Experience of dignified care among hospitalized patients: a phenomenological study

Abstract

Background

The problem of undignified care is troublesome, especially in low- and middle-income nations. Patients are more likely to lose their dignity when they need to be admitted to the hospital. Dependency during hospitalizations poses a threat to patients’ dignity, in particular when it comes to personal care. Dignified care enhances overall patient well-being, satisfaction, psychological comfort, and confidence. Even though it is necessary, little is known about dignified care in Ethiopia, particularly in Jimma. Analyzing dignified care, therefore, helps healthcare providers and program managers design better strategies.

Aim

To explore the experience of dignified care among adult patients admitted to Jimma Medical Center, southwestern Ethiopia, from June 1–30, 2023.

Design

A qualitative phenomenological study design was employed.

Methods

A qualitative phenomenological study design was employed among six key informants and thirteen patients. Purposive sampling techniques were utilized to recruit study participants. Data were collected through semi-structured, in-depth interviews from June 1–30, 2023. The rigor criteria outlined by Lincoln and Guba (1985), namely credibility, transferability, dependability, and conformability, were used to enhance the trustworthiness of the findings. Thematic analysis was conducted using ATLAS-ti 7.1 version software.

Results

Six themes were identified: communication, privacy, respect, autonomy, care provider factors, and organizational factors. Dignity was preserved when patients were treated with respect, communication was effective, privacy was protected, and patients were involved in their care. Dignified care also required providers to have adequate knowledge, a favorable attitude, and ethical commitment, supported by strong organizational backing and resources. Therefore, a concerted effort from all health professionals and administrators is essential to consistently deliver and enhance dignified care.

Implication

This study provides critical insights into dignified care for hospitalized adults in Ethiopian hospitals, serving as a foundational resource to guide future research and the development of practical interventions and national strategies.

Keywords

Adult patient, Dignity, Dignified care, Qualitative, Jimma medical center

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-026-14115-y.

Background

Dignified care supports, encourages, and upholds the patient’s self-worth, regardless of any variations in sociodemographic factors between the patient and care providers [1]. It is acknowledged as a fundamental human need and as a key issue in health science [2]. Delivering dignified care increases satisfaction, confidence in care, and psychological comfort, and enhances the Patient’s mental health [3]. Globally, the problem of undignified care is worrisome, especially in low- and middle-income nations [4]. Patients are more likely to lose their dignity when they need to be admitted to the hospital [5]. Dependency during hospitalizations poses a threat to patients’ dignity, in particular when it comes to personal care [6].

The World Health Organization stated in its 1994 proclamation that maintaining patient dignity was crucial to enhancing patient health [7]. Everybody has the right to freedom and the right to receive dignified care, according to the United Nations Declaration [8]. A person’s dignity should not be restricted by their age, color, creed, culture, gender, sex, nationality, ethnicity, social class, or state of health, according to the International Council of Nurses Code of Ethics 2012 [9]. According to the Nursing and Midwifery Council Code of Professional Conduct, care providers are required to put patients’ needs first by treating them like unique individuals and upholding their dignity [10].

Despite being a well-recognized issue, measuring its precise global prevalence is difficult because of several factors, such as cultural norms, variations in healthcare systems, and views on dignified care [11]. According to research from North China, over 75% of patients said they were no longer satisfied with their dignified care [12]. Another study conducted in northwestern Iran revealed that the dignity of Iranian cancer patients is not fully respected in clinical settings [13]. Further reports from Ghana indicate that approximately half of the patients get low- to moderate-dignified care [14].

According to the findings of a systematic review of research, care providers uphold patients’ dignity when they effectively communicate, respect patients’ privacy, show empathy, and cultivate trust [6, 15]. In 2021, a systematic study conducted in China found that a patient’s feeling of dignity was correlated with many variables, including age, gender, education, employment status, income, and religious affiliation [16]. Furthermore, the integrated review of the Middle East in 2021 emphasizes that the socio-political, cultural, and economic circumstances of the nation, as well as patient financial stability, all influence dignified care [17].

Patients frequently express dissatisfaction with the level of dignified care provided by hospitals, a concern that is reportedly linked to core values they hold about health care [18]. Individuals who have had undignified care could be hesitant to seek prompt medical attention in the future, which could hurt their health results [19]. The load on healthcare resources may increase when dealing with the aftermath of providing undignified treatment, such as treating problems brought on by postponing seeking medical attention or treating patients’ psychological distress [20].

