective presence of others alongside them and to receive different forms of support from those around them. The theme of receiving attention included two categories: presence for the patient and meeting the patient’s needs. The actual presence of the healthcare team alongside the patient brought comfort to the patients. This kind of presence suggested a valuing of the patients and paying attention to them and to their needs:

For example, when the doctor comes beside me and I talk with him about my drugs and ask him what to do and he answers me with patience and guides me, it means that he is a good doctor. (P2)

Also, from the patients’ perspective, the presence of family and close relatives at their bedside resulted in improved spirits and relaxation:

When my family and relatives visit me we talk together and they tell me about their affection for me; this makes me feel good. (P2)

In addition, when the healthcare staff and the family members showed real care for the hospitalized patient, this led to a sense of satisfaction in the patients and improved their morale:

I’m really pleased with that nurse. When I have no companion she gives me the medication herself, brings water for me and puts tablets in my hand. She is careful about what I want and takes care of me as much as possible. (P6)

When my friends, my brother, my sister and my wife are around me, they help me in every way to provide my well-being. That’s a great hope. (P7)

Discussion

Preserving dignity is essential to ensure high-quality healthcare. Since an understanding of this concept from the perspective of hospitalized patients can improve the patient’s recovery process and emotional well-being, it is necessary to explore this through in-depth studies.

In this study, from the perspectives of patients in the setting of a general hospital, dignity was understood in terms of four themes: ‘respectful atmosphere’, ‘patient privacy’, ‘patient authority’ and ‘receiving attention’.

One of the main needs of the interviewees was a respectful hospital atmosphere in which the healthcare team respect all of the patients and their companions and, in turn, the patients respect the healthcare team. They believed that this respectful atmosphere could have a significant effect on patients’ comfort and play an important role in their recovery. In the study conducted by Borhani et al.,²⁸ the influence of the care environment, especially the effect of the human environment on preserving the dignity of patients with heart disease, was also noted. In line with the findings of this study, the need for the healthcare team to preserve respect for their patients has been shown in other studies to be one of the important elements in preserving patients’ dignity.^22,42 The need for respectful interactions between the patients and the nurses has also been identified.^5,10

In terms of creating a respectful atmosphere, a further finding of this study was the necessity to respect the patient’s companions. In the healthcare system of Iran, having a companion has a special place and, from the perspective of patients, is considered to be a necessity. However, in many cases, the companions of patients are disregarded, despite the fact that they provide for the basic needs of patients in Iran.²⁰ This factor has not been identified in the findings of other studies based on Western societies²⁰ and may be due to the different cultural and social contexts of the society and the hospital settings in Iran. In Western-Asian cultures, individual attitudes are more dependent on society and people see themselves as a nature that is connected to society, whereas in Western and North American cultures, a more individualist and independent attitude is reinforced in people.^43,44 Generally, in contrast to individualistic communities, people in pluralistic communities place more emphasis on doing their duty and accepting responsibility for others,⁴⁵ thus, in Asian cultures, including Iranian culture, pluralistic values and adapting to the group culture are highly emphasized. As a consequence, teaching individuals to engage in more social interaction and to pay attention to their fellow man is more present in these cultures. Therefore, in such cultures, there is a greater likelihood that people will put themselves in the patient’s shoes and show more empathy for him than it occurs in Western communities.⁴⁶ Thus, it is common for a patient’s family, relatives and close friends to be present at the bedside to support him and, consequently, importance is placed on the necessary respect for family, group ties and related values.

In this study, patients also wanted respect for nurses. According to some studies, when the dignity of nurses is not preserved, their ability to respect others is reduced.^28,47
–49 According to several studies, nurses do not feel worthy and respectful as a result of some influential factors, including patients and their families, doctors, the structure and principles of state systems and, especially, nursing management.⁵⁰ Korsah’s⁵¹ study in Ghana also revealed that confrontations between companions and nurses lead to negative interactions between the nurses and their patients. Therefore, providing a supportive environment in which nurses also feel that they are respected is necessary to retain a respectful atmosphere and to improve the quality of care.

The need to respect the patient’s dignity has been identified in this and other studies. However, a distinctive aspect of the findings of this study is the importance that patients placed on the need to create a respectful atmosphere. On one hand, the importance of respect could be rooted in the religious beliefs of the patients, all of whom were Muslim and Shi’a, because in Muslim religious texts, it is highly recommended to have respect for all human beings^52,53 and to wish for the worthy and desirable things for others that one would wish for oneself.⁵⁴ On the other hand, this need to respect others could be rooted in orientations towards collectivism and related cultural values among Iranian people. Since a respectful atmosphere has been identified in this study as one of the essential components of dignity preservation, it seems that providing an environment in which the dignity of all individuals, including patients, healthcare staff and companions, is preserved can lead to calmness, satisfaction in people and can provide the context for effective interactions and receipt of various forms of support.

