Dignity in care

After a while, the hospital or care home where you work becomes as familiar to you as your own home. But it’s important to remember that for patients and relatives these alien environments can often feel scary and add to the vulnerability they are feeling.

You can help to minimise anxieties by providing dignified and compassionate care and this should be a fundamental part of training for all nurses and healthcare assistants.

Everyone deserves to be treated in a dignified way. Whether you are caring for a young mother, an elderly gentleman or a person at the end of their life the principles remain the same. The individual’s identity and wishes should be at the forefront of treatment and care planning.

What is dignified care?

The Royal College of Nursing’s (RCN) definition is: ‘Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals.’

There is no ‘one size fits all’ approach to any aspect of care, however there are principles that we know help to make individuals feel cared for and respected.

Person-centred care

The individual should always be at the centre of their care. The RCN states that person-centred care is all about the ‘needs of the person rather than those of the staff or patient’s location’.

To help promote dignity in care, you need to listen your patients and take their needs and wishes into account. For example, an older female may not wish to be bathed by a male carer. This needs to be documented within the care plan to ensure that the patient retains her dignity.

Dignity care factors

One way to approach dignified care is to think ‘How would I like to be treated?’ or ‘How would I care for a loved one?’

Below we explore the need for choice, communication, and dignity in personal care.

Choice

• Personal choice is an important aspect in helping to maintain your patient’s dignity and should form a natural part of person-centred care.
• As a nurse or healthcare assistant, you need to take the time to understand your patient and their needs. Ask about their family, life experiences and work. Talk as an equal so that they can remain in control. Though this may seem like ‘more work’, by engaging you patients you may in fact save time along the way. And your patient will feel more respected and cared for.
• Your patient should feel empowered to make informed, proactive choices based on the information and advice that you give them. It is important to remember that the patient is at the centre of this type of care: their answers should not be pushed or moulded in any way.
• Certain groups such as the elderly, those with a communication or learning difficulty, may need more time to understand what their choices are.

Communication needs

• Do you know what name your patient or resident prefers to be called? Many older people don’t wish to be addressed by their first name, preferring, for example, Miss or Mrs instead. This should be respected, as your name is linked to your sense of identity. The main thing is not to make assumptions.
• Try to take some time throughout the day to ‘check in’ with your patients, e.g. as you are providing care or taking observations. Do they have any concerns or worries? This ensures the continuity of communication.
• Remember to check for understanding. Again, don’t assume that because you have said something once your patient has taken this in. If a person’s first language is not English, or if they have speaking or hearing difficulties, then a translation service may be needed.
• You should be adequately trained to communicate with persons with cognitive or learning disabilities. Extra training should be given to ensure these patients’ dignity in care needs are fully met.

Personal care

• Personal care needs are an integral part of every care plan. But remember to consider each person’s wishes. For example, do they want a daily shower? Do they prefer a weekly bath? Do they only want female carers to assist them with washing and dressing? All of this should be taken into account to maintain dignity at all times.
• Personal care should meet the needs of the individual, not those of the carer or the ward routine. They should not be based on the expectations of the person delivering the care, or anyone else.
• Personal care can be invasive and is carried out when a person feels at their most vulnerable, so it is vital to respect the person’s wishes.

Legislation

There are various pieces of legislation that govern the overall care of patients and care home residents. These will depend on the area of the UK where you live and include:

• Care Act 2014 (updated in 2016)
• Mental Capacity Act (MCA) 2005
• Adult Support and Protection (Scotland) Act 2007
• Patients’ Rights (Scotland) Act 2011
• Public Bodies (Joint Working) (Scotland) Act 2014

There are also various polices and organisations that are linked to maintaining, improving and promoting the dignity of all patients and care home residents. These include The National Dignity Council.

Ongoing training in dignity and person-centred care

Dignity in care needs to be a core topic within healthcare training. Courses should cover a range of topics to help nurses and carers better understand how to provide dignified care in a variety of settings, e.g. the care home or hospital environment.

These courses can be delivered via eLearning or in person. Dignity in care training covers a wide range of subjects including dignity in continence care, person-centred care, older people and end of life care. It’s also highly encouraged that all staff working within the health and social care sectors train to become a Dignity Champion.