While the importance of maintaining patient dignity in hospital care for psychological well-being and service uptake is globally recognized [21, 22], evidence from low-resource settings is notably limited. More critically, to the best of our knowledge, this study represents the first comprehensive investigation into dignified care specifically conducted in Ethiopia, and particularly within the Jimma region. This significant absence of prior research highlights a crucial knowledge gap regarding the local context of dignified care delivery and patient experiences within the Ethiopian healthcare system. Given this critical lack of local evidence in Ethiopia, a study focused on Jimma Medical Center is highly warranted. Examining the adult patients’ experience of dignified care at Jimma Medical Center will directly facilitate the development of more effective and contextually relevant strategies for program managers and healthcare providers. Therefore, this study explores the adult patients’ experience of dignified care at Jimma Medical Center in Oromia Regional State, southwestern Ethiopia.

Objective

To explore the experience of dignified care among adult patients admitted to Jimma Medical Center, southwestern Ethiopia, from June 1–30, 2023.

Methodology

Study area

Jimma Medical Center is approximately 352 km south-west of Ethiopia’s capital city, Addis Ababa. JMC is the only specialized referral hospital in southwest Ethiopia. It serves approximately 15 million people in a catchment area of approximately 250 km in southwest Ethiopia. It receives approximately 2, 21,344 patients per year. JMC has a bed capacity of 800 and 972 health professionals on staff, among which 573 are nurses. Among nurses, 14 were master’s degree holders, 446 were BSc degree holders, and 113 were clinical nurses. It has a total of 45 inpatient and outpatient departments. There are major departments for adult inpatient care at JMC: internal medicine, surgery, gynecology, maternity, ophthalmology, and the psychiatry ward.

Study design and population

A qualitative phenomenological study design was employed. This approach was chosen to explore the multifaceted and subjective nature of dignified care from the patient’s and key informant’s perspective. This approach allows us to delve into the lived experiences of patients and key informants. All adult patients who were admitted to Jimma Medical Center and all key informants working at Jimma Medical Center during the study period were considered the source population. Inclusive criteria include patients whose ages were over 18, who stayed at the hospital for a long period, and key informants of Jimma Medical Center who served as head nurses of the ward at least once and have experience of greater than or equal to 5 years and willingness to engage in the study. The selection criteria followed the principles of maximum variation.

Sample size and sampling technique

The selection of thirteen patients and six key informants was purposive. All 19 participants (13 patients and 6 key informants) who were approached agreed to participate and were enrolled in the study. We purposefully selected individuals who possessed unique experiences and information related to the care given and can provide valuable insights on dignified care; these included patients who had stayed in the hospital for more than 11 days and had been admitted at least twice and key informants in Jimma Medical Center who had served as head nurses of the ward at least once and had experience of greater than or equal to 5 years. Selection of participants for in-depth interviews followed maximum variation principles: age, gender, educational status, occupation, type of department, type of disease, duration of admission, and frequency of admission of the patient were taken into account. The purpose was to get detailed information from those participants who met the criteria. The number of participants was determined by achieving thematic saturation, which occurred when no new themes or codes emerged from the analysis of the final three consecutive interviews (specifically, patient interviews P011, P012, and P013 and key informant interviews P05 and P06).

Data collection tool and procedure

Data were collected using open ended, interviewer-administered questionnaires, which was developed for this study (Supplementary file). The study participants were selected from all adult inpatient departments at JMC. Semi-structured, in-depth interviews were undertaken during the discharge so that patients could discuss their experiences of dignified care and their dignity during hospitalization. Interviews were conducted by two trained research assistants who held Master’s degrees in Public Health and had prior experience in qualitative data collection. They received specific training in phenomenological interviewing techniques, active listening, and rapport building. Crucially, neither research assistant was involved in the clinical care of the participants to ensure independence and minimize potential power imbalances. Before each interview, participants were explicitly informed that their responses were confidential and would not influence their medical treatment, thus helping to mitigate social desirability bias.

Patient interviews were conducted from June 1–30, 2023. All patient interviews were performed 1–2 days prior to their discharge, after their acute medical condition had stabilized, to allow for reflection while minimizing the potential for discomfort or perceived impact on their ongoing care. Interviews with key informants (KIIs) were conducted 1 week post-discharge, allowing for retrospective reflection. This timing was chosen to balance participants’ comfort and reflection.

