Dignity in Care

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Dignity in Care

• Julia Ryan
• Director of Research and Graduate Studies
• Senior Lecturer in Older Adult Nursing
• j.ryan_at_salford.ac.uk
• 0161 2952790

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What is dignity?

• Isnt it obvious?

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• The Healthcare Commission identified the most
  common complaints they receive which impact on
  older peoples experience of dignity in care
• What do you think might in the Commissions list?
• Spend two minutes talking to the person next to
  you about what you think.

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• Being addressed in an inappropriate manner
• Being spoken about as if you are not there
• Not being given proper information
• Not being asked for consent
• Being left in soiled clothes
• Being exposed in an embarrassing manner

• Not being helped to eat and drink
• Being in mixed sex accommodation
• Being left in pain
• Being in a noisy environment at night
• Lack of protection of personal property
• Being subject to mistreatment and abuse

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Dignified care

• When you feel that they treat you with loving
  care, affection, attention, gentleness it makes
  you feel good. It makes you feel like a human
  being
• They always find time to talk to me and treat me
  with dignity. It didnt matter whether they were
  just passing, you were acknowledged and you were
  treated like the person you are.
• They never make me feel like another old woman.
  They remember who I am, a mother, a grandmother,
  and that I bring another life with me

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Undignified care

• He was, well, a sort of dignified man.
  Marvellous mind. And he had to go into hospital
  towards the end of his life and he did tell me,
  when I went in to see him once, and he told me
  that he couldnt stand this business of Come on
  love or them calling him George . That just
  wasnt his language, he was very dignified.
• The doctor and the nurse just chatted together
  while he put in the drip- it was awful. They just
  moved him as if he were an object. Not one word,
  not one smile, nothing.
• They would not do any deliberate harm to her but
  they did a lot of negative harm in the way in
  which they treated her, because she was still
  able to make certain kinds of decisions for
  herself. But somehow even these were taken away
  from her

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Why does dignity matter?

• Positive health and social outcomes
• Legal and professional requirements
• Fundamentals of care
• It is right

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Dignity a Human Right?
The right to life
Freedom from degrading treatment
Freedom of thought, conscience and religion
Freedom of expression
The right to liberty
The right not to be discriminated against in any
of these rights or freedoms
The right to respect for private and family
life
The right to peaceful enjoyment of your property
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ITS NOT ROCKET SCIENCE?

• OR IS IT?
• What do you do to ensure dignity in care?

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Care which enhances dignity

• Respect
• Privacy
• Autonomy
• Sense of self

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The Senses FrameworkNolan et al

• Security
• Belonging
• Continuity
• Purpose
• Achievement
• Significance

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Relationships and sense of community

• Pragmatic
• Task focused
• Personal and responsive
• Resident focused
• Reciprocal
• Relationship focused
• Brown Wilson 2009

• Residents
• Family
• Friends
• Neighbours
• Staff

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• Leadership
• Shared values
• Teamwork
• Continuity and consistency
• Mutual Trust
• Reciprocity

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Enhancing dignity
Fairness
Autonomy
Continuity
Doing
Purpose
Respect
Trust
Belonging
Achievement
Being
Significance
Security
Privacy
Independence
Equality
Participation
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Do the mirror test!
What do you see?
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• Selected bibliography
• Abbott S., Fisk, S. Forward, L. (2000) Social
  and democratic participation in residential
  settings for older people. Ageing and Society
  20 327-340
• Boyle, G. (2008) Autonomy in long term care a
  need, a right or a luxury, Disability and
  Society 23 229-310
• Brooker, D. (2004) What is person centred care
  in dementia? Reviews in Clinical Gerontology 13
  215-222
• Cohen, L, OConnor, M. Blackmore, A.M.(2002)
  Nurses attitudes to palliative care in nursing
  homes in Western Australia International
  Journal of Palliative Nursing 8(2) 88-98
• Cook, G. (2006) The risk to enduring
  relationships following the move to a care home
  International Journal of Older People Nursing
  1(3)182-185
• Dewing, J. (2004).Concerns related to the
  application of frameworks to promote person
  centredness in nursing older people
  International Journal of Older People Nursing 13
  (3) 39-44
• DH (2003) Care Homes for Older People, National
  Minimum Standards The Stationary Office, UK
• DH (2003) Care Homes for Adults (18-65), National
  Minimum Standards The Stationary Office, UK
• Healthcare Commission (2007) Caring for Dignity
  A national Report on Dignity in Care for Older
  People While in Hospital Commission for
  Healthcare Audit and Inspection, London
• Help the Aged (2007) The Challenge of Dignity in
  Care upholding the rights of the individual.
  Help the Aged, London
• Jacelon, C.S., Connelly T.W., Brown, R., Proulx,
  K. Vo, T (2004) A concept analysis of dignity
  for older adults Journal of Advanced Nursing 48
  76-823
• Katz, J, Komaromy, C Sidell, M (1999)
  Understanding palliative care in residential and
  nursing homes International Journal of
  Palliative Nursing 5(2) 58-64

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• MacKinlay, E. (2008) Practice developments in
  aged care nursing of older people the
  perspective of ageing and spiritual care.
  International Journal of Older People Nursing 3
  151-158
• McCormack, B. McCance, T. (2006) Development of
  a framework for person centred nursing Journal
  of Advanced Nursing 56 472-479
• Nolan, M.R., Davies, S., Brown, J., Keady, J.
  Nolan, J. (2004) Beyond personal centred care a
  new vision for gerontological nursing.
  International Journal of Older People Nursing in
  association with the Journal of Clinical Nursing
  13 (3a) 45-53
• Royal College of Nursing (2008) Defending
  Dignity- challenges and opportunities for nursing
  RCN London
• Royal College of Nursing (2008) Delivering
  Dignified care a practice support pack for
  workshop facilitators RCN London
• See http//www.rcn.org.uk/__data/assets/pdf_file/0
  008/191735/003285.pdf
• Who cares wins leadership and the business of
  caring at
• http//www.burdettnursingtrust.org.uk/public/docum
  ents/who_cares_wins_031006_1.pdf
• Dignity and Older Europeans
• http//www.cardiff.ac.uk/medic/subsites/dignity/in
  dex.html