The perception of dignity in the hospitalized patient: Findings from a meta-synthesis.

Dignity is a value inherent to all human beings, guaranteed to every individual from birth, and influenced by culture and society. It is protected by various laws and declarations, and represents one of the fundamental human rights. Preserving human dignity is an essential aspect of nursing practice and a central element of care. Dignity is a highly subjective and personal concept; there may be variations in the way that patients perceive it and in the ways that nurses can guarantee it. A systematic review of the qualitative literature was conducted to obtain a comprehensive understanding of adult patients' perceptions of dignity in a hospital setting. This review adhered to the PRISMA Statement for reporting systematic reviews, and the results were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. Major databases (PubMed, CINAHL, Scopus, and PsycINFO) were consulted and resulted in the inclusion of 21 studies. Methodological quality was assessed using the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Six main themes emerged from the data analysis: (1) The concept of dignity and its various dimensions; (2) The significance of maintaining one's own privacy and confidentiality; (3) The hospital environment's influence on patients' dignity; (4) Healthcare professionals' characteristics and behaviours that affect dignity; (5) The role of communication and the relationship with healthcare providers; and (6) The patient's ability to make choices and be involved actively in their care. These findings underscore the importance of understanding caregivers' perspectives on dignity to ensure that they provide respectful and dignified care and treatment that prioritizes the patient's mental and physical needs.

Self-reported dignity and factors that influence dignity in hospitalised older adults: A cross-sectional survey.

OBJECTIVE: This study examined levels of self-reported dignity and explored factors expected to influence dignity experienced by older adults during acute hospitalisation in Ghana. BACKGROUND: Dignified care has been recognised as inseparable from quality nursing care and maintaining patients' dignity has been highlighted in professional codes of conduct for nurses. However, there is a lack of research on self-reported dignity and the factors that influence the dignity of older adults during acute hospitalisation in Africa. SETTING: A large teaching hospital in the northern region of Ghana. PARTICIPANTS: Hospitalised older adults. METHODS: A cross-sectional survey was used to gather data from a convenience sample of 270 older inpatients, using the Hospitalized Older Adults' Dignity Scale. Data were analysed using descriptive statistics and stepwise ordinal logistic regression to investigate stratified dignity outcomes. The study was reported following the STROBE checklist. RESULTS: More than half of the older adults surveyed reported low to moderate levels of dignity. Demographic characteristics such as age, marital status, religious status, occupation, level of education and type of hospital ward did not show any significant associations with dignity levels. However, there was a significant association found between dignity levels and sex and the number of hospitalisations. CONCLUSION: Most older adults in a Ghanian hospital experienced loss of dignity during their acute hospitalisation. Male older adults reported higher dignity levels during acute hospitalisation than their female counterparts. Further, older adults who were admitted to hospital for the second time reported less dignity compared to those admitted three or more times. RELEVANCE TO CLINICAL PRACTICE: The results emphasise the importance of healthcare professionals having the necessary knowledge and skills to provide gender-sensitive care, which ultimately promotes the dignity of all patients. Additionally, the results underscore the urgency of implementing measures that guarantee patients' dignity during all hospital admissions. PATIENT OR PUBLIC CONTRIBUTION: Survey questionnaires were completed by hospitalised older adults at the study setting.

Development and psychometric validation of the hospitalized older adults' dignity scale for measuring dignity during acute hospitalization.

AIM: To develop and validate a culturally appropriate patient-reported outcome measure for measuring dignity for older adults during acute hospitalization. DESIGN: A three-phased exploratory sequential mixed-method design was used. METHODS: Domains were identified and items were generated from findings of a recent qualitative study, two systematic reviews and grey literature. Content validity evaluation and pre-testing were undertaken using standard instrument development techniques. Two-hundred and seventy hospitalized older adults were surveyed to test construct and convergent validity, internal consistency reliability and test-retest reliability of the measure. Analysis was performed using Statistical Package for the Social Sciences, version 25. The STROBE checklist was used to document reporting of the study. RESULTS: We established the 15-item Hospitalized Older Adults' Dignity Scale (HOADS) that has a 5-factor structure: shared decision-making (3 items); healthcare professional-patient communication (3 items); patient autonomy (4 items); patient privacy (2 items); respectful care (3 items). Excellent content validity, adequate construct and convergent validity, acceptable internal consistency reliability and good test-retest reliability were demonstrated. CONCLUSION: We established the HOADS is a valid and reliable scale to measure dignity for older adults during acute hospitalization. Future studies using confirmatory factor analysis are needed to corroborate the dimensionality of the factor structure and external validity of the scale. Routine use of the scale may inform the development of strategies to improve dignity-related care in the future. IMPACT: The development and validation of the HOADS will provide nurses and other healthcare professionals with a feasible and reliable scale for measuring older adults' dignity during acute hospitalization. The HOADS advances the conceptual understanding of dignity in hospitalized older adults by including additional constructs that have not been captured in previous dignity-related measures for older adults (i.e. shared decision-making and respectful care). The factor structure of the HOADS, therefore, includes five domains of dignity and offers a new opportunity for nurses and other healthcare professionals to better understand the nuances of dignity for older adults during acute hospitalization. For example, the HOADS enables nurses to identify differences in levels of dignity based on contextual factors and to use this information to guide the implementation of strategies that promote dignified care. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in the generation of items for the scale. Their perspectives and the perspectives of experts were sought in determining the relevance of each item of the scale to patients' dignity.

[Nursing ethics and the mandate of care-current limits using the example of inpatient care for the elderly]. / Pflegeethik und der Auftrag der Pflege ­ Gegenwärtige Grenzen am Beispiel der stationären Altenpflege.

The central guiding ethical principles of professional care are dignity, care, justice, and respect. The current framework conditions and circumstances in the care of the elderly mean that professional care ethics are no longer feasible in many cases. This leads not only to enormous (moral) burdens among the nursing staff, but also to a comprehensive degree to professional dissatisfaction and to leaving the profession. The term "Pflexit" (based on the German word "Pflege" = care) was first raised during the corona pandemic and has not faded. In order to ensure ethically justified and dignified care for the elderly that is also oriented towards human rights, as is conveyed politically in charters and rightly expected by people in need of care, rapid and comprehensive social and political intervention is required.In this context, dignity and respect are also a social mandate. Dignified professional care based on ethical values can only be implemented if nurses are shown this same respect. The clear warnings of a "nursing climate crisis" must finally be followed by action to stop the exodus from the profession. In this discussion paper, the importance of a professional care ethic is first explained. In a second step, the framework and current problems that oppose a comprehensive implementation of core values in nursing care for the elderly are highlighted. The focus here is on the effects of the precarious personnel situation.

Methodological quality of dignity-related patient reported outcome measures used in acute hospital settings: A systematic review using the COSMIN methodology.

AIMS AND OBJECTIVE: The aim of this systematic review was to examine the methodological quality of dignity-related patient reported outcome measures (PROMs) used to measure patients' dignity during acute hospitalisation using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology for systematic review of PROMs. BACKGROUND: Previous scoping review studies on the methodological quality of dignity-related PROMs lack specificity for dignity during acute hospital admission. They included PROMs that were developed to measure constructs of care other than patient dignity or designed to measure dignity in contexts outside of the acute hospital setting. STUDY DESIGN: A systematic review based on COSMIN methodology. METHODS: A systematic search was undertaken using five databases (CINAHL Complete, Medline Complete, EMBASE, PsycINFo and AgeLine) for articles published between 2000 and 2022. Relevant papers were identified using strict adherence to eligibility criteria, and studies that included development of dignity-related PROMs for use in acute hospital settings were selected. Two reviewers independently screened the identified papers, extracted data and examined the quality of studies. RESULTS: Six papers met the inclusion criteria. Two PROMs, the 25-item Patient Dignity Inventory and the 34-item Inpatient Dignity Scale, met the COSMIN quality criteria because of their sufficient quality of evidence for content validity and reliable internal consistency. None of the PROMs met the quality criteria for assessment of measurement error, criterion validity, cross-cultural validity and responsiveness. CONCLUSION: We recommend the Patient Dignity Inventory and the Inpatient Dignity Scale as the PROMs of choice for evaluating patients' dignity and/or dignified care during acute hospital admissions. These PROMs were developed using robust procedures with sufficient overall quality for content validity, internal consistency reliability and other measurement properties, and with moderate to high quality of evidence for these measurement properties. Researchers and clinicians who wish to use other dignity-related PROMs identified in this review should consider the methodological limitations of these PROMs, as highlighted in the present systematic review. RELEVANCE TO CLINICAL PRACTICE: The review findings will guide healthcare professionals about their choice of patient reported outcome measures for evaluating patients' dignity or dignified care during acute hospitalisation.

Individual factors in dignified care: A cross-sectional study of critical care nurses.

AIM: To determine the level of dignified care provided by critical care nurses, and explore the associated individual factors. BACKGROUND: Dignity is a fundamental right of human beings. Critically ill patients are dependent on nurses. Their need for respect and dignity is liable to be neglected in intensive care unit settings. Both critically ill survivors and dying patients suffer mental anguish due to loss of dignity. METHOD: This was a cross-sectional study of 526 critical care nurses working at intensive care units for adults in Zhejiang Province, China. Data were collected from February 2021 to May 2021 using the Intensive Care Unit Dignified Care Questionnaire, Wong and Law Emotional Intelligence Scale, Jefferson Scale of Empathy-Health Professional and Nurses Professional Values Scale-Revised. RESULTS: The total score of dignified care was 67.37 (8.83), with the standard score as 74.07 (12.99). Participants who performed poorly in absolute and relative dignity accounted for 8.4% and 31.2% of the total sample, respectively. Emotional intelligence (ß = .379, p < .001), empathy (ß = .319, p < .001), professional values (ß = .147, p < .001), age (ß = .075, p = .003) and training in dignified care (ß = .074, p = .010) were associated with dignified care, explaining 67.6% of the variance. CONCLUSION: The average level of participants' behaviours of maintaining patient dignity was medium. Critical care nurses need to improve their ability to maintain relative dignity of patients. Emotional intelligence, empathy, professional values, age level and training in dignified care were predictors of dignified care. IMPLICATIONS FOR NURSING MANAGEMENT: Improving emotional intelligence, empathy and professional values of critical care nurses and training them (especially less experienced nurses) will enhance their ability in dignified care. This study provides a novel perspective to help nursing managers develop interventions to promote humanized care in the intensive care unit.

A systematic review of patient-reported dignity and dignified care during acute hospital admission.

AIMS: To synthesize quantitative evidence on levels of dignity during acute hospital admission and identify barriers and facilitators to patients' dignity or dignified care from the perspective of hospitalized patients. The secondary aim was to examine the relationship between dignity and demographic, clinical and psychological characteristics of patients. DESIGN: A systematic review based on the protocol of the Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline for reporting systematic reviews. DATA SOURCES: Five electronic databases (PubMed, CINAHL, Embase, PsycINFO, AgeLine) were searched in February 2021, followed by backward-forward searching using Web of Science and Scopus databases. REVIEW METHODS: Potentially eligible articles were scrutinized by two reviewers. Articles that met the eligibility criteria were appraised for quality using the Critical Appraisal Tool for Cross-Sectional Studies. Two reviewers extracted data for the review and resolved differences by consensus. RESULTS: Out of 3052 potentially eligible studies, 25 met the inclusion criteria. Levels of dignity for hospitalized patients vary widely across geographic locations. Patients' dignity is upheld when healthcare professionals communicate effectively, maintain their privacy, and provide dignity therapy. Patients' perceptions of dignity were, in some studies, reported to be associated with demographic (e.g. age, marital status, gender, employment, educational status), clinical (e.g. hospitalization, functional impairment, physical symptoms) and psychological (e.g. depression, anxiety, demoralization, coping mechanisms) variables whilst other studies did not observe such associations. CONCLUSION: Patients in acute care settings experience mild to a severe loss of dignity across different geographic locations. Patients' dignity is influenced by several demographic, clinical and psychological characteristics of patients. IMPACT: The findings of the review support impetus for improvement in dignified care for hospitalized patients, addressing factors that facilitate or impede patients' dignity. Measures aimed at alleviating suffering, fostering functional independence and addressing patients' psychosocial needs can be used to promote dignity.

Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana.

BACKGROUND: Evidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives' perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility. METHODS: We employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study. RESULTS: The findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO's quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building. CONCLUSION: We conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities.

A Quality Improvement Study on Improving Communication between Health-Care Provider and Laboring Woman: A Step toward Respectful Maternity Care.

BACKGROUND: Effective communication between health-care providers (HCP) and women during labor is a key component for providing dignified and consented maternity care. The quality improvement (QI) study was planned to improve the communication skills of HCP to provide dignified and consented care in the labor ward. METHODOLOGY: This study was conducted at the labor ward of a tertiary care hospital. To assess the magnitude of nondignified and nonconsented care, baseline data were collected from the women who had normal vaginal delivery through interviews using a prestructured questionnaire. The HCPs were also interviewed about the reasons for nondignified and nonconsented care. Various change ideas were tested through the plan-do-study-act cycle to sensitize the HCP with World Health Organization recommendations on intrapartum communication. RESULTS: There was a marked improvement in communication between HCP and women in labor, i.e., addressing the woman by her name (100%), consent before each clinical examination (93%), and providing information about the progress of labor after each examination (50%). CONCLUSION: A QI approach is feasible and effective as a behavior change intervention to provide dignified and consented care in the existing settings.

The meaning of dignity for older adults: A meta-synthesis.

Dignified care is a central issue in the nursing care of older adults. Nurses are expected to treat older adults with dignity, and older adults wish to be treated in a dignified manner. Researchers have recommended investigating the concept of dignity based on specific contexts and population groups. This meta-synthesis study aims to explore the understandings of dignity from the perspective of older adults in the Nordic countries. Synthesising findings from qualitative studies on older adults' experiences of dignity has provided important insight into what can be essential for dignified care in a Nordic context. The importance of visibility and recognition for the experience of dignity is an overarching theme in all the studies. The participants' descriptions mostly implicated an existence dominated by a lack of recognition. The older adults do not feel valued as people or for their contribution to society and strive to tone down their illnesses in an attempt to become more visible and acknowledged as people. Toning down their illnesses and masking their needs can protect their independence. At the same time, becoming less visible can leave them without a voice. The metaphorical phrase protected and exposed by a cloak of invisibility is used to express the authors' overall interpretation of the findings. Lack of recognition and being socially invisible is a genuine threat to older adults' dignity.

Perspectives about dignity during acute care for older people and their relatives: A qualitative study.

AIMS AND OBJECTIVES: The aim of the study was to enhance understanding about dignified care from older peoples' and their carers' perspectives. The information will contribute to the development of a tool to measure older peoples' dignity during hospitalisation. BACKGROUND: Older people are a vulnerable cohort at risk of loss of dignity during acute hospitalisation arising from environmental, behavioural and patient factors. It is not clear how older people and their relatives define dignified care in acute care settings. DESIGN: An interpretative descriptive method was used. METHODS: A purposive sample of older people (at least 65 years) who had been hospitalised in acute care and subsequently transferred to sub-acute care, and their relatives, were invited to participate. The study was undertaken in one sub-acute ward in a regional healthcare organisation in Victoria, Australia. Individual interviews were audio-recorded then transcribed. Data were analysed using thematic content analysis. The COREQ checklist was used to document reporting of the study. RESULTS: Individual interviews were conducted: 24 patients and 12 relatives. Three main themes were identified: "Involve me in decisions about my care and treatment," "Keep me safe when I am vulnerable" and "Treat me as an individual and with respect." Older people want to be involved in decisions about their care and treatment and to receive adequate, suitable information. They feel vulnerable during hospitalisation and want to feel safe when speaking up about concerns. Individual acknowledgement is an important aspect of dignity. CONCLUSIONS: Older people and their relatives identified specific elements of care that uphold or threaten dignity during acute hospitalisation. Nurses play a major role in upholding dignity for older people in hospital. RELEVANCE TO CLINICAL PRACTICE: Clinicians may benefit from systematic dignity-related training. Specific strategies to enhance older persons' dignity, including communication skills training and continence management need to be developed, implemented and evaluated.

