Development of tools to measure dignity for older people in acute hospitals

Background: Dignity is a concept that applies to all patients. Older patients can be particularly vulnerable to experiencing a loss of dignity in hospital. Previous tools developed to measure dignity have been aimed at palliative and end-of-life care. No tools for measuring dignity in acute hospital care have been reported. Objectives: To develop tools for measuring patient dignity in acute hospitals. Setting: A large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 years or above. Methods: Three methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6–24); a format for nonparticipant observations; and individual face-to-face semi-structured patient and staff interviews (reported elsewhere). Results: A total of 5,693 surveys were completed. Mean score increased from 22.00 pre-intervention to 23.03 after intervention (p < 0.001). Staff–patient interactions (581) were recorded. Overall 41% of interactions (239) were positive, 39% (228) were neutral, and 20% (114) were negative. The positive interactions ranged from 17%–59% between wards. Quality of interaction was highest for allied health professionals (76% positive), lowest for domestic staff (22% positive) and pharmacists (29% positive), and intermediate for doctors, nurses, healthcare assistants and student nurses (40%–48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief)–63% (longer interactions) (F[2, 557] = 28.67, p < 0.001). Conclusions: We have developed a simple format for a dignity survey and observations. Overall, most patients reported electronically that they received dignified care in hospital. However, observations identified a high percentage of interactions categorised as neutral/basic care, which, while not actively diminishing dignity, will not enhance dignity. There is an opportunity to make these interactions more positive.