A semi-structured question guide was used to lead the discussion. The researchers performed a pretest on two patients who met the inclusion criteria before beginning data collection; the results of that study and participants were subsequently excluded from the analysis. The pretest helps the investigator determine any issues with the audiotape, interview guide, environment suitability, and interview duration.

Before the start of the interview, each participant in this study provided their consent. The interview started with the researcher introducing himself and asking questions based on a detailed interview guide. The interview started with the first broad question, Can you explain your experience with dignified care in this hospital?” and what are the barriers to dignified care in this hospital? And after that, more focused questions that addressed the study’s goal were posed. The discussion was continued with additional questions and probes. A high-quality audio recorder and notebook were used to fully capture their opinions after they were told about the objective of the study and their consent was obtained. Interviews were conducted in a private room free from noise and prepared for this purpose. Each interview lasted an average of 50 minutes.

Data quality assurance

The rigor criteria outlined by Lincoln and Guba (1985), namely credibility, transferability, dependability, and conformability, were used to enhance the trustworthiness of the findings. Credibility was achieved by member checking. We presented preliminary interpretations and findings to five participants for their feedback on whether the findings accurately reflected their experiences of Dignified Care. Participants confirmed that the themes resonated with their lived realities. We ensured transferability by providing thick description the study participants, context, and data analysis procedures.

Conformability was achieved by keeping records for an audit trail of entire documents and checking transcripts for errors regularly. Data has been properly checked by all users, and there were agreements and confirmations to show their validity. To ensure dependability, research processes were documented thoroughly, including data collection procedures, coding schemes, and analytic decisions. Blind readings of interview text were performed by one epidemiology student who has no connection to the study to ensure transparency and potential replication.

Data processing and analysis

The qualitative data were analyzed using ATLAS-ti 7.1 version software. Data analysis was started at the same time as the data collection period, and each interview was transcribed verbatim and analyzed before the next one took place, with each interview providing the direction for the next one. Audio-taped interviews and interview notes were transcribed verbatim by a trained local transcriber. The accuracy and completeness of transcribed data were checked by comparing them to audio-taped interviews and interview notes. The transcripts were then translated into English by the principal investigator (a fluent bilingual speaker). To ensure accuracy and maintain the original nuances of participants’ expressions, back-translation of 20% of the transcripts was performed by an independent bilingual expert who was blind to the original English translation. Discrepancies were discussed and resolved through consensus among the research team.”

The translated Word document was converted to a PDF document. The PDF format of the document was uploaded to the ATLAS—ti 7.1 version software. Data analysis was performed by two independent coders (principal investigator and a research assistant with qualitative coding experience). An initial codebook was developed inductively by the principal investigator after reading the first three transcripts multiple times, identifying initial open codes. This preliminary codebook was then discussed and refined collaboratively with the second coder. Subsequently, the two coders independently coded two full transcripts (representing approximately 10% of the total data). Their initial coding was compared, and any disagreements were discussed extensively until consensus was reached, clarifying definitions and application of codes. This iterative process led to the refinement of the codebook. All remaining transcripts were then coded by the principal investigator, with regular team meetings to discuss emerging themes and ensure consistency with the established codebook. Then, similar codes were grouped into the same categories to form a family. Further, similar families developed a superfamily (themes). To help with the understanding of the data in each theme and group, related verbatim quotes were reported while presenting the data. Final themes were reviewed and validated by the entire research team.

Results

Participants of the study

We conducted in-depth interviews with 19 participants from Jimma Medical Center – 13 patients and 6 key informants. The sample comprised 10 men and 9 women aged 23–55 years. The patients were drawn from 12 different departments and had been had been admitted 2–3 times with lengths of stay ranging 11 to 32 days (Table 1).

Table 1.

Sample characteristics of patients for in-depth interviews admitted to Jimma medical Center, oromia region, Southwest Ethiopia, from June 1–30

