title: Dignity-conserving care in palliative care settings: An integrative review.
abstract: OBJECTIVE
  To report an integrative review of evidence relating to dignity-conserving care in palliative care settings. It will also suggest avenues for future research.
  
  
  BACKGROUND
  Research suggests that dignity is welcomed by those receiving palliative and end of life care. However, as dignity is a subjective term, it is not always explicit how this may be employed by nurses. Given that the preferred place of care for patients with palliative care needs is the home, the issue of dignity may be particularly important for community nurses. Therefore, synthesising evidence of dignity-conserving care for community nurses caring for people with palliative care needs provides clarity in a complex area of palliative care research.
  
  
  METHODS
  Integrative literature review.
  
  
  METHODS
  The review involved key bibliographic and review databases CINAHL, MEDLINE, EMBASE, ASSIA and PsycInfo. Medical Subject Headings and free terms were undertaken for articles published from January 2009-September 2014 and retrieved papers were assessed against inclusion criteria. Final included articles were reviewed for reported dignity-conserving care actions, which were classified under nine themes of the Dignity Model.
  
  
  RESULTS
  Thirty-one articles were included. Nine Dignity Model themes were used to classify care actions: Level of Independence; Symptom Distress; Dignity-Conserving Perspectives; Dignity-Conserving Practices; Privacy Boundaries; Social Support; Care Tenor; Burden to Others; and Aftermath Concerns. Reported care actions included listening, conveying empathy, communication and involving patients in care.
  
  
  CONCLUSIONS
  Care actions could be classified under most of Dignity Model themes. However, there were less reported care actions related to Level of Independence and Aftermath Concerns, which meant that these had to be formulated independently. Future research should be structured around these areas to determine appropriate care actions for nurses to give dignity-conserving care that addresses these specific themes.
  
  
  CONCLUSIONS
  Synthesising the available evidence of dignity-conserving care identifies evidence-based care actions and provides guidance to nurses in clinical practice caring for patients with palliative care needs. Future opportunities for research are identified to guide promotion of dignity in palliative care.
authors.affiliation: Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen's Medical Centre, Nottingham, UK.
authors.forename: Bridget
authors.initials: B
authors.lastname: Johnston
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin and Our Lady's Hospice and Care Services, Dublin 4, Ireland.
authors.forename: Philip
authors.initials: P
authors.lastname: Larkin
authors.affiliation: School Of Nursing, Midwifery & Health Systems, Health Sciences Centre, University College Dublin, Dublin 4, Ireland.|All Ireland Institute of Hospice & Palliative Care (AIIHPC), Education and Research Centre, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland.
authors.forename: Michael
authors.initials: M
authors.lastname: Connolly
authors.affiliation: Dignity Care Intervention Ireland, All Ireland Institute of Hospice and Palliative Care, Education and Research Centre, Our Lady's Hospice and Care Services, Harold's Cross, Dublin, Ireland.
authors.forename: Catriona
authors.initials: C
authors.lastname: Barry
authors.affiliation: Sue Ryder Care Centre for the Study of Supportive, Palliative and End of Life Care, School of Health Sciences, The University of Nottingham, Queen's Medical Centre, Nottingham, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Narayanasamy
authors.affiliation: Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.|Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Östlund
authors.affiliation: University of Ulster/All Ireland Institute of Hospice & Palliative Care (AIIHPC), Newtownabbey, UK.
authors.forename: Sonja
authors.initials: S
authors.lastname: McIlfatrick
mesh_terms: D003142:Communication; D006301:Health Services Needs and Demand; D006801:Humans; D010166:Palliative Care; D028723:Personhood; D012944:Social Support; D013727:Terminal Care
keywords: care actions; community; dignity; dignity-conserving care; end of life; integrative review; palliative care