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 or over. Methods: Three methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6‐24); a format for non‐participant observations; and individual face‐to‐face semi‐structured patient and staff interviews (reported elsewhere). Results: 5693 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% to 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, Health Care Assistants and student nurses (40% to 48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief) to 63% (longer interactions) (F[2, 557]=28.67, p<.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 make these interactions more positive