Participant code	Age	Sex	Education	Occupation	Ward	Disease	admission duration	Frequency of admission
P01	37	Female	PE	Merchant	GFW	HF	20 days	3 times
P02	48	Male	NFE	Farmer	GMW	T1DM	10 days	3 times
P03	46	Female	NFE	Farmer	Orthopedic	Fracture	42 days	2 times
P04	34	Female	Univ	Employee	Maternity	Pregnancy	11 days	2 times
P05	40	Female	NFE	Merchant	OBGN	Fistula	21 days	3 times
P06	28	Male	SE	Student	ESW	Pancreatitis	14 days	2 times
P07	55	Female	NFE	Farmer	Elsa	Hernia	7 days	2 times
P08	48	Male	PE	Merchant	ESW	Burn	24 days	2 times
P09	34	Male	SE	Employee	CPU	TB	14 days	3 times
P010	55	Male	NFE	Farmer	Opt.	Glaucoma	10 days	3 times
P011	46	Male	PE	Farmer	Psy	Schizo	32 days	2 times
P012	44	Female	Univ	Employee	Oncology	Cancer	12 days	3 times
P013	23	Female	SE	Student	Maternity	Pregnancy	13 days	2 times
P014	51	Female	Univ	Head of ward	GMW
P015	40	Male	Univ	Staff Nurse	Orthopedic
P016	44	Male	Univ	Head of ward	OBGN
P017	54	Male	Univ	Supervisor	Maternity
P018	34	Male	Univ	Staff Nurse	Psy
P019	49	Female	Univ	Head of ward	Oncology

Key: NFE = no formal education; PE=primary education; SE=secondary education; Unv= university, ESW=emergency surgical ward; ELSW=elective surgical ward; PSY=psychiatry; Opth=ophthalmology; CPU=cardiac and pulmonary unit; OBGN=obstetric and gynecology ward; Schizo=schizophrenia; TB=tuberculosis; T1DM=type 1 diabetes mellitus

Thematic findings

Perspectives on dignified care

The participants provided multiple perspectives regarding elements they believed were necessary for maintaining dignity during hospitalization. Data analysis generated 55 codes, which were in line with how all participants experienced dignified care. The codes were clustered into 20 subthemes and six major themes. The six themes described patients’ and key informants’ experiences of dignified care: (1) communication; (2) autonomy; (3) privacy; (4) respect; (5) care providers factors; (6) organizational factors. Each major theme was supported by related subthemes (Table 2).

Table 2.

Identified themes and subthemes from experience of dignified care of adult patients and key informants of Jimma medical Center, oromia region, Southwest Ethiopia

Themes	Subthemes
Communication	Information
	Interpersonal interaction
	Barrier to communication
Privacy	Physical privacy
	Informational privacy
Autonomy	Decision-making
	Promoting independence
Respect	Cultural and Diversity Sensitivity
	Compassion from care providers
Care provider factors	Knowledge of care providers
	Attitude of Care providers
	Ethical commitment of care providers
Organizational factors	Organizational support
	Resource

Theme 1. Communication

Communication emerged as a theme for most of the participants. Participants described the importance of the exchange of information, effective communication, and how healthcare professionals interact with patients. By maintaining effective communication with admitted patients, healthcare providers can foster a patient-centered, supportive environment that values clear, respectful, and empathetic communication as a crucial component of dignified care delivery.

Information

Participants reported that the exchange of information during hospitalization was important because they wanted to know their health conditions. Getting information includes understanding the crucial role of accurate, clear, and timely information exchange in ensuring that patients receive the necessary details about their condition, treatment plan, and overall care.

…Stuff Interactions made me feel in control by explaining and giving information related to my illness, and gaining consent…(P01, female, 37)

…I was given information about my diagnosis, medication, my stay in the hospital, and a full explanation of any procedures carried out on me… (P07, female, 55; P02, male, 48)

Barrier to communication

Healthcare professionals can proactively address communication barriers. Identifying barriers involves providing clear explanations and ensuring patients feel heard and understood.

Participants indicated that communication barriers hurt their dignity because they prevented them from communicating their problems with care providers appropriately:

…But the challenge I have is that I know only Afan Oromo, and this has caused me troubles….(P03, female, 46)

A 51-year-old female nurse with 15 years of experience supports the above statement:

…Language barriers have an impact on patients’ dignity, so that care providers always seek language interpretation services promptly, ensuring effective communication and a respectful care environment for all admitted individuals…(P014, Nurse, GMW)

Interpersonal interaction

Interpersonal connection includes empathy, awareness of human behavior, and skillful communication. Healthcare professionals may improve satisfaction among patients, foster trustworthy connections, and ensure care is provided with dignity, empathy, and respect.

