Download - Dignity Challenge
Dignity Challenge
Andrew Gallini
Background
Patients’ Dignity must be respected: legislation (Human Rights Act 1998)
Codes of Professional Conduct (NMC, 2004; ICN, 2001a, 2001b)
Health policy (DH, 2001a, 2001b; 2006a) including Launch of the Dignity Challenge by Ivan Lewis Care Services Minister (2006b)
Defining Dignity
“… a state, quality or manner worthy of esteem and self-respect”
“Dignity in care means the kind of care which supports and promotes a person’s self-respect”
“Being treated like I am somebody”
Dignity – key elements
Respect Privacy Autonomy Self-worth
10. Act to alleviate people’s
loneliness & isolation
9. Assist people to maintain
confidence & self-esteem
8. Engage with family
members and carers as care
partners
7. Ensure people feel
able to complain 6. Respect
people’s right to privacy
5. Listen and support
people to express
4. Enable maximum levels of
independence
3. Treat each person as an individual
2. Support people with
respect
1. Zero Tolerance of
Abuse
Ten Dignity Challenges
Organisational ValuesOrganisational Values
- Protected Meal Times- Protected Meal Times
- Adult Protection- Adult Protection
- Single Sex Bays- Single Sex Bays
Local Policies – Privacy & DignityLocal Policies – Privacy & Dignity
PEATPEAT
Essence of Care BenchmarksEssence of Care Benchmarks
Standards for Better HealthStandards for Better Health
Lining up with key targets
National focus Increasing focus on performance
management of Dignity Shift from Targets to Quality and
Outcomes
CommunicationCommunication
Patient Care Environment
Patient Care Environment
Promoting HealthPromoting Health
Self careSelf care
Personal HygienePersonal Hygiene Mental HealthMental Health
Record KeepingRecord Keeping
Privacy & DignityPrivacy & Dignity
Pressure UlcersPressure Ulcers
Food and NutritionFood and Nutrition
ContinenceContinence
Essence of Care Benchmarks
Essence of Care Benchmarks
Evidence
However, patients are vulnerable to a loss of dignity in hospital (Seedhouse and Gallagher 2002; Jacelon, 2003; Matiti and Trorey, 2004)
The meaning of dignity as a concept is unclear (Tadd et al. 2002)
Dearth of research relating to patient dignity and few studies have explored patients' perspectives.
Most previous research relates to older people in long-term settings or terminal care.
Human dignity is an essential value of professional nursing (Jacelon 2004)
Evidence – Discovery Interviews
Research undertaken to understand and improve the experience of patients over 75s, and their carers
Identified as a particular cohort of patients whose needs are often more complex, likely to wait longer in A&E and more likely to be admitted.
They are also the people least likely to complain and most likely to be overlooked or misunderstood.
Discovery interview approach explores what it is like to be the person or carer with a particular illness accessing services
Evidence – Discovery Interviews
“The environment could be changed, the noise when they let go of the rubbish bins, and some of the other noise is unnecessary, people are not aware of the level of noise they make when they are rushing around, and it can be terrifying for the patient suffering from dementia”
Evidence – Discovery Interviews
“The staff were all very kind and put her very much at ease, they also explained everything but she’s also in pain so very unlikely to remember what was said or what advice she was given and a follow up phone call knowing her sight is poor is like what should I expect, apart from that I think the service was excellent”
Evidence – Discovery Interviews
“One more thing. And please take this to all the consultants. I think if some SHO comes to see you, each one of them should not ask the relative if you do or do not want to resuscitate. I think the first one should ask, they should put a sticker on the notes. With my mother, I was asked by three different young doctors, that caused me some distress, within the five hours that she was there.”
Evidence – Discovery Interviews
“No, Nobody seemed to have done much. They were sort of buzzing about but the thing that absolutely got me was that I asked “ could I have a glass of water?” and they said “ No I’m terribly sorry we’ve run out of polystyrene mugs” So there was a cleaner man sort of shuffling around and I said “Couldn’t he go and fetch some?” and they said “ oh certainly not, we might have a strike on our hands” and that gave me a fierce fright. So I had nothing to drink, so that wasn’t very good.”
