Enhancing dignity in the care of people with

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					Enhancing dignity in the
  care of people with
                   Professor Lesley Baillie
              Florence Nightingale Foundation
              Chair of Clinical Nursing Practice,
             London South Bank University and
            University College :London Hospitals

What is dignity?

What influences the dignity of people with

How can we promote dignity for people with
Types of dignity
 • Human dignity: the dignity that all humans
   have and cannot be taken away
 • Social dignity: experienced through
   interaction - dignity-of-self and dignity-in-
   relation (Jacobson 2007)
 • So for people with dementia:
    • We must acknowledge and respect their
      human dignity
    • We must recognise how their dignity is
      affected by how they feel and by our
      interactions with them
What is the
                                 How does it feel
meaning of
                                 to have dignity?

                How does it
              feel to lose our
  The meaning of dignity

• 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

     (Royal College of Nursing [RCN] 2008, p.6)
        Definition of dignity
• When dignity is present:
  • people feel in control, valued, confident,
    comfortable and able to make decisions for

• When dignity is absent:
  • people feel devalued, lacking control and comfort.
    They may lack confidence and be unable to make
    decisions for themselves. They may feel
    humiliated, embarrassed or ashamed.

    (RCN 2008, p.8)
Definition of dignity

• Dignity applies equally to those who
  have capacity and to those who lack it.
• Everyone has equal worth as human
  beings and must be treated as if they
  are able to feel, think and behave in
  relation to their own worth or value

 • (RCN 2008, p.8)
  Vulnerability to loss of dignity for
       people with dementia
• Loss of control and identity
• Specific effects of dementia and
  other concurrent conditions
• Negative attitudes and stigma:
  ‘Undignified care of older people
  does not happen in a vacuum; it
  is rooted in the discrimination
  and neglect evident towards
  older people in British society
   – (Commission on Dignity in Care, 2012).
     How can we promote dignity?
      Interactions:                     Care activities:
• Respectful                       • Address fundamental
  communication.                     human needs - nutrition,
• Promotes autonomy and              elimination, personal
  a sense of control.                hygiene/appearance - in
• Inclusive and                      a respectful, sensitive
  encourages participation.          manner.
• Promotes identity.               • Top tips for nurses, from
                                     Alzheimer’s Society:
• Recognises human
  rights such as equality,         • http://www.alzheimers.or
  respect and autonomy.    
• Focuses on the                     D=1211
  individual. – person-
  centred                          • Respects privacy
              (Tadd et al. 2011)
Person-centred care
‘VIPS’ framework for describing person-
centred care:

V – Valuing people with dementia and carers;
I – treating people as Individuals;
P – using the perspective of the Person with
S – a positive Social environment.

 (Brooker 2007)
Person-centred care
     Communication that promotes dignity

Helping people Sensitivity and compassion; Empathy;
to feel        Developing relationships; Conversation
comfortable    and friendliness; Reassurance;
Helping people Explanations and information giving;
to feel in     Choices and negotiation; Gaining consent

Helping people Giving time and listening; Concern for the
to feel valued person as an individual; Courteousness

                             (RCN 2008; Baillie 2009)
                            Individual interactions

 I took him to the shower, he was
 quite happy, I allowed him to do
    what he wanted to do I just
supported him and he liked opera,
   so I got him in the shower and
   he’s singing his opera and I’m
 going, “ooh, ooh”, we’re doing it
 together, he was having a lovely
 time. He was loving it; came out
    of there all fresh and clean.

                                     Student experience
  I talked to her and asked her what
  her daughter did and her daughter
  was a musician and I said, “so, do
 you like music”? She said she liked
 classical music and I thought, we’ve
  got a radio here with headphones,
 you can put them on. […] I just lifted
the earpiece up to her and said, “can
      you hear that music” it was a
 classical music station on the ward,
 put the headphones on her and she
               was happy.