Many participants reported that respectful interaction with care providers has a positive impact on their dignity because it enables them to communicate their problems with care providers appropriately and without fear:

…I have established a sense of trust with care providers because they make me feel comfortable, respected, and confident in the care I receive…(P013, female, 23)

A 40-year-old male nurse with 10 years of experience supports the above statement:

…Maintaining transparency and honesty in communication with admitted patients and their families is vital to building trust and upholding their dignity during their healthcare journey… (P015, Nurse, orthopedic)

Theme 2. Privacy

Privacy is another theme. It encompasses physical privacy and confidentiality of medical information. Respecting patient privacy involves creating an environment where patients feel secure and have control over who has access to their personal and medical information.

Physical privacy

Participants described physical privacy as an important subtheme. Respecting patient physical privacy involves creating an environment where patients feel secure, by providing adequate spaces for personal care.

Many participants reported that care providers ensure their privacy while performing procedures and they see this action as important for their dignity:

…The health professionals draw a bed screen before any procedure; this is very interesting. It is the rule to lock the door when any procedure is done because if you close it, no one else can see the human body. Otherwise, it is unpleasant or annoying… (P01, female, 37; P05, female, 40)

In contrast to what was mentioned earlier, a participant mentioned that caregivers failed to protect their privacy throughout procedures:

…The HPs S/times didn’t control the flow of individuals before the procedure, which is very frustrating, because it is not pleasant if someone sees someone’s body…(P08, male, 48)

Informational privacy

Safeguarding patients’ health information and ensuring informational privacy enables patients to feel confident in the security and confidentiality of medical data. Informational privacy involves creating an environment for the patient to control who has access to their personal and medical information.

Participants reported the importance of ensuring informational privacy while discussing their condition:

…But it is important to emphasize the need for health care workers to lower their voices while discussing issues with them behind drawn curtains, as curtains are not soundproof…(P07, female, 55)

A 44-year-old male nurse with 15 years of experience supports the above statement:

…Professionals uphold patient confidentiality and privacy rights forms the cornerstone of dignified care, ensuring that patients feel respected and their personal information is safeguarded, Otherwise they are corrective measures will be taken…(P016, Nurse, OBGN)

Theme 3. Autonomy

This theme underscores the importance of respecting autonomy and independence of patients. In dignified care, patients are empowered to make decisions about their treatment, preferences, values, and choices. Preserving autonomy is an essential component of patient-centered, ethical treatment.

Decision-making

To make decisions regarding their care, patients must be aware of their requirements, preferences, and role within the healthcare system. A comprehensive approach to decision-making that a participant reports includes autonomy, collaborative decision-making, informed consent and information sharing, and respecting individual preferences. Participants reported the importance of making decisions concerning their care:

One of the most important ethical obligations that helps to maintain patients’ dignity during their hospital stay is respecting their autonomy to make decisions regarding their care..(P016, Nurse, OBGN)

In contrast to what was mentioned earlier, a participant mentioned that caregivers failed to involve them in decision-making through their care:

…They will simply write the prescription and hand it to you without checking to see if you can pay the price, whether they are prescribing medicine or a laboratory test…(P06, male, 28)

Promoting independence

From the patient’s point of view, encouraging patient independence concerning their care entails acknowledging the person’s autonomy, preferences, and capacities and giving them the power to actively engage in choices and actions about their health.

The participants reported that they lost their independence to perform their daily activities and family members’ involvement in their care:

…They stop me from going here and there, but I can go; this has been very painful for me…(P011, male, 46)

…I have no control over myself. Everybody takes my card and sees and practices on me…(P013, female, 23)

Theme 4. Respect

Participants complain that respect is the most important concept in dignified care. This involves treating patients with respect, compassion, and understanding. To give patients respectful care, healthcare professionals should work to establish a setting that values each patient’s uniqueness, autonomy, and value by promoting a culture of compassion, and patient-centered care.

Cultural and diversity sensitivity

Healthcare providers should acknowledge patients’ individuality, cultural background, and personal beliefs, and ensure that they are addressed in a respectful and non-discriminatory manner.

Participants reported the importance of cultural and diversity sensitivity while providing care for the patients:

… Patients need to be respected; they respected my cultural values and beliefs. Care providers respected my ethnicity and religious beliefs and gave me appropriate care. I performed my religious affiliation as much as I could. Nothing is lost…(P05, female, 55; P012, female, 44)

…Our organization contributes to a more dignified care experience by acknowledging and honoring the individual backgrounds and preferences of each admitted patient….(P017, Nurse, maternity)

Compassion from care providers

Patients complain that compassion from care providers is important. Dignified care depends on the compassion of caregivers. Healthcare professionals ought to establish a setting that respects each patient’s emotional and cultural requirements. Understanding the essential role of empathy, kindness, and genuine concern is important for dignified care.

