Promoting Dignity in Care

It is very important that we are all treated with respect as individuals, but when somebody moves into care, their dignity is often overlooked. It is not difficult to treat people with dignity; it often only requires an extra little time and thought.

Sadly, time is not something that many overstretched care workers have much of, but nonetheless it is essential that the dignity of residents or patients is preserved at all times. After all, these people have had a lifetime of being respected as ordinary citizens, just like you, and they still require the same consideration now they are in care. Being treated without basic respect or with a disregard of their own preferences, will make a difficult situation even worse for them to bear.

What is dignity?

The concept of dignity can be hard to pin down but according to a European study (Nordenfelt and Edgar (2005)) there are four different types of dignity. These are as follows:

• Menschenwurde: this is the basic dignity of all human beings. Simply by being human we are all entitled to this and even if someone lacks the ability to think, move or communicate, it is important to remember that a human being should always be treated in a way that maintains human dignity.
• Dignity as merit. This type of dignity is conferred upon someone because of their title, rank or what they have done in their life regarding their deeds or merits. For example, if a resident or patient has a professional status such as a doctor or a title, taking this away from them, takes away their dignity and sense of self-worth.
• The dignity of morality. This refers to somebody’s own moral code and beliefs. So, for example, if somebody is a lifelong vegetarian, insisting that they now eat meat goes against this concept of dignity. We might not agree with an individual’s moral code but we must respect it.
• The dignity of personal identity. Ignoring somebody’s personal identity and humiliating them or abusing them because of this, robs them of their dignity. We all have a right to maintain our own individuality and ignoring this or actively ridiculing somebody’s beliefs goes against the concept of dignity.

Although these concepts may seem academic, if you work in care you can probably see when unthinking actions about residents and patients, cross the line into taking somebody’s dignity away.

There are safeguards in place to protect people when a deprivation of liberty is the only viable care option. In many cases doing this goes hand in hand with providing dignity and respect in care.

Why is it important to promote dignity in care?

If people feel that they are not being treated with dignity, it will stop them from enjoying their lives in care. None of us want to be in this situation. We do not want to depend upon strangers for our daily care, and if small choices are taken away from us such as what we want to wear or eat, it takes away the little autonomy we have left to us.

Living in care is inherently not very dignified. We are not accustomed to depending on people to wash us and take us to the toilet. Many people are uncomfortable about being seen naked, and although people working in care are used to it, the patient or resident will not feel the same.

Taking away somebody’s dignity by reducing him or her to a job of work, publicly drawing attention to incontinence or other disrespectful actions is not only against basic human rights, it is extremely cruel. Many care workers do not intend to be cruel but the end result is the same, even if it is unintentional.

It is important to remember that for the resident in a care home this is their home and not your workplace. Everyone comes from a different background and staff should do their best to create a homely environment.

According to the Social Care Institute there are eight factors to dignity.

The eight factors to dignity

• Choice and control
• Communication
• Food and nutritional care
• Pain management
• Personal hygiene
• Practical assistance
• Privacy
• Social inclusion

To make this easier, let’s take a look at some examples.

How to promote dignity in care

Choice and control: We all have our own clothes and we know what we like to wear. Enabling a resident to choose what he or she wants to wear helps maintain a sense of individuality. You can help them choose by discussing clothing but the choice should always be open. You shouldn’t lay out the clothes for them but involve them in the choice. Keep it simple but don’t make all decisions for them. Many elderly ladies especially like to be involved with what they wear and enjoy looking well turned out in their favourite clothes.

Communication: You should always involve the patient or resident in any decisions about their care. Perhaps there is a change of medication or your resident has been advised to drink more fluids? Involving them in decisions relating to their care will help the person feel he or she has some control over their care.

Also relating to communication, you should always address the person with respect. Not everyone appreciates being patronised or talked to as if they were a child, so too many ‘darlings’ or ‘sweethearts’ in a high-pitched tone may be upsetting and patronising.

If your patient or resident likes to be called Mrs Smith or Elsie, remember it and address them by their preferred name. Likewise, if your resident is a doctor or has a title, calling them by their preferred title will help them retain their dignity.

