10 Dignity in care for older people
• To explore the concept of dignity in care for older people and related policy and initiatives
• To examine how dignity specifically applies within the context of care of older people
• To consider how student nurses can promote dignity while on placements where they work with and care for older people
Introduction
For example, you may have a preference for how you like to be addressed when you visit your doctor and you would probably expect an element of privacy if you were a patient on a hospital ward. As a student, when you attend lectures or tutorials you probably expect that the teacher will listen to your views and respect what you have to say on a given issue. These examples are all aspects of dignity and perhaps as such lead us to think about dignity as an interactive process. By this we mean that it is the way in which we feel about a particular situation or event, the way in which we are treated by others, whether we feel that our views are heard and the impact that this has on us as individuals. Equally, as we discuss, the ‘feeling’ or intangible quality that surrounds the concept of dignity makes it difficult to quantify objectively. This doesn’t mean that it is impossible to define, simply that dignity is a difficult concept to measure and we need to think about the kinds of ways in which we can describe, quantify, embed or benchmark dignity in everyday nursing practice. For example, Help the Aged (now Age UK) (2008) has highlighted that in dignified care for older people, the importance of measuring dignity lies in ‘not simply what is done but how it is done’ and this is a pivotal consideration.
We have already discussed The National Service Framework (NSF) for Older People (Department of Health (DoH) 2001) and the subsequent development of particular policy initiatives for older people. All of these are directly linked to dignified care. In this chapter we focus on the contemporary initiatives that directly aim to embed this dignified care and dignity within the health and social care service provision for older people.
In direct response to the recognition of the sustained deficits in the quality of care experienced by older people, The NSF for Older People (DoH 2001) was launched in 2001. The cornerstone of The NSF for Older People lies in its commitment to promoting healthy ageing, the eradication of ageist practice, the provision of universal care and services regardless of age, founded on the key principles of equity, dignity, respect and individuality. Latterly, a number of core policy initiatives and national reports, for example The Dignity in Care Campaign (DoH 2006a) and Dignity: at the Heart of Everything we do (Royal College of Nursing (RCN) 2008a), have further reinforced these guiding principles as central to healthcare provision. In conjunction with these, the report on future nursing workforce needs, Modernising Nursing Careers (DoH 2006b), also highlighted the ongoing reforms to care delivery and needs of particular groups and individuals.
Activity
As we set out in the introduction, expressed simply, dignity means different things to different people. In a recent study which used a focus group approach, McGarry et al (2009) explored the concept of dignity in care for older people with a group of student nurses. The students described and thought about dignity in lots of different ways, often using examples of care interactions in order to explain how they identified dignity or how they felt about the importance of dignified care.