Many participants reported the importance of compassion from care providers while providing care for patients:

…H.P. considers my personal needs and treats me as valued. It’s pleasant to hear someone speak in a soothing language. If health personnel are rude to patients, their care will not cure anyone… (P01, female, 37; P010, male, 55)

…Our staff members are dedicated to providing each patient with individualized attention, compassion, and empathy. Ensuring dignified care for patients during their hospital stay is imperative…(P018, Nurse, psychiatry)

Theme 5. Care provider factors

Care provider factors are another important theme that emerged from participants’ reports. It encompasses three subthemes: attitude of care providers, knowledge of care providers, and Ethical commitment of care providers.

Knowledge of care providers

A key component of providing patients with dignified care is the knowledge and skill of caregivers. Healthcare practitioners must be equipped with requisite knowledge, abilities, and comprehension of patient care best practices. This includes medical knowledge, cultural competency, and communication style comprehension.

Participants reported the importance of care providers’ knowledge for providing dignified care for patients:

…Keeping up to date on symptom control and pain management enables the healthcare provider to deliver dignified treatment. Attending to and easing the agony that hospitalized patients are experiencing, ensures that they receive dignified care…” (P016, Nurse, OBGN).

…Being understanding of the unique needs of various populations of patients allows a healthcare professional to deliver care that is respectful and specific to each individual, upholding their dignity… (P018, Nurse, psychiatry).

Attitude of care providers

Patients’ experiences are greatly influenced by the attitudes of the caregivers. A welcoming atmosphere can help patients feel appreciated, understood, and supported. Patients who experience unfavorable attitudes or a lack of empathy may feel more distressed, powerless, and less worthy of dignity. Key informants described the importance of care provider’s attitudes toward providing dignified care.

…Maintaining a non-judgmental approach whenever dealing with admitted patients assists in developing an environment where their dignity remains preserved and their voices are valued…(P014, Nurse, GMW)

In addition to this, a nurse with 10 years of experience states the importance of implementing a patient-focused approach and establishing a culture of kindness during care to maintain patient dignity.

…Implementing a patient-focused approach allows healthcare professionals to give priority to maintaining each patient’s dignity, respecting their autonomy, and engaging them in the decision-making process regarding their care…(P015, Nurse, Orthopedic)

Ethical commitment of care providers

Key informants described the importance of the ethical commitment of care providers toward providing dignified care. The provision of dignified care is contingent upon the ethical commitment of healthcare staff. It is a moral obligation that involves ethical concepts and responsibilities intended to preserve patients’ autonomy, dignity, and overall well-being. This commitment is based on moral principles, professional standards, and patient-centered care. This sub-theme emphasizes patient confidentiality, autonomy, respect, transparency, evidence-based practice, advocacy, and cultural sensitivity.

…Upholding transparency and honesty when interacting with hospitalized patients and their caregivers is essential for establishing trust and maintaining their dignity during their healthcare process…(P016, Nurse, OBGN):

…One of the most important aspects of care providers’ ethical commitment is respecting the admitted patients’ cultural, religious, and spiritual values. This guarantees that the care they receive respects and incorporates their varied identities…(P017, Nurse, maternity)

Theme 6. Organizational factors

From the perspective of the participant, healthcare organizations may gain about how organizational elements, especially organizational support and resource allocation, affect the provision of dignified care. This information can guide strategic efforts to improve the experience of patients and ensure care maintains dignified care. Systemic factors include the work environment, resource allocation, policies and protocols, training and support, communication and collaboration, and ethical considerations.

Resource

Most of the participants described the importance of resources toward dignified care for patients as follows. Resource-related aspects were identified as critical components toward admitted patients receiving dignified care when participants’ perspectives were explored about this concept. It is imperative to take into account the diverse range of resources and their influence on providing courteous and honorable care. This subtheme offers insights into the various resource-related aspects that affect how hospital settings treat admitted patients with dignity and respect.

…Our hospital’s investment in advanced medical equipment and technology enhances our capacity to provide comprehensive and quality care for patients, guaranteeing precise diagnoses as well as successful treatment…(P018, Nurse, psychiatry)

In contrast to the above statement, another nurse with experience of 17 years states that the hospital has encountered shortages of medical supplies for the past few years:

…Lack of ready access to a range of medical supplies and pharmaceuticals prohibited us from promptly addressing the requirements of admitted patients decreasing their comfort and well-being during their stay…(P019, Nurse, oncology)

Organizational support

Key informants described the importance of resources toward dignified care. Ensuring dignified care requires strong organizational support. To promote a culture of dignified care, they emphasize education, training, ethical norms, standardized procedures, facility design, and technological integration.

