Skip to main content

Table 3 Chochinov model used for deductive analysis

From: Dignity in bodily care at the end of life in a nursing home: an ethnographic study

A Model of Dignity and Dignity-Conserving Interventions for Patients Nearing Death
  Factors Dignity-Related Questions (interviews) Therapeutic Interventions (observations)
Illness-related Concerns
1. Symptom distress A. Physical distress How comfortable is the person? Is there vigilance to symptom management? Is there a frequent assessment? Is there application of comfort care?
B. Psychological distress How is the person coping with what is happening to him/her? Is a supportive stance assumed? Is there empathetic listnening? Is there referral to counseling?
C. Medical uncertainty Would the person like to know anything further about his/her illness? Does he/she have all the information that he/she feels is needed? If requested – are accurate and understandable information and strategies to deal with possible future crises provided?
D. Death anxiety Would the person like to discuss things about the later stages of his/her illness?
2. Level of independence A. Independence Has the illness made the person more dependent on others? Is the person participating in descicion-making, regarding both medical and personal issues?
B. Cognitive acuity Does the person have any difficulty with his/her thinking? Is delirium treated? When possible, are sedating medications avoided?
C. Functional acuity How much is the person able to do for him/ herself? Are orthotics, physiotherapy and occupational therapy performed?
Dignity-conserving Repertoire
3. Dignity-conserving perspectives A. Continuity of self Are there things about the person that disease does not affect? Are those aspects of life that the person values the most acknowledged? Is the person seen as worthy of honor, respect and esteem?
B. Role preservation What were the most important things the person did before illness?
C. Of pride What about self or life is the person most proud of?
D. Hopefulness What is still possible? Is the person encouraged and enabled to participate in meaningful or purposeful activities?
E. Autonomy/control How in control does the person feel? Is the patient involved in treatment and care decisions?
F. Generativity/legacy How does the person want to be remembered? Is the person active with life projects (making videotapes, writing letters, journaling)?
G. Acceptance How at peace is the person with what is happening to him/her? Is the person supported in his/her outlook? Is the person encouraged to do things that enhance his/her sense of well-being (meditation, light exercise, listening to music, prayer) ?
H. Resilience/fighting spirit What part of the person is strongest right now?
4. Dignity-conserving practices A. Living in the moment Are there things that take the person’s mind away from illness and offer comfort? Is the person allowed to participate in normal routines or comforted in momentary distractions (daily outings, light exercise, listening to music)?
B. Maintaining normalcy Are there things the person still enjoys doing on a regular basis?
C. Finding spiritual comfort Is there a religious or spiritual community that the person is or would like to be connected with? Are referrals to chaplain or spiritual leaders made? Is the person enabled to participate in particular spiritual and/or culturally based practices?
Social Dignity Inventory
5. A. Privacy boundaries What about privacy or body is important to the person? Is permission asked to examine the person? Is draping done properly to safeguard and respect privacy?
B. Social support What people are most important to the person? Who is the person’s closest confidante? Are there liberal policies about visitation?
C. Care tenor Is there anything in the way the person is treated that undermines his/her sense of dignity? Is a stance where the person is treated as worthy of honour, esteem and respect adopted?
D. Burden to others Does the person worry about being a burden to others? If so, to whom and in what ways? Are explicit discussions about these concerns with those they fear they are burdening encouraged?
E. Aftermath concerns What are the person’s biggest concerns for the people he/she will leave behind? Are the setting of affairs, preparation of an advanced directive, making a will, funeral planning encouraged?