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? | |