Case Study Title: “Transforming Care” at Noble’s Hospital: Privacy and Dignity Contributor: Shelagh Leonard, Senior Nurse, Professional Development, Noble’s Hospital, Isle of Man Related Theme: Quality Improvement Keywords: Privacy and dignity; Essence of Care Everyone has the right to be treated with respect, to have their values and beliefs maintained and, while in hospital, to receive care that maintains their privacy and dignity. Too many times health professional hear patients say “Oh don’t worry, you leave your pride at home when you come into hospital”. How often are people’s cultural and spiritual needs really explored and care planned to meet those needs? People are very vulnerable when they are ill and in hospital. Under the umbrella of “Transforming Care” (the local delivery of the “Essence of Care” initiative), the Privacy and Dignity Group at Noble’s Hospital, is a multi- professional team that includes a member of the public as our lay representative. We are a multi-professional, proactive team entirely focused on improving the experience patients have while in hospital. As privacy and dignity are fundamental aspects of care, our work impacts on some of the other groups in our local “Transforming Care” initiative. We are a very focused team, who enjoy working together and are very excited about some of the changes we have already been able to influence to improve issues relating to privacy and dignity for our patients, e.g. all doors now have engaged/vacant signs on them to alert staff not simply to enter patients’ rooms without establishing if it is appropriate to do so. Similarly we have developed laminated signs that attach to curtains to indicate that care is in progress and staff should not enter until they have established that it is appropriate to do so; we have also developed signs that indicate patients are resting. These are all simple, but effective, measures which reduce the embarrassment people can feel if they are interrupted while receiving aspects of care. The privacy and dignity initiative involves not only staff who deliver direct patient care; with the support of the laundry and the portering services, all window curtains, bed curtains and curtain rails have been marked to correspond ensuring that following regular curtain laundering, the correct sized curtains are always in the right place. The cultural diversity in the Isle of Man is rapidly increasing and it is important that health professionals are equipped to meet the challenges this brings with it. Our team researched the needs of a wide variety of different cultures and religious groups and has introduced a Cultural and Spiritual Awareness resource file to all clinical areas, supported with addition literature and we hope to get funding to supply all areas with books that relate to the specific nursing/care needs of a wide range of cultural and spiritual diversity. Patients’ modesty is vitally important both from a personal and religious perspective. Many patients, both in-patients and out-patients attending for investigations, are required to wear gowns supplied by the hospital. These are very unflattering, often miss-sized and have the potential to leave people partially exposed and very vulnerable. We have designed a new patient gown with a variety of features that not only improve the functionality and versatility of the gown but significantly improve the privacy offered. The laundry services department has very kindly made a “prototype” for us, which we have been able to demonstrate, and have received favourable feedback. We are now in the process of agreeing the final design and communicating with potential manufactures. Also with support from the laundry services we have introduced modesty capes for women having chest examinations and gowns specifically designed for critically ill patient in Intensive Care. Using the Essence of Care benchmark for Privacy and Dignity, we have developed and carried out a hospital wide audit which has been analysed and will be presented at various forums in the near future. This will become a standard annual audit for all clinical areas. We are in the process of finalising a hospital Privacy and Dignity Policy and have written a Hospital/Patients’ Partnership Agreement. This aims to increase patients’ and family awareness of issues relating to expectations that individual privacy, dignity and modesty will be maintained, and encourages feedback and suggestions from those people using the service. We will continue to carry out regular Observations of Care to highlight areas of good practice and celebrate them as well as identifying areas for improvement, which we will readily advise and support teams in bringing about. We are planning a public awareness exercise of our work and improvements the team have already implemented, to take place at the beginning of July 2006. This is exciting work that really is making a difference to patients and hospital users. For further information please contact Jayne Kerruish. Acting Patient Services Development Manager, Clinical Governance Directorate, Telephone: 01624 650763 email: Jayne.Kerruish@gov.im . More on the “Transforming Care" Project at Noble’s Hospital "Transforming Care" is a local initiative in which many of the vital aspects of patient care are reviewed to ensure that they meet, and where possible, exceed patient expectation. Based around the “Essence of Care”, the “Transforming Care” initiative seeks to make sustained and sustainable improvements in patient care. Why is it needed? There have been numerous advances in health care over the last decade. It is important to us that whilst advancing the practice of health care we do not lose sight of the fundamental aspects which can matter the most to patients. What are the fundamental aspects of care the project addresses? They include aspects of care such as: privacy & dignity; communicating with patients & relatives; pressure ulcers; food & nutrition, record keeping and oral & personal hygiene. They also include aspects of practice which underpin the delivery of first class treatment such as the implementation of clinical policies and procedures and the measurement of vital observations. In order to make significant changes to patient care, we will have to start to work in new ways and therefore the final aspects which are addressing are: the role of the housekeeper and the role of the health care assistant in the delivery of first class care. What will this mean for patient care? Patients are placed at the centre of all hospital activity; where ever possible, hospital routines are adapted to patient need rather than expecting patients to adapt to hospital routines. “Transforming Care” is about making significant and sustainable improvements in patient care. What changes can patients expect to see? A variety of small scale improvements (rather than a few large changes), all of which will directly improve patient care. Further information The Project Sponsor, Bev Critchlow (Director of Nursing, Midwifery & Professional Development), can be contacted on tel.: 01624 650600 email: Beverley.Critchlow@gov.im and the Project Leader, Shelagh Leonard (Senior Nurse, Professional Development) can be contacted on tel.: 01624 650116 email: Shelagh.Leonard@gov.im .