Abstract Background: Nurses have a professional duty to respect patients' dignity. There is a dearth of research about patients' dignity in acute hospital settings. Objective: The study investigated the meaning of patient dignity, threats to patients' dignity, and how patient dignity can be promoted, in acute hospital settings. Design: A qualitative, triangulated single case study design (one acute hospital), with embedded cases (one ward and its staff, and 24 patients). Setting: The study was based on a 22-bedded surgical ward in an acute hospital in England. Participants: Twenty-four patients, aged 34-92 years were purposively selected. There were 15 men and 9 women of varied socio-economic backgrounds. They could all communicate verbally and speak English. Twelve patients, who had stayed in the ward at least 2 days, were interviewed following discharge. The other 12 patients were observed and interviewed on the ward. The ward-based staff (26 registered nurses and healthcare assistants) were observed in practice. 13 were interviewed following observation. Six senior nurses were purposively selected for interviews. Methods: The data were collected during 2005. The Local Research Ethics Committee gave approval. Unstructured interviews using topic guides were conducted with the 24 patients, 13 ward-based staff and 6 senior nurses. Twelve 4-h episodes of participant observation were conducted. The data were analysed thematically using the framework approach. Findings: Patient dignity comprised feelings (feeling comfortable, in control and valued), physical presentation and behaviour. The environment, staff behaviour and patient factors impacted on patient dignity. Lack of environmental privacy threatened dignity. A conducive physical environment, dignity-promoting culture and other patients' support promoted dignity. Staff being curt, authoritarian and breaching privacy threatened dignity. Staff promoted dignity by providing privacy and interactions which made patients feel comfortable, in control and valued. Patients' impaired health and older age rendered them vulnerable to a loss of dignity. Patients promoted their own dignity through their attitudes (rationalisation, use of humour, acceptance), developing relationships with staff and retaining ability and control. What is already known about the topic? Dignity is complex and multi-faceted, relating to feelings, control, presentation of self, privacy and behaviour from others. Patient factors, the environment and staff behaviour can threaten or promote patients' dignity but their impact in an acute hospital setting has been little studied. What this paper adds The core of patient dignity in an acute hospital setting is feeling comfortable, in control and valued; other components are physical presentation and behaviour. Patients are vulnerable to loss of dignity due to their impaired health, which is further threatened by lack of privacy, and curt or authoritarian staff behaviour. Patients' ability to rationalise their situation, other patients' support, a dignity-promoting culture, and staff interactions making patients feel comfortable, in control and valued, promote dignity when under threat
