Dignity Interventions

 

Illness-related concern: Physical distress
What it means: Pain or discomfort caused by the illness
Questions to ask: “How comfortable are you?”
“Is there something we can do to make you more comfortable?”
Interventions: Conduct baseline and frequent ongoing assessment of physical and psychological symptoms
Manage symptoms vigilantly
Use comfort care

 

Illness-related concern: Psychological distress
What it means: Anxiety, fear, agitation
Questions to ask: “How are you coping with what is happening to you?”
“Is there anything further about your illness that you would like to know?”
“Are you getting all the information you feel you need?”
“Are there things about the later stages of you illness that you would like to discuss?”
Interventions: Conduct baseline and frequent ongoing assessment of physical and psychological symptoms
Show you are supportive
Listen with empathy
Refer to counselling
Provide information about treatment options or the expected course of the illness
Upon request, provide accurate, understandable information and strategies to deal with possible future crises

 

Illness-related concern: Cognitive acuity
What it means: Ability to think clearly, reason, remember
Questions to ask: “Are you having difficulty with your thinking?”
Interventions: Conduct baseline and ongoing assessment of cognitive functioning
Detect and treat delirium
When possible, avoid sedating medication(s)

 

Illness-related concern: Functional capacity
What it means: Ability to perform the tasks of daily living
Questions to ask: “How much are you able to do for yourself?”
Interventions: Conduct baseline and ongoing assessment of ability to carry out activities
Refer to occupational and physiotherapy as appropriate
Provide supports needed to maintain independence (such as walker, raised toilet seat)
Involve patient in decision-making regarding plan of care, as desired by patient

 

Dignity-conserving trait: Continuity of self
What it means: The person’s belief that the essence of who they are is still intact, despite the illness
Questions to ask: “Are there things about you that this disease does not affect?”
Interventions: Talk to the person about the facets of life not affected by the illness
Learn about the person’s biography, attending to those aspects of life that he/she values most
See and relate to the patient as someone worthy of honour, respect and esteem

 

Dignity-conserving trait: Role preservation
What it means: Ability to engage in the person’s usual roles
Questions to ask: “What things did you do before you were sick that were most important to you?”
Interventions: Learn about the patient’s biography, and understand the roles that are most important to him or her
Facilitate enactment of these roles within the limitations of the person’s illness
See and relate to the person as someone worthy of honour, respect and esteem

 

Dignity-conserving trait: Maintenance of pride
What it means: The person’s ability to maintain positive self-regard and self-respect in the face of diminishing independence
Questions to ask: “What about yourself and your life are you most proud of?”
Interventions: Talk to the person about the aspects of his/her life that instil pride
See and relate to the person as someone worthy of honour, respect and esteem
Maintain a professional demeanour when providing care

 

Dignity-conserving trait: Hopefulness
What it means: The person’s belief that activities and events in life are still possible and meaningful, despite the current situation
Questions to ask: “What is still possible?”
Interventions: Talk to the person about what is still possible, despite illness limitations
Encourage the person to redefine goals and expectations
Encourage and enable the person to participate in activities he/she feels are meaningful and purposeful

 

Dignity-conserving trait: Autonomy/control
What it means: The person’s perception that they have autonomy and control over life circumstances, regardless of functional limitations
Questions to ask: “How in control do you feel?”
Interventions: Assess the person’s perceived level of control Involve patients in care, treatment and planning decisions, as desired by patient Where possible, provide choices

 

Dignity-conserving trait: Generativity/legacy
What it means: Taking comfort in feeling that something of value will be left behind that transcends death
Questions to ask: “How do you feel your life has affected and benefited others?”
Interventions: Facilitate life review or support the patient in other projects that foster the sharing of memories that are meaningful to the person (for example, making audio/video tapes, writing letters, journaling)
Suggest Dignity Therapy

 

