ICU nurses’ maintaining dignity among older patients: A mixed methods study

Abstract

Background

Preserving dignity is a core element of nursing care. Older adults admitted to intensive care units (ICUs) are particularly vulnerable to dignity loss due to critical illness, invasive interventions, and limited communication.

Objective

This study examined the status and influencing factors of dignified care practices among ICU nurses in caring for older patients, with the aim of informing quality-improvement strategies.

Design

An explanatory sequential mixed-methods design was employed.

Participants and Setting

A questionnaire survey was completed by 487 ICU nurses from 5 tertiary hospitals in Hunan Province, China. Semi-structured interviews were then conducted with 18 ICU nurses. Qualitative data were analyzed using a descriptive phenomenological approach.

Ethical Considerations

The study was approved by the institutional ethics committee, and informed consent was obtained from all participants.

Findings

Nurses reported moderately high dignified care (79.12 ± 10.40). Scores were higher in absolute dignity (87.05 ± 11.43) than in relative dignity (70.19 ± 12.86). Regression analysis identified six predictors—gender, education, ethics training, work environment, moral sensitivity, and psychological capital—explaining 38.4% of the variance. Qualitative findings revealed four themes: difficulty balancing technical demands with dignity preservation; patient-related barriers such as severe illness and poor adherence; cultural conflicts between traditional respect for older adults and family decision-making; and organizational constraints, including heavy workloads and implicit workplace norms.

Conclusion

ICU nurses generally demonstrate competence in dignity preservation; however, limitations remain in addressing individualized dignity needs. Dignified care is influenced by the interplay of individual, environmental, and cultural factors. Improvement requires optimizing the clinical environment, strengthening ethics education and psychological support, applying dignity-centered standards, and promoting patient-centered cultural transformation through leadership. Coordinated efforts by healthcare administrators are essential to achieve sustainable quality improvement.