Patients in the study also preferred to preserve their physical and informational privacy during the delivery of care services and also under other conditions. Other studies of factors that impact patient’s dignity have also noted the importance of preserving the patient’s physical²⁰ and informational⁵⁵ privacy. In a study by Ebrahimi et al.,²⁰ participants’ perspectives on the lack of respect for privacy included the two categories of indecent body exposure and multi-gender conditions. In this study, the presence of hospital personnel, roommates or visiting attendants of the opposite sex also threatened the dignity of the participants. A number of other studies have also identified informational privacy as an important dimension of preserving patients’ privacy^55,56 and the results of these studies are in accordance with those obtained from this study. In this study, female participants mostly referred to the importance of preserving their physical privacy. It would appear that this is influenced by some of the social and religious norms of Iranian patients in respect of the necessity of covering the body of a Muslim woman, especially against ghayr mahram (non-mahram) men.

It also seems that some factors, such as a large number of patients in hospital rooms and a crowded healthcare environment, pose important threats to patients’ privacy in the public educational hospitals of Iran. Although people are willing to receive treatment in public hospitals – where the need to keep costs low can result in overcrowded rooms – these conditions can be regarded as a serious problem in terms of observing patient’s privacy. With regard to the privacy of hospitalized patients, taking measures, such as placing patients of the same gender in the same room, emphasizing that healthcare staff should use curtains around a patient when his or her body is naked, taking account of gender homogeneity when allocating nurses to patients, discussing patients’ problems in a quiet tone of voice or in a private conference room and following the principles of confidentially, can all contribute to respecting the privacy of hospitalized patients.

For the hospitalized patients in this study, to preserve their dignity, they needed to be involved in decision-making about their health and care issues and to have sufficient control and freedom to undertake their daily routines during their hospital stay. In a study by Bagheri et al.,³³ the preservation of authority was one of the most important interpersonal factors related to preserving the dignity of patients with heart disease. According to several studies, dependency, lack of control and limitation of activities are related to loss of dignity.⁵⁷ Matiti and Trorey²⁵ noted that patients receive dignity when they can be involved in care decisions; thus, dignity is affected if the patient’s expectation of being taken seriously and being involved in individual care is not met.⁵⁸ In addition, the necessity for the healthcare team to pay attention to the suggestions and priorities of the patients has also been mentioned in other studies.⁵⁹ It would appear that empowering the patient gives him a sense of being involved in his care and treatment and in controlling what is happening; this plays a role in observing the patient’s dignity. Furthermore, it has been identified that empowering the patients and allowing them greater authority to carry out everyday activities gives them a sense of value and, hence, can have an important impact on improving their sense of dignity.

Therefore, it is likely that when patients have sufficient authority to make decisions about their own health and their affairs, they feel more valuable and more effective. Although certain, appropriate medical decisions are made for them, their participation increases and, ultimately, giving patients greater authority can improve their mental health and their positive health outcomes.⁶⁰ However, it must be noted that observing authority in East-Asian cultures is also not an individual matter. A disease is a shared family event rather than an individual occurrence in many Asian cultures.⁶¹ The family is the source of power, hope and connectedness to others. Therefore, the principle of autonomy and, consequently, authority does not hold as much weight as in Western cultures.⁶² In Western cultures, individuals are usually considered as the target group for counselling and awareness.⁶³ Nevertheless, it seems that in Asian culture it is the family that must undertake the requirements and commitments for the process of making medical decisions without the patient’s request or permission.^64,65 Therefore, the family is the core of decision-making.⁶² Thus, similar to some of the studies conducted in other Asian countries^66,67, it seems that in Iran, the patient–family–doctor relationship model can provide a suitable alternative to the patient–doctor relationship model. In this respect, patients must be the focus of counselling and must make decisions about themselves by being the first to be informed of everything related to their conditions. Their families should be engaged in the decision-making processes based on the patient’s priorities and preferences.⁶³ In this regard, it is suggested that the patient’s family is involved in making decisions related to his curative process, as well as providing an environment in which the patient’s ideas and needs are respected.

Similar to other studies,^22,68 in this study, receiving attention from others was one of the important components for preserving patients’ dignity and the presence of the healthcare team and the relatives at the patient’s bedside, and consideration of their needs, reflect the attention of others to the patient. Studies have shown that disregarding the needs of patients threatens their dignity.²⁸ Holistic nursing is a comprehensive patient care system that reflects their spiritual, economic, emotional and physical needs.²⁸ According to the experiences of the participants in the study conducted by Borhani et al.,²⁸ holistic care was a major factor influencing patient dignity, which led to a sense of security for patients.