…Effective staffing levels and management of workloads improve the institution’s capacity to give priority to patient care needs and provide personalized care while maintaining the dignity of the patients…(P016, Nurse, OBGN)

…The absence of adequate training programs and career development restricts staff’s ability to continually enhance their skills, improving their ability to provide dignified and evidence-based care to patients…(P018, Nurse, psychiatry)

Discussion

To the best of our knowledge, this is the first study to explore adult patients’ and key informants’ perspectives of dignified care during hospitalization in the Ethiopia context. The participants provided multiple perspectives regarding elements they believed were necessary for maintaining dignified care. Several factors that promote or impede adult patients’ dignified care were identified, and these factors suggest effective communication with patients; promoting patient autonomy; ensuring patient privacy; providing respectful care; organizational factors; and care providers factors.

In the current study, we discovered that dignified care required effective communication between care providers and patients as well as providing patients with sufficient information about their health status. The majority of participants felt more confident about themselves and their diagnosis as a result of receiving sufficient information about their health condition. However, some individuals who did not get information regarding their condition reported feeling less confident in the ability of care providers to manage it effectively and lower self-worth. This result validates earlier studies on the importance of care providers-patient communication [23–25]. Some study participants blamed language barriers for poor nurse-patient communication, which is consistent with an earlier study conducted in Ghana that found that language barriers between patients and healthcare professionals prevented adult patients from effectively using healthcare services [26].

The results of this study indicate that respecting patients’ autonomy also preserves their dignity. The results of the other study demonstrated that preserving autonomy is an essential component of upholding human values and serves as the cornerstone of patient-centered, ethical treatment, which helps to preserve a patient’s dignity [27, 28]. Limited patient autonomy and engagement in care decisions were found to be a barrier to dignity in the current investigation. For students to be involved in their care, participants were not consulted, and other decisions about their care were made without their approval [1, 29, 30]. Additional research indicates that the promotion of admitted patients’ dignity occurs when they have control over their care and participate in decision-making [11].

Maintaining participant privacy became a top priority in our study, particularly when physical care was being provided. Participants’ privacy was protected when they were let into private rooms with private bathrooms. On the other hand, people who were allowed into the shared room talked about how their dignity was in danger. Their dignity was also violated by a lack of a bed screen and an inability to manage how people moved around while receiving care. Additionally, several studies have shown that patient privacy is crucial to dignity and dignified treatment [11, 29–32]. In line with what we discovered, According to a recent meta-analysis, bed screens not being pulled across and admittance of patients into multi-bed wards both compromise their dignity [31]. They claimed that the medical staff’s inquisitiveness about their private and personal affairs infringed upon their dignity. Regarding this, the results of previous studies have also suggested that avoiding inquiry and unwarranted intervention is a fundamental component of giving patients effective and sufficient care [33].

When care providers treated patients with respect, they reported feeling very dignified. Respect for human values is one of the most important factors in preserving the dignity of the admitted patients, based on the experiences of the participants. This result is in line with past research on providing admitted patients with dignified care [11, 25, 34].

Our finding also states that care provider factors are the other factors that influence the experience of dignified care. The participants stated that one of the key components of delivering dignified care is HCP attitudes. This finding is consistent with prior research on dignified care for hospitalized adult patients [35]. These results support the widely accepted theory that compassionate care delivery and compassion itself are the foundations of safe and high-quality nursing care [36]. A few participants also discussed the attitudes of professional healthcare professionals toward the promotion of dignity. They stated that they felt more valued as human beings when healthcare professionals showed sensitivity to their suffering or considered their requirements. This is in line with earlier research that finds that failing to assess patients’ progress and paying insufficient attention to their requirements compromises patients’ dignity in addition to lowering the standard of care [5].

This study found that providing patients with care by qualified and competent staff was one of the most important factors in upholding their human values. The availability of a sufficient number of highly experienced specialists was also a concern. These findings are consistent with previous research indicating that professional and skilled personnel are necessary for providing patients with dignified care [28, 37, 38].

