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Dignity Challenge Andrew Gallini

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Page 1: Dignity Challenge

Dignity Challenge

Andrew Gallini

Page 2: Dignity Challenge

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)

Page 3: Dignity Challenge

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”

Page 4: Dignity Challenge

Dignity – key elements

Respect Privacy Autonomy Self-worth

Page 5: Dignity Challenge

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

Page 6: Dignity Challenge

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

Page 7: Dignity Challenge

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

Page 8: Dignity Challenge

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)

Page 9: Dignity Challenge

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

Page 10: Dignity Challenge