Maintaining patient dignity in intensive care settings.

Maintenance of the dignity of intensive care unit (ICU) patients, particularly minimizing exposure of genitalia, may be problematic. The aim of the study was to develop strategies to maximize the dignity of ICU patients using an action research methodology. The first stage assessed current practice through 62 hours of non-participant observation of patient care. Patient dignity was maintained in almost one-third of observed cases. However, more intimate areas such as bosom and genitalia were exposed in over 40% of the incidents. Whilst screens were fully used in over one-third of exposure incidents, full screening did not occur for all or part of the remaining incidents. Significant factors (P < 0.05) influencing exposure included gender and age. Female and younger (< 60 years) patients were more likely to be exposed; older patients (> 70 years) were less likely to be screened when exposed. The next stage involved identification of solutions to the problem of inappropriate patient exposure through the medium of a multi-disciplinary focus group. The focus group recommended raising staff awareness and documentation of situations that may compromise maintenance of dignity. The final stage of the study involved an audit of these recommendations. The main audit findings were more adequate clothing of patients plus a high level of staff awareness of patients' dignity needs.