How to Treat Patients With Dignity: A Primer for Hospital-Based Fieldwork Students and New Graduate Practitioners

Jim Kelly, OTR/L

“Sick man looking for the doctor's cure, looking at his hands for the lines that were, for dignity.”

- Bob Dylan, Dignity

Dignity is the state of being worthy of respect. Dignity is also the sense of self-respect that feeling worthy of respect engenders. One’s sense of autonomy, or control over one’s situation and actions, is built on the foundation of feeling acknowledged and being treated with dignity. Anyone who has ever been hospitalized for more than a day or spent time with a hospitalized loved one knows that it can be difficult to maintain one’s sense of dignity while receiving medical treatment in a confined, isolated, and foreign place. A hospitalized human being is vulnerable to acute pain and frustration. The person submits their body to our science, our care, and our mercy. So how can we ensure, for every medication injected into a patient’s bloodstream, that we as occupational therapy practitioners are injecting a deliberate dose of dignity into that patient’s heart, body, and spirit?

Hospital-based occupational therapy practitioners meet patients who need to improve their independence with the daily tasks that almost everyone takes for granted. Our patients are often forced to learn again how to get out of bed, sit, stand, toilet, bathe, perform personal hygiene, and move around the world safely. All throughout, they remain autonomous human beings who have the right to consent to or refuse any treatment session at any time. We have to both ensure that our treatments do not erode a patient’s sense of dignity and accelerate our patient’s improvements in their ability to complete daily living tasks safely with maximal independence.

Productivity demands may make you feel as though you need to move from patient to patient with a laser focus on meeting quantifiable markers of progress. This is natural, as we want to do our job efficiently and we know that our patients’ safety is in our hands. Within one session we often accomplish many tasks that are challenging for our patients and ourselves. In the span of 50 minutes we might help a patient clean up after an incontinent episode, bring a spoon to their mouth with a bib on, accept that re-learning how to move safely will require some degree of enduring painful sensations, and register that when they leave the hospital they may have to change their home environment, their daily routine, and the way they interact with loved ones.  

Because of the physically demanding patient handling that is essential to our interventions, it is easy to overlook the traumatic effect that our necessary treatment sessions can have on our patients. Some of that trauma we cannot prevent, but we can ease the severity of difficult experiences by making clear that we respect, empathize with, and are committed to helping our patients. What is at stake is not only our patients’ functional independence and safety moving around the world, but also their equally essential feeling of being treated with dignity.

There are many ways to catalyze a patient’s ability to rebound from the feelings of frustration, belittlement, embarrassment, helplessness, and hopelessness that may arise during their hospitalization. Inside the hospital, they need to know that a caring professional is devoted to giving them everything they can to help them re-establish wellness, safety, and meaningful daily routines in their lives. The following eight suggestions are meant to prompt you to imagine unique ways that you can infuse your patients with a sense of dignity without reducing productivity:

May these suggestions aid you as you continue to build your own sense of dignity inside and outside of the hospital. Consider using them to tailor your own list of ways that you can prepare yourself to increase your own sense of the dignified nature of your work, your patients’ sense of being treated with dignity, and both you and your patients’ overall well-being. Part of what brings dignity to our profession is sharing and learning from each other’s experience. No therapist is an island, and it is only through learning from our patients, our fellow health care professionals, and each other that we can all become the best therapists, representatives of our dignified profession, and human beings that we can be.

Jim Kelly, OTR/L, is an aspiring educator, and an entry-level OT in the inpatient rehabilitation setting in upstate New York. He graduated with an MSOT from Washington University in St. Louis in 2019.

1. Be willing to take impatient and unkind verbal abuse. This may sometimes happen when helping your patient toilet, undress, handle a catheter, or get out of the shower. Don’t take it personally! Take it in stride. They are frustrated and you need not be offended.
2. Offer choice in activities. Even if it’s an apparently meaningless choice, like choosing whether to practice transfers or do core exercises first, offering a choice will remind your patient that they have the power to make decisions.
3. Socialize judiciously. Crack a joke at your own expense. Smile when passing your patient in the hallway. Shake hands and say nice things for the few minutes your patient wants to introduce you to their grandson after you’ve been on your feet for 6 hours straight and just want to use your break to go outside, eat, or take a deep breath.
4. Be honest about everything you don’t know. The patient doesn’t benefit from deifying you, and you don’t deserve to be worshipped, because there is a lot you don’t know. You probably don’t know when their pain will stop, when they will start walking, or exactly how many repetitions at what resistance will be just right for your patient’s home exercise program. Your patient benefits from realizing that, to differing degrees, they will have to be their own advocates, researchers, and therapists.
5. Help your patients plan for the future. They’ll need to consider the next steps in their lives, and you can help prepare them for their transition into a different life. You need to sense when and where your patient is most ready to hear some of the difficult truths that you’ll need to tell them, and how to say them in the way they can best digest.
6. Empathize with your patients’ frustrations. Be there to hear and acknowledge them. Avoid telling them reasons they shouldn’t be frustrated, how what they are feeling is “normal” because everybody feels frustration, or why it’s important to quickly get over their frustration. Listen, empathize, and give them space and time to voice how they feel.
7. Ask your patients about their lives, hobbies, and passions. This re-orients patients during a time of change and confusion to their life narrative and past joys. It also requires sensitivity to difference. Don’t ask questions based on assumptions. Your 92-year-old patient might not like to crochet, and your teenage patient might.
8. Take care of yourself as much as possible during and after work. Our job is fast paced. You’re likely to become overstimulated, frazzled, and tired occasionally during your workday and your career. You will need “you” time to learn, rest, and grow. This is not selfish; it is a necessary ingredient in providing dignified quality care to your patients.