Evidence – Discovery Interviews
“I think that, the staff in A&E, as part of their training, should be aware that patients with dementia may become aggressive. I think the staff should be aware of how to handle demented patients. They approach her bed, she doesn’t understand the language, she’s demented, she’s in a strange environment, and they try to change her and she lashes out, and they see it as assault”
Evidence Case Study
Study looking at one ward and the staff within an acute Hospital on a surgical urology ward
24 patient participants Staff participants: ward based (registered
nurses and health care assistants), visiting staff (specialist nurses, doctors and allied health professionals and senior nurses)
Range of methods used; Review of documentation, participant observation and interviews
Case Study - Overview of findings
Patients’ dignity in hospital:FeelingsPhysical
presentation Behaviour to and from
others
Threats to patients’ dignity
in hospital:environment
staff behaviourpatient factors
Promotion of patients' dignity
in hospital:environment
staff behaviourpatient factors
Evidence - How patients’ dignity is threatened or promoted in hospital (Baillie 2007)
Measuring Dignity – Help the Aged 2008
Four cross cutting themes: Choice - support to make choices, personalisation
and tailoring care Control – respect for individual lifestyle preferences
and involvement in decision making Staff Attitudes – respectful attitude in relation to all
aspects of care and courtesy and sensitivity in relation to all forms of communication
Facilities – availability and access to appropriate facilities/equipment and cleanliness of facilities
Measuring Dignity – Help the Aged 2008
Nine domains Autonomy – support to be involved in care if
people want to be Communication Eating and Nutrition End of Life Care Pain
Measuring Dignity – Help the Aged 2008
Personal Care (practical assistance) Personal Hygiene Privacy Social Inclusion
Development of Gap Analysis/Action Plan
Identifying gaps as well as best practice Clear Trust wide and Directorate Leads Key pieces of work around
PPI Adult Protection Improving care for patients with Dementia Nutrition, Falls and Continence
Dignity Workshops
Wide cross section of staff from range of different healthcare professionals, patients and members of the public and staff from local PCT’s
Group work exploring personal commitments to take away to change practice to improve dignity for patients
Support to make it happen
Quality Teams & Multiprofessional LeadsSupport for staff who have
undertaken Dignity Workshops to deliver on commitments to change
Directorate Quality Boards Receives reports from Lead Nurses
on progress against action plans
Trustwide Dignity Steering Group Gives leadership, direction and support
to enable delivery of real change To improve dignity
Healthcare Professional or Support member of staff
who has undertakenDignity workshop
Summary of achievements Executive Support from Director of Nursing Services Trust wide Steering Group Identifying Champions for Dignity to be able to change
practice Gap analysis and Action Plan for six of the Ten
Elements Dignity Challenge Workshops Structure to support changes in practice Robust PPI Action Plan Collaboration with Health and Social Care Advisory
Service and Kings Funds Developing and integrating this work at Hammersmith
Hospitals
Next steps - Overarching aims/projects
Integrated work on the Dignity Challenge across St Mary’s and Hammersmith Hospitals sites
Involvement of patients and the public in focus groups, the steering group to give direction to the implementation of actions to improve dignity
Use of Discovery interviews to further inform ways to improve dignity
Work around Protection of Vulnerable Adults and Project around improving care of patients with
Dementia
And Finally!
Not optional
“About attitudes, not resources”
“Dignity is everyone’s business”
References
Baillie, L (2007) Unpublished PHD Thesis Southbank University, LondonDawood, M (2007) Discovery Interviews of the experiences of patients over 75 and their carers accessing urgent care,
unpublished.Department of Health (2001a) Essence of Care: Patient-focused benchmarking for health care practitioners. London:
DH.Department of Health (2001b) The National Service Framework for the care of Older People. London: DH.Department of Health (2005) Research Governance Framework for Health and Social Care. 2nd Ed. London: DH.Department of Health (2006a) A new ambition for old age: next steps in implementing the National Service Framework
for Older People. London: DH.Department of Health (2006b) About the Dignity in Care campaign. Available from http://www.dh.gov.uk/dignityincare International Council of Nurses (2001a) Nurses and Human Rights: International Council of Nurses position statement.
Nursing Ethics, 8(3), pp. 272-273. International Council of Nurses (2001b) The ICN Code of Ethics for Nurses. Nursing Ethics, 8(4), pp. 375-9.Jacelon, C (2003) The dignity of elders in an acute care hospital. Qualitative Health Research 13(4), pp. 543-556.Nursing and Midwifery Council (2004) The NMC code of professional conduct: standards for conduct, performance and
ethics. London: NMCMatiti, M.R. and Trorey, G. (2004) Perceptual adjustment levels: patients' perception of their dignity in the hospital
setting. International Journal of Nursing Studies, 41(7), pp. 735-44.Seedhouse, D and Gallagher, A. (2002) Undignifying situations. Journal of Medical Ethics. 28(6), pp.368-372.Tadd, W.; Bayer, T. and Dieppe, P. (2002) Dignity in health care: reality or rhetoric. Reviews in Clinical Gerontology.
12(1), pp.1-4.