Social inclusion is important. Mealtimes are often a highlight of the day, so ensuring that your residents enjoy these makes a great difference to their daily wellbeing. Make sure that everyone is sat at a table where they can enjoy social interaction with their peers and don’t rush them through their meal. Activities are also important for social inclusion and so crafts or hobbies and arranging group activities like this will help forge inclusion. Many care homes celebrate special events such as Royal events, international sports events or special days like Easter. Getting everyone involved with these special occasions will help many people feel included within the care home and society as a whole.

Food and nutrition is important. The people in your care may not be eating the same type of food as they enjoyed at home so it is important that they have some choice over what they eat. Always ask your resident what they want to eat from the choices available and help them to enjoy their meal. The elderly especially can be slow eaters so give them enough time to enjoy their meal, helping when necessary, rather than clearing the table away and rushing them away to the lounge because you need to clear away before the next shift arrives.

Mealtimes are a highlight of the day so it is crucial that they can enjoy this as much as possible. Being served up a pizza on a plastic plate, for example, is depressing and lacks dignity especially if they are expected to finish it off quickly in order to fit in with the nursing or care home’s shift patterns.

Personal hygiene, practical assistance and privacy often fall into the same category of areas where maintaining dignity is important. Your patient or resident may feel awkward about being washed and dressed by another person and not feel comfortable about being naked. To help maintain dignity always ask for consent first and use the time to chat. Listening to the radio or having the TV on may help distract the person, but again always ask for permission first.

Privacy is important to us all so always respect your resident’s personal space and belongings. Knock before you enter his or her room and don’t go through their belongings uninvited. This would be a massive invasion of privacy. Imagine if somebody entered your home uninvited and then started rifling through your drawers and possessions!

How to understand the needs of individuals

In many cases, the best way to understand the needs of your residents is to take time to chat and listen to what they say. It can be hard to find the time for a quick 10-minute one-to-one conversation, but it is extremely important to wellbeing.

Finding out about your resident’s background can often be extremely interesting and it will give you a deeper insight into how they see themselves. We all like to be listened to, after all, and engaging in some quality time with the people in your care can be enriching for both parties. In addition, your resident is more likely to open up to you if they are experiencing any difficulties or pain and feel that you will listen.

Taking time to chat with the people in your care makes a big difference to their morale and mood. It may be the only proper conversation they have all day and it does make a big difference.

The core principles of dignity

Care is a difficult and demanding job but the importance of maintaining dignity should never be overlooked. To make this easier, the National Dignity Council has identified seven key principles. This was devised in 2014 and gives guidance to people working in social care of the best way to offer care and support.

• Value the uniqueness of every individual
• Uphold the responsibility to shape care and support services around each individual
• Value communicating with individuals in ways that are meaningful to them
• Recognise and respect how an individual’s dignity may be affected when supported with their personal care
• Recognise that an individual’s surroundings and environments are important to their sense of dignity
• Value workplace cultures that actively promote the dignity of everybody
• Recognise the need to challenge care that may reduce the dignity of the individual.

In summary

Many care environments can be challenging, and sadly there is a culture in some care homes and nursing homes of a callous indifference to the people who are dependent upon care. And with the usual staffing shortages and heavy workload it can be very easy to overlook the feelings and needs of the residents; in many cases care staff work against the clock in order to complete the physical tasks of washing, cleaning and toilet visits within a limited time frame. It doesn’t always leave a lot of time for anything else.

In truth it does not take too much adjustment in order to turn this around. It usually comes down to staff training and attitude of management. Many care workers will follow the example and the attitude of management, so it is crucially important to ensure that you lead by example if you want to have a well maintained and happy nursing or care home.

At the end of the day, the main requirement for any care home is that the residents are safe, looked after and are as happy as possible. This means that the residents should be treated with dignity and respect in all aspects of their daily life as well as their basic physical needs being met.

If you ever have any concerns about the level of care and dignity in your workplace, you should raise these with management first if appropriate. Alternatively you can report it to the Care Quality Commission. The Commission has a wealth of information about “whistle blowing” and will deal with any concerns in the strictest of confidence.

If you find it difficult to remember the guidelines, an easy way to treat people with the dignity they deserve, is to put yourself in their position.

After all, one day you may be there too and if you don’t like being shouted at or patronised like a child, if you like to choose your own clothes or make your own decisions about small things such as your food or your hairstyle, rest assured this will not change in the future.