Dignity-conserving trait: Acceptance
What it means: Accepting the unavoidable course of illness so energy can be focused on appropriate and meaningful activities
Questions to ask: “How at peace are you with what is happening to you?”
Interventions: Explore the impact of the illness for the patient
Appreciate the dynamism of the process of responding to a life-threatening illness
Support the person in his/her outlook
Encourage doing things that enhance his/her sense of well-being (such as meditation, light exercise, listening to music, prayer)

 

Dignity-conserving trait: Resilience/fighting spirit
What it means: The person’s ability to rally against his/her illness-related concerns
Questions to ask: “What part of you is strongest right now?”
Interventions: Support the person in his/her outlook
Encourage doing things that are meaningful and enhance his/her sense of well-being (such as meditation, light exercise, listening to music, prayer)

 

Dignity-conserving trait: Living in the moment
What it means: Focusing on the here and now, rather than worrying about the future
Questions to ask: “Are there things that take your mind away from illness, and offer you comfort?”
Interventions: Support the patient’s efforts to participate in normal routines, or to take comfort in momentary distractions (such as daily outings, light exercise, listening to music)
Make appropriate use of humour, and discuss issues that are non-illness related

 

Dignity-conserving trait: Maintaining normalcy
What it means: Maintaining some sense of normality while coping with the challenges of illness
Questions to ask: “Are there things you still enjoy doing on a regular basis?”
Interventions: Support the person’s efforts to participate in normal routines, or to take comfort in momentary distractions (such as daily outings, light exercise, listening to music)
Support and enhance independence using appropriate resources, assistive devices and personnel

 

Dignity-conserving trait: Finding spiritual comfort
What it means: Finding solace within a spiritual belief system, which may include rituals and practice of organized religion, being in touch with nature and/or connecting with a uniquely defined creative life force
Questions to ask: “Is there a religious or spiritual community that you are, or would like to be, connected with?”
Interventions: Sensitively assess the ways in which the person best expresses his/her sense of spirituality
Respect individual belief systems
Enable the person to participate in particular spiritual and/or culturally based practices
Enlist support of spiritual care leaders identified as being important to the person

 

Dignity-conserving trait: Privacy boundaries
What it means: Encroachment on someone’s personal space in the course of receiving care
Questions to ask: “What about your privacy is important to you?”
“How can we improve upon your sense of privacy?”
Interventions: Be sensitive to the need for secure personal space
Ask for the person’s permission to do an examination
Practice proper draping to safeguard and respect privacy
Knock on the patient’s door when entering

 

Dignity-conserving trait: Social support
What it means: Availability of networks of support
Questions to ask: “Who are the people that are most important to you?
“Who is your closest confidante?”
Interventions: Determine the individuals perceived by the patient to provide meaningful emotional support and practical assistance
Encourage the involvement of a wide support network
Allow liberal visitation policies and rooming in

 

Dignity-conserving trait: Care tenor
What it means: Attitudes and behaviours of those interacting with the patient
Questions to ask: “Is there anything in the way you are treated that is undermining your sense of dignity?”
Interventions: Treat the person as someone worthy of honour, esteem and respect
Respect the person’s individuality
Explore with the patient any facets of care that are perceived as eroding dignity
Be mindful of reactions toward the person, particularly with regard to changing physical appearance
Learn and practice the ABCDs of Dignity in Care

 

Dignity-conserving trait: Burden to others
What it means: The person’s concern that his/her care is burdensome to others, or may become so in future
Questions to ask: “Do you worry about being a burden to others? If so, to whom and in what ways?”
Interventions: Anticipate and explore this potential area of concern, with both patients and care providers
Encourage explicit discussion of these concerns with those they fear they are burdening

 

Dignity-conserving trait: Aftermath concerns
What it means: A person’s worries about the difficulties loved ones will face once death finally occurs (such as funeral planning, legal and financial concerns, care of minor children)
Questions to ask: “What are your biggest concerns for the people you will leave behind?”
Interventions: Encourage patients to reflect on these worries
Help the person prepare a plan of action to address the most pressing issues (such as settling affairs, preparing an advanced directive, making a will and funeral planning)