The Dignity Model
The dignity in care research team identified a range of factors that can support or undermine a person’s sense of dignity when they are dealing with a medical concern.
The illness itself can lead to concerns about lost independence, distressing symptoms and overwhelming anxiety.
The person’s own approaches and perspectives can help to maintain their sense of dignity.
The way the person is treated by others can either support or erode dignity.
When grouped together, these factors form the Dignity Model.
The Dignity Model shows three major categories of factors that affect the patient’s sense of dignity:
- Illness-Related Issues: How the illness itself affects personal feelings of dignity
- Dignity-Conserving Repertoire: How a patient’s own perspectives and practices can impact their sense of dignity
- Social Dignity Inventory: How the quality of interactions with others can enhance or detract from one’s sense of dignity
| Category | Themes and Sub-themes |
|---|---|
Illness-Related Concerns | SYMPTOM DISTRESS Physical distress: Pain, discomfort Psychological distress: Medical uncertainty, anxiety LEVEL OF INDEPENDENCE Functional capacity: Ability to perform normal daily tasks Cognitive acuity: Ability to think clearly, reason, remember |
The Person’s Perspectives and Practices (The Dignity-Conserving Repertoire) | HOW THE PERSON PERCEIVES THE SITUATION Autonomy/control: Do I feel in control? Acceptance: Am I at peace with what is happening? Maintenance of pride: Do I take pride in myself? Hopefulness: Do I look forward to anything? Role preservation: Have I lost my place in life? Continued sense of self: Am I the same person I used to be? Resilience/fighting spirit: Do I have the will to go on? Generativity/legacy: What will I leave behind? WHAT THE PERSON DOES TO EASE THE SITUATION Living in the moment: Not dwelling on the medical concern Maintaining normalcy: Sticking to a routine Seeking spiritual comfort: Finding solace in spiritual or religious practices |
The Person’s Perspectives and Interactions with Others (The Social Dignity Inventory) | Care tenor: Being treated with respect and kindness Privacy boundaries: Feeling control over privacy Social support: Ability to draw support from friends and family Burden to others: Worry about how others are affected Aftermath concerns: Concerns about those left behind |
Illness-related issues
Studies of cancer patients show illness may affect sense of dignity because of concerns about independence and distressing symptoms.
Level of independence
Illness can reduce a person’s sense of independence in two ways:
- Cognitive: Not being able to think clearly – because of either the illness or drug therapy
- Functional: Inability to perform the tasks of daily living
Symptom distress
Illness symptoms can cause two forms of distress:
- Physical: The strong link between pain, depression and anxiety is well-documented. Patients often say that intense, prolonged pain can make them feel that personal dignity has been lost and life is no longer worth living.
- Psychological: Uncertainty about one’s health status, treatment and what the future will bring can cause enormous fear and anxiety – which in turn threatens the patient’s sense of dignity. The two main forms of psychological distress are uncertainty about one’s health status, and death anxiety – worry or fear regarding the process or anticipation of death and dying.
The Dignity-Conserving Repertoire
Even when facing serious illness and death, many people maintain their sense of dignity through their own personal perspectives and practices. This intuitive protection of “self” can be encouraged by the way we provide care.
Dignity-Conserving Perspectives
A personal sense of dignity is often based on long-held notions of what makes people “themselves.” With advancing illness, people can keep this sense of self intact by holding onto perspectives such as:
- Autonomy and sense of control
- Acceptance of what is happening
- Pride
- Hopefulness about something in the future
- Continuing to identify with their self-defined roles (for example, spouse, parent, teacher, contributing citizen)
- An enduring belief that they are worthy of respect
- Resilience and fighting spirit
- Feeling that they are leaving a legacy
Dignity-Conserving Practices
People can use personal approaches and techniques to bring dignity to their lives while ill:
- Living in the moment (focusing on immediate issues or tasks instead of worrying about the future)
- Maintaining routines (which helps people manage day-to-day challenges)
- Seeking spiritual comfort (finding solace in a religious or spiritual belief system)
The Social Dignity Inventory
How patients believe they are seen by others can have a powerful influence on their sense of dignity.
Patients’ preferences in these areas are as dynamic and individual as their own life experiences. It’s important to allow the patient to define what is most significant for him or her. Studies point to five major factors:
- Privacy boundaries
- Social support
- Care tenor
- Burden to others
- Aftermath concerns
Social support
Having a support network of family and friends influences feelings of dignity and comfort.
Aftermath concerns
Dying patients may worry about how their death may cause suffering for those who are left behind. They may be concerned about parenting and finances, for example.
Burden to others
Chronically ill or dying patients can become very distressed if they feel they are becoming a burden to caregivers.
Care tenor
People who work in health care can affirm a patient’s sense of value and dignity by paying careful attention to the tone of care. The more the patient’s value can be affirmed, the more likely the patient’s sense of dignity will be upheld.
Privacy boundaries
Loss of privacy is a difficult transition for most people who rely on others for care or support, whether they are still living in their own home, with a family member or in a care facility. Privacy boundaries are individual, but most people feel their dignity is encroached when they rely on others for bathing and toileting.