Introduction

In this chapter we consider the concept of dignity and dignified care and how it specifically applies to older people. Despite being a term that is in common usage, dignity remains a difficult concept in terms of describing what we mean when we say that we are being treated with dignity, or conversely that we are not. If we asked a number of people what dignified care meant to them, they may have different ideas or personal priorities depending on the particular issues that are important to them.

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.

Activity

There are a number of definitions of dignity, for example the Oxford Dictionary describes dignity as ‘the state or quality of being worthy of respect’. Consider for a moment how you would define dignity and what you consider to be dignified care. Note down your thoughts as we return to this later.

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.

Compare your earlier notes with these quotes. You may concur with these statements and you may also have added some different points to your own thoughts. Would you add or change anything in light of reflecting on these students’ views?

I think it’s the little things, like making sure they’ve had their hair brushed and that their teeth have been cleaned and that they’ve got you know like a lot of them they wear underskirts and that they’re being treated in the way that they would expect to be treated. (FG2B)

[Older] people have led really active lives and they’ve you know been in positions of power or whatever or even if they haven’t they’ve been mums and dads and you know I think people forget sometimes and that’s one thing that I find I’m always thinking about when I’m looking after older people, I’m always thinking about [that]. (FG2A)

And I think they deserve you know the same as everybody else but you’ve got to make sure they’ve got their dignity … I feel quite passionate about this dignity thing and that’s where it’s come from, from seeing people being, not being treated [as people] with dignity. I think it’s [about] personal values. (FG2A)

As you might expect, given our previous discussion, the students in our study were able to express their understanding of dignity through the impact or outcomes of a particular interaction, for example personal hygiene activities. This leads us to ask the question of how nurses can ensure or measure dignity and dignified care in their everyday practice.

On your next placement when you are caring for an older person, reflect on the above discussion and consider through your own practice the following: