The challenge of maintaining personal
dignity in the nursing home
A qualitative study among Dutch nursing home residents
RESEARCH HIGHLIGHTS
• Nursing home residents do not consider living
in a nursing home in itself to be unworthy; they
see it as a consequence of being ill or frail
• Many nursing home residents feel discarded
by society and stigmatized simply because of
their illness or age
• Aspects of nursing home care can hamper a
resident’s personal dignity, but good
professional care can preserve it as well
Mariska Oosterveld-Vlug, MSc¹
Roeline Pasman, PhD¹
Isis van Gennip, MSc¹
Martien Muller, PhD²
Dick Willems, MD, PhD³
Bregje Onwuteaka-Philipsen, PhD¹
¹ Department of Public and Occupational Health, EMGO Institute for Health and
Care Research, Expertise Center for Palliative Care,
VU University Medical Center, Amsterdam, The Netherlands
² Department of Nursing Home Medicine, EMGO Institute for Health and Care
Research, VU University Medical Center, Amsterdam, The Netherlands
³ Department of General Practice, Division Clinical Methods and Public Health,
Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
Contact: m.oosterveld@vumc.nl
BACKGROUND
METHODS
Nursing home residents are exposed to diverse factors
which may be associated with loss of personal dignity: they
experience functional incapacity, are heavily reliant on
nurses, have little privacy and few belongings. To help them
withstanding these threats, it is important to investigate the
concept of dignity from the residents’ perspective.
Study population
AIM
To gain more insight in the way Dutch nursing home
residents experience their dignity and the factors that
hamper or preserve this.
30 recently admitted nursing home residents on the
somatic wards of 4 nursing homes in the Netherlands.
Data collection and analysis
• In-depth interviews using a topic list (May ‘10 to June ‘11).
• Interviews were recorded, transcribed literally and analyzed
using Atlas-ti software.
• Codes were organized according to the themes in the
‘generic model of dignity in illness’ (Van Gennip et al., 2012),
because open coding revealed considerable overlap with the
themes in this model.
RESULTS
Dignity hampered because of functional incapacity
rather than because of living in a nursing home
The fact that residents were admitted to a nursing home
was not degrading in itself, but seen merely as an
inevitable consequence of having lost functional capacity:
Yes, this is a completely different kind of life, you don’t really have
a life. Lying there all day, it’s not really a life the way I am now.
That’s because of my illness. It’s got nothing to do with the nursing
home. My illness, that’s the source of all the misery. Otherwise I
wouldn’t be lying here. I’m glad there are such things as nursing
homes. It would be a sorry state of affairs if they weren’t there. If
they weren’t there, it would be undignified.
Man, 66; amyotrophic sclerosis
Violation of dignity caused by feeling discarded and
stigmatized by society
By living in a nursing home, many residents believed they
were no longer part of society. In getting older and less
able to function, they felt stigmatized by society, e.g.
when other people treated them as if they were insane:
You notice that when you get old, people stop taking you seriously:
“That person’s so old, we’ll just park him in a corner then he won’t
bother us any more.” That’s often what happens. You no longer
count. Young people today are more concerned with their own
things than with all those old people. They’re really not interested in
all that whining. They don’t want anything to do with you.
Woman, 85; arthrosis
Nursing home aspects that hamper personal dignity
For example, having to wait for help and a dearth of time
and attention from nursing staff could violate dignity:
I feel that impatient haste with which they do everything, they are
kind of jumping about next to you, desperate to move on. It’s a
routine and that’s their approach to everything. I do find that
inattentive, I do think it makes the patients feel less dignified. You
mustn’t forget you are dealing with a gentleman.
Man, 88; CVA, problems with kidney
Nursing home aspects that preserve personal dignity
Good professional care (e.g. being treated with respect,
being taken seriously and receiving good quality care)
could prevent dignity from being violated:
I’m proud of the fact that here in the home they take people’s
feelings into account. They don’t do that everywhere. So if they wash
you, that means that they do it properly, that they don’t do a rush
job and then off they go again and now you have to eat because it’s
meal time. No, they do it all very properly, you know. Attentively.
Woman, 75; hydrocefalus
RECCOMENDATION FOR PRACTICE
To support residents in their challenge of maintaining
dignity, nursing home staff, relatives and society
should pay more attention to the way they address
and treat residents.