Table 4 Major Theme Exemplars and Quotations

Dignity in and of itself

1.1 Dignity as a Value

“Respect for the person, their beliefs (…) therefore dignity is doing the least possible that would disturb a person, their beliefs, their values, their culture.“ (Patient 4)

“It is equally important not to lose dignity.“ (Nurse 4)

“Each of us has our dignity to maintain whenever and wherever we are.“ (Nurse 6)

1.2 Sense of Intactness

“I believe that if someone lost their dignity, to me they would no longer make sense as a person. (…) To live without dignity strips away personhood.” (Nurse 4)

“To have dignity, it is important to be treated as a person, not as a COVID-19-positive patient.“ (Patient 1)

1.3 Humanity

“Knowing that you have been important from a human point of view.” (Patient 2)

“More than dignity, it was actual humanity, especially if we consider everything that they needed to pay attention to.” (Patient 6)

“I believe that dignity is the meaning of life; it is what a person can have, which is, to be dignified” (Patient 6)

“Dignity is doing what is necessary to care for people, giving care to the patients we have, and taking into consideration the humanity, the part of the patient that is personal, and not only the disease on a scientific basis. For there to be dignity, there must also be a human and personal part, in my opinion.” (Physician 2)”

Category 2

Themes

Exemplars and Quotations

Dignity in relationships

2.1 Fragility

“(…) In those moments you are bound to them, you depend on them, you are in their hands. In the end, if I am still alive, I have them to thank for it.“ (Patient 6)

“Difficulties related to exhaustion, to tiredness, to the fatigue from seeing so many patients, to no longer being able to listen because you can no longer physically cope with it, combine with the additional difficulty of not having the tools or adequate knowledge.“ (Physician 5)

2.2 Reciprocity

“You may sometimes conduct yourself in a dignified manner, then you find yourself in a given situation that, conversely, deprives you of your dignity… In such a circumstance, it is normal that your dignity would have to be reset. That’s what I think.“ (Patient 6)

“Dignity came from the patients, from their thanks, from the acknowledgment that, in any event, what we had done had helped them, including from an emotional point of view.“ (Physician 5)

2.3 Deep Understanding

“Understanding what the patient is going through (…) taking into account what a person––one with a serious illness––is feeling (…) “dignity” includes an understanding of the feelings of the individual.“ (Patient 3)

“When they had the final ‘okay’ (for my discharge), a nurse came in (too bad I don’t remember her name). She came in and said to me ‘Anto, you’re going home! Anto, you’re going home! I’ll call you an ambulance!’. What happiness. What happiness! It felt like a party, because everyone––each and every one of the people working––were all cheerful, because they had found out that the doctor was discharging me, and I could go home. They helped me to prepare my things, then I got up on my own, put on my gown and shoe covers, and they helped me to do it as quickly as possible, so I could go home. When I left, they said, ‘Good-bye Anto! Don’t come back here! We don’t want to see you here anymore!‘ So, I repeat, that was a really good moment I had, really nice” (Patient 6)

2.4 Connectedness

“But I was alone from morning to night and from night to morning… thinking, “Okay. Help, if it’s not good, I’ll go to the intensive care unit. Help, if it’s not good I’ll go to the intensive care unit.”(Patient 5)

“To see people die like that––that is, in addition to dying, being so isolated, without anyone, without a family member by their side, something that everyone in a moment of illness, of fragility, would like to have.” (Nurse 4)

“After the patients had only us HPs, the relationship between us and them became closer. For example, they needed us even just to eat. So the concept of dignity has changed during this time. Relatives always remain important, and their absence is felt, but we have tried to do what we can as HPs, to make them feel as good as is possible, so that is another positive aspect. The patient has established a relationship of trust and closeness [with us] in part due to this exclusion of relatives because of COVID.” (Nurse 7)

“All of the HPs were very attentive from a human standpoint. They were really supportive of the patients, in an extremely empathetic and intense way, and that is a wonderful thing.” (Physician 3)

“(…) However, many patients that we have seen have been ‘adopted’ (…) patients who felt more and more ‘at home,’ almost.” (Physician 1)

Category 3

Themes

Exemplars and Quotations

Dignity in practice

3.1 Preservation of Choice

“The dignity of the patient (…) as much as I have been able to guarantee it to them (…) begins, first and foremost, with true and transparent information, with giving them the possibility to make choices about their life and not treating them like a child, not hiding anything from them.“ (Physician 3)

“In my opinion, dignity is making the sick person understand why we are treating them, and not just doing things to them without (their) awareness. In my opinion, patients have the right to understand and be aware of their illness, of their own state of health.“ (Physician 2)

“Then you were abandoned to your own devices (…) and you did not know if you were going to stay or if you would have to go into intensive care (…) you were very afraid because you did not know what was happening to you… No one who gives you feedback tells you anything.“ (Patient 5)

“They answered every question I asked very thoroughly, and in terms of answering, they expressed themselves very clearly. I am not a doctor, I do not have great capacity for understanding medical terms, but they explained them to me.“ (Patient 1)

3.2 The Body and Small Everyday Acts

“I still wasn’t accustomed to this act of being washed. They told me not to worry, that it was their job, like many others. [They were] so very kind, they gave me back my dignity.“ (Patient 3)

“Yes, now and then we shaved him. It was like something from ordinary, everyday life, which was not always possible during the first lockdown, when there was even more confusion (…); now we also know a little bit more about what to do, and we can better transmit a sense of ordinary life to the patients.“ (Physician 2)

3.3 Information overload

“Yes, I think that (dignity) can also be influenced by others, by the media… Going back to speech in newspapers, it matters a lot, because, when I would enter the rooms, we’d have the TV, and the channels were all talking only about COVID, COVID, COVID, COVID. I’d go in and I couldn’t even make a joke.” (Nurse 4)

“Before being hospitalized, I said, “I will be cured,” and I didn’t think anymore about the news and that ‘bombardment’ (…) With so much information, you didn’t know what might happen to you.” (Patient 8)

“So, I was afraid of what the news would tell us every day. It may be true in part, but when you experience it firsthand, you realize that many things are not true.” (Patient 8)

“Sometimes you entered the rooms (…) (and you would hear), ‘Enough, you are annoying. It’s always the same thing. I do not want to do this thing, because it’s useless anyway,’ and so on. Yes, there were also those episodes, but not many. I don’t know, maybe they were influenced by a transient factor, from the TV. Because, no matter what, everything has an impact (…) so maybe they were conditioned by outside factors and they took it out on us as well.” (Nurse 4)