In fact, the nature of nursing or healthcare is closely related to ontology.⁵ Thus, humanistic theories of nursing that are rooted in humanistic, ontological and phenomenological philosophy⁶⁹ claim to provide new insights for both patient and healthcare professionals and to explain the true meaning of humanity, health and nursing.⁷⁰ According to some theories, the humanitarian response of the nurses to the patients occurs through the active presence of the nurse in time and space, which is termed ‘being with the patient’.^69,71 Through this authentic presence, the mutual human love between the spirits of two human beings flows and the nursing care takes place in a true sense, which leads to the patient’s dignity being preserved.⁵ Furthermore, Watson’s humanistic healthcare theory is developed from humanistic philosophy.⁷² Based on this theory, Watson defines healthcare as the moment when the patient and the nurse experience a deep spiritual connection that goes beyond time and place and each person identifies the human dignity of the other and tries to proceed on the caring healing-loving journey.⁷³ All these studies show that an important element of nursing care is the necessity for the nurse to pay full attention to his patient and to respect the patient’s dignity.

A further important issue with regard to the patient’s dignity is the involvement of the family’s support within the health team.²⁸ However, few studies have noted the effect that family presence and support has on patient’s dignity⁴² and it seems that the reason for this is that studies mainly conducted in Western culture reflect the different cultural norms of societies regarding the role of the family for hospitalized patients. In Iran, the family is the most important organization influencing a person’s life. Families have complex networks of relationships with relatives and they are the emotional support centre for all family members. Families support and protect their members in critical situations.⁷⁴ Therefore, in Iranian culture, families play a very significant role in supporting the patient, such that the presence of family members and relatives at the patient’s bedside and addressing the patient’s different needs, as well as visiting relatives and acquaintances, are part of their usual duties towards the patient and this is also an aspect of people’s social and religious values. In such a culture, holistic healthcare performance should imply that healthcare team professionals consider the needs of both the patients and their family members in the hospital environment.⁷⁵

It seems that one of the most important spiritual needs of humans is for others to take them into account. Perceptions of achieving the others’ attention, which indicate one’s importance and value, are found in the context of social relationships. Therefore, the need for the healthcare team to establish an effective interaction with the patient while maintaining a holistic approach in providing opportunistic services can be a major contributor to meet this need. Developing principles to facilitate the effective participation and care of the families and acquaintances that are at the bedside of the patient may also be helpful in this regard.

Finally, it can be said that one of the most important social care needs of patients is to preserve their dignity. The patients participating in this study felt that their dignity was preserved when they were hospitalized in a respectful atmosphere in which their privacy was respected and where they also had the authority to decide on matters of their personal and medical affairs and to receive the attention of the healthcare team and their relatives. These conditions resulted in satisfaction and positive health outcomes for the patients.

One of the limitations of this study was that the participants were only patients hospitalized in public hospitals. The selection of participants from private hospitals could broaden the scope of our findings. Among the other limitations of this study was that data collection relied on individual interviews – utilizing other qualitative methods of collecting information could lead to a richer outcome. It is, therefore, recommended that future studies on the dignity of patients hospitalized in private hospitals should adopt other methods of gathering qualitative data, such as observation or focus groups, in addition to individual interviews.

Conclusion

Hospitalized patients are susceptible to losing their dignity due to their vulnerability. Given that preserving the dignity of hospitalized patients has resulted in desirable outcomes for them, preserving their dignity has significant importance. It appears that investigating the dignity of patients hospitalized in different cultures and communities can lead to an increase in the knowledge and awareness of this concept among healthcare professionals and can play an important role in improving patients’ dignity. According to the results of this study, providing a respectful hospitalization atmosphere, while respecting the patient’s privacy and paying attention to him, as well as giving patients adequate authority, can help to preserve their dignity. Therefore, it is suggested that a cultural, professional and institutional environment should be provided in which all the principles of the preservation of patients’ dignity are respected and emphasized. In this regard, it seems that health authorities and policy-makers should also consider the findings of this study to provide a suitable support environment in terms of providing patients with the different aspects of dignity. In addition, due to its complex and abstract nature, the concept of dignity should be considered in education, research and in health policies and their implementation.

Footnotes

Acknowledgements

This article is a part of the PhD dissertation written by Fahimeh Alsadat Hosseini that was funded by the Vice Chancellor for Research, Shiraz University of Medical Sciences, Shiraz, Iran (No. 12032). The authors sincerely thank the authorities of the Nursing and Midwifery School of Shiraz, the patients who participated in this study and the other people who helped us in this research.

Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship and/or publication of this article.

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