Healthcare personnel’s ethical commitment is a prerequisite for providing admitted patients with dignified care, according to participant reports. This sub-theme highlights the need for patient confidentiality, openness, evidence-based practice, advocacy, and cultural sensitivity in maintaining ethical standards in healthcare settings. Additional research emphasizes the significance of patient-centered care and the ethical commitment needed to uphold that dignity, especially in difficult healthcare environments [34].

When participants’ viewpoints were investigated regarding this notion, resource-related variables were found to be crucial for admitted patients to get dignified care. It is critical to consider the wide variety of resources and how they affect the provision of dignified care. Furthermore, additional research demonstrates that having a skilled medical staff, sufficient facilities, and appropriate equipment will improve patients’ sense of dignity [30–40]. Participants also noted that for admitted patients to obtain dignified care, organizational support was needed. The significance of ongoing education, training, standard operating procedures, facility planning, and technology integration was underlined. This result is consistent with another study that found that “staffing level, training, and support” were both facilitators and barriers to providing dignified care [41].

Strengths and limitations of the study

This study is the first of its type in Ethiopia. The use of maximum variation sampling captured a wide range of participant experiences. Furthermore, the study tries to incorporate both care providers’ and patients’ perspectives to enhance credibility. Despite this, the scientific communities should consider the following limitations while generalizing the findings of this study. First, there is a limitation of literature on this topic in Ethiopia so that comparison of study results was done with other countries where the health institutions’ setup, health policy, and other factors are quite different. The study participants were recruited from a single hospital, which may limit the transferability to other settings; participants, especially providers, may have provided socially desirable responses; and including only long-stay and repeat-admission patients limits transferability. Finally, potential translation bias, despite rigorous checks, as nuances can be lost when translating rich qualitative data from Afan Oromo and Amharic to English.

Implication for healthcare practice

This study has implications for nursing practice. By identifying factors associated with dignified care, care providers can be aware of these factors and tailor their care accordingly. Furthermore, it enables care providers to provide clear and respectful communication while actively involving patients in their care. Additionally, it emphasizes the importance of recognizing and honoring patients’ autonomy in decision-making and respecting their values, beliefs, and preferences. Enable care providers to ensure adequate privacy during patient interactions, examinations, and discussions. It could also encourage care providers to build therapeutic relationships with patients to enable them to identify their need for respect and dignity.

Moreover, the findings may be used to develop practical guidelines and formulate more specific strategies for dignified care. It could also inform policy formulation in the health sector to support dignified care. The development of a model for maintaining dignified care derived from a conceptual framework should be integrated into practice protocols and disseminated to care professionals in clinical care settings.

Conclusion

The findings explored six key themes: communication, autonomy, respect, privacy, organizational factors, and care provider factors. Several enablers and barriers to dignified nursing care have been identified and have been discussed in previous studies. The unique factors identified in the study area context were environmental barriers to privacy, involvement in decision-making, resource and organizational support, ethical commitment, attitude, and knowledge of the care provider. These findings collectively emphasize the need for targeted interventions to improve dignified care at Jimma Medical Center.

Recommendation

To enhance communication and patient autonomy, we recommend implementing bedside daily briefings involving patients and their families. To address privacy concerns, the hospital should prioritize the installation of privacy screens around beds in open wards. Furthermore, dignity-focused in-service training will be proposed for all healthcare providers to enhance their knowledge and attitudes, alongside the development of language interpretation protocols to improve communication with linguistically diverse patients. Finally, further studies are also suggested to investigate family members’ perspectives.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

MDK, ANN, and MBD made substantial contributions to the design of the work, the first draft of the article, and conducted in-depth interview. HMB transcribed and translated the data to English. BWI and DDG interpreted the data, revised, or critically reviewed, important intellectual content. All authors gave final approval of the version to be published, agreed on the journal to which the article has been submitted, and agreed to be accountable for all aspects of the work.

Funding

No financial support.

Data availability

Upon a reasonable request, the corresponding author will provide all study data.

Declarations

Ethics approval and consent to participate

The Helsinki Declaration was followed in the conduct of this study. Before data collection, ethical clearance was granted by Jimma University Institute of Health’s institutional review board (Ref. No: JUIH/IRB/388/23). A cooperation letter was received from the nursing school and submitted to the Jimma Medical Center clinical directorate. A permission letter was obtained from the hospital before data collection. Written informed consent was obtained from each participant, stating that participation is voluntary and they have the right to withdraw at any time from the study. Confidentiality was ensured throughout the process of the research study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.