Being in a space of sharing decision-making for dignified mental care.

WHAT IS KNOWN ON THE SUBJECT?: Several studies describe barriers and facilitators for implementing shared decision-making in mental care, yet a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care. Mental care is intended to empower the patients by increasing their responsibility and self-awareness and helping them to use their own resources. Too much focus on the patients' independence, responsibility and choice may hinder the patients getting the help they need. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The meaning of SDM can be understood as a continuous relational process between the patients and MHCPs in search of dignified care. Practising shared decision-making is a challenging process which requires the MHCPs to possess high professional competence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental healthcare professionals should be conscious of their own role in the asymmetrical power relationship in decision-making and use their professional competence for their patients' benefit. Clinical supervision can be a tool for developing professional competence and is considered important when assisting mental healthcare professionals practising shared decision-making for dignified care. Abstract Introduction Several studies describe barriers and facilitators for implementing shared decision-making in mental care. However, a deeper understanding of the meaning of shared decision-making in this context is lacking. Shared decision-making is aimed at facilitating patients' active participation in their care by placing them at the centre of care. Too much focus on the patients' autonomy may hinder them getting the help they need. A comprehensive understanding of shared decision-making is needed for its implementation. Aim/research question To interpret the meaning of shared decision-making in mental care as perceived by patients and mental healthcare professionals. The research question was: What is the meaning of shared decision-making in mental care? Method A hermeneutic inductive design with a thematic interpretative analysis of data was performed from in-depth interviews with 16 patients and multistage focus group interviews with eight mental healthcare professionals. Results The overall theme being in a space of sharing decision-making for dignified mental care was described by the three themes engaging in a mental room of values and knowledge, relating in a process of awareness and comprehension and responding anchored in acknowledgement. Discussion Balancing the patients' need for assistance with autonomy, while safeguarding their dignity, is a challenging process requiring mental healthcare professionals to possess professional competence. Implications for practice Organized professional development of the carers' professional competence is important to facilitate shared decision-making.

Validez factorial del cuestionario sobre trato digno en enfermería / Review of the effect of uncertainty in adults with type 2 diabetes mellitus

Introducción: Ofrecer un trato digno a los pacientes es un componente central en la calidad de los servicios de salud, por lo que su medición válida resulta altamente relevante. Objetivo: Evaluar la validez de constructo del cuestionario Trato digno en enfermería, desarrollado por la Secretaría de Salud en México. Métodos: Estudio observacional, transversal y analítico. Se seleccionó una muestra por conveniencia, la cual estuvo constituida por 355 pacientes atendidos en el 100% de los 89 centros de salud. Resultados: Hubo en promedio de puntuaciones altas de trato digno (0.84, rango 0-1)), el ajuste del modelo resultó adecuado al considerar diversos índices: NNFI = 0.99; NFI = 0.98; CFI = 0.99; RMSEA = 0.04; PNFI = 0.70 y chi cuadrada normada = 2.37. Un hallazgo notable fue la correlación positiva (p < 0.05) entre las dimensiones de relaciones humanas con la dimensión comunicativa (r = 0.95), relaciones humanas con la dimensión interior de la persona (r = 0.90) y dimensión comunicativa con dimensión interior de la persona (r = 0.90). Conclusión: Se comprobó la validez de constructo del cuestionario Trato digno en enfermería.