              Student experience
  Dilemmas in promoting
                               • Are the care home staff’s
• Marie goes in to visit her     actions promoting
  aunt Margaret who has          Margaret’s dignity
  dementia and lives in a
  care home. Marie finds         through allowing her
  that she has not been          autonomy?
  washed and has on            • Or have they diminished
  yesterday’s soiled             her dignity as Margaret
  clothes. The staff say she     previously took a pride in
  did not want a wash or         her appearance?
  clean clothes today.
                               • What alternatives were
Dilemmas in promoting dignity
        Scenario                          Questions

• Tom (a former naval            • Are the staff justified in
  captain) is on an acute          persisting with keeping
  hospital ward and is             Tom on the ward
  constantly packing his           apparently against his
  bag trying to leave the          wishes?
  ward as he says he has to      • Or are the staff
  go to sea. All morning           diminishing Tom’s
  there is commotion as            dignity by preventing
  staff try to get him back to     him from being in
  his bed. Tom is clearly          control?
  agitated and the staff are     • What alternatives were
  stressed.                        there?
      Culture of the care environment

• Social norms and                         (Patient)
                             There's a very caring,
  accepted practices         respectful approach. The
• Culture can have a         ward is friendly - there's
  positive or negative       a nice feel about the
  effect on how staff        place. People on this
  behave                     ward are sensitive to
• Some wards/teams/          making you feel dignity is
  units/care homes have      promoted all the time
  a culture of respect for
  patients and sensitivity
• Leadership is key

   Setting and monitoring standards

• Establish and maintain standards for a care
  environment that supports dignity in care
• Set organisational expectations for:
  • dignity at the core of all care activities – all staff
    and all care environments
  • zero tolerance of indignity
  • the expectation to challenge and be challenged
  • a culture of improvement and development - all
    staff can be involved in improvement –
     • Dignity champions
   Example of culture change
• Project aimed to improve dignity for patients with
  dementia in an acute orthopaedic ward
• 3 workshop days and a working group of ‘forget-me-not
• Designated ‘forget-me-not’ bay: homely decoration, non-
• Personal care plans: likes and dislikes
• ‘The approach now is not how to get the job done but how
  can we make this as pleasurable as possible for the
  patient – going with the patients flow and mood rather
  than a list of tasks. We enjoy their company and the bay
  has its own atmosphere and feeling’.
                                      (Sanders & Webster 2011)
• All health and social care staff have a duty to promote
  the dignity of people with dementia
• Need to create a culture that values people who have
  dementia and has dignity as a core value
• We must respect the human dignity of people with
  dementia and promote their dignity through our
  interactions: all interactions, all the time:
   • Find out about the person’s perspective of care
     and what matters to them
   • Listening to individuals and try to address their
   • Be creative and willing to make changes
   • Provide excellent fundamental care and
     communicate in ways that make people feel
     comfortable, in control and valued
          References/further reading
•   Baillie L (2009) Patient dignity in an acute hospital setting: a case study.
    International Journal of Nursing Studies 46: 22-36.
•   Baillie, L., Merritt, J., Cox, J. (2012) Nursing students’ strategies for caring
    for older people with dementia in hospital. Nursing Older People. 24(9), 22-
•   Brooker D (2007) Person Centred Dementia Care: Making Services Better.
    Jessica Kingsley, London.
•   Commission on Dignity in Care (2012) Delivering dignity: Securing dignity in
    care for older people in hospitals and care homes. Available from:
•   Jacobson N (2007). Dignity and health: A review. Social Science and
    Medicine 64(2): 292-302.
•   Matiti, M., Baillie, L. (2011) (Eds) Dignity in Healthcare: a practical approach
    for nurses and midwives. London: Radcliffe Publishing Ltd.
•   Royal College of Nursing (2008) Defending Dignity – Challenges and
    Opportunities. London: RCN.
•   Stokes, G. (2010) And still the music plays: stories of people with dementia.
    London : Hawker Publications Ltd
•   Tadd W, Hillman A, Calnan S et al. (2011) Dignity in Practice: An exploration
    of the care of older people in acute NHS Trusts Cardiff University and
    University of Kent – Research Report.
• Alzheimer’s Society: Understanding and respecting the individual
• Care Quality Commission: The essential standards
• My Home Life
• Royal College of Nursing Dignity campaign resources
• Dignity in Care website:
• RCN Dementia resources:
• Scottish Human Rights Commission: ‘Care about Rights’
• SCIE – Dignity in Care:
• SCIE Dementia resources:

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