Introduction: Providing dignified care to patients is one of the main components in health care quality, which is why measuring it is really important. Objective: To evaluate the construct validity of the Dignified Care questionnaire in nursing, this was developed by the Secretaría de Salud (Mexico's Health Secretary). Methods: Observational, cross-sectional, and analytical study. 355 patients, attended in all the 89 health centers, were selected by convenience sampling. Results: There were on average high punctuations of dignified care (0.84, range 0,1). The adjustment of the model was appropriate, since several indexes were considered: NNFI = 0.99; NFI = 0.98; CFI = 0.99; RMSEA = 0.04; PNFI = 0.70 and normalized chi squared = 2.37. A remarkable finding was the positive correlation between the following dimensions (p < 0.05): human relations with communication (r = 0.95), human relations with the patient's inner dimension (r = 0.90), and communication with the patient's inner dimension (r = 0.90). Conclusions: Construct validity of the Dignified Care questionnaire in nursing was confirmed.

Respectful care of human dignity: how is it perceived by patients and nurses?

OBJECTIVE: Dignified care protects the patient's rights and provides appropriate ethical care while improving the quality of nursing care. In this context, the opinions of nurses and patients who receive nursing care about dignified care are important. The aim of this study was to explore the opinions and experiences of Turkish patients and nurses about respectful care of human dignity. METHODS: This descriptive cross-sectional study was conducted in Turkey. Participants were inpatients at cardiology, neurology and neurosurgery clinics and nurses working in these clinics. The data for the study were collected from face-to-face interviews using questionnaires. The percentages of characteristics and preferences of the participants were calculated, and the results were analysed using statistical tests. RESULTS: A total of 150 patients and 78 nurses participated in the study. The patients stated that the protection of their rights was the most important factor for dignified nursing care. The nurses stated that being careful to not expose the patients' body and being respectful of the patients' privacy were important in dignified nursing care. The age of the patient, duration of the disease, number of hospitalisations and length of time the nurses had been working at the clinic caused significant changes in the factors considered important in dignified care. CONCLUSIONS: Our findings provide a perspective on dignified care in the Turkish healthcare setting. There were some differences between patients and nurses in the factors considered important for dignified care. The discussion with patients and nurses related to care and practices that protect or detract from human dignity can provide insights to ethics.

Beneficiaries of conflict: a qualitative study of people's trust in the private health care system in Mogadishu, Somalia.

BACKGROUND: In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as "access to adequate health care for all at an affordable price". Despite this, an estimated 90% of Somalia's largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people's trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country. METHODS: A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis. RESULTS: Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country's citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging - including the widespread practice of further appointments for follow-up - which inflates the costs. The study also found poor patient-provider relationship and widespread distrust of the private health care system. CONCLUSION: The study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor-patient relationship has been - and remains - a keystone of care; thus, there is an urgent need for guidelines for private health care providers to treat their patients with dignity and respect. The education system, particularly the syllabus used by medical faculties, should be reviewed and improved to provide medical students with necessary knowledge, skills and attitudes to maintain patient dignity and rights.

'It's the little things that count': healthcare professionals' views on delivering dignified care: a qualitative study.

AIMS: To explore healthcare professionals' perspectives of dignified care and experiences of providing care. BACKGROUND: Although 'care' and dignity in care are seen as central to the delivery of good care by patients, families and professionals, we still lack a clear understanding of what these, often contested and elusive concepts, mean in the practice setting, particularly from the perspective of healthcare professionals. DESIGN: Interview based qualitative research design. METHODS: In-depth interviews were conducted with healthcare professionals working in four UK NHS trusts. Data were collected between June-November 2012. Interviews were audio-recorded, transcribed and analysed using thematic analysis. FINDINGS: Forty-eight healthcare professionals took part in this interview based study. Two main themes that encapsulated how care and dignity in care is enacted by professionals were identified: focusing on the 'little' things that matter to both professionals and patients; and improving care by making poor care 'visible'. CONCLUSION: Our findings show that the 'little things' in care allow professionals to 'care for' but also 'care about' patients, suggesting that these two aspects of caring become intrinsically interlinked. Our findings also suggest that 'making poor care visible' challenges engrained and task rather than human focused care in a non-threatening way, which can be the catalyst for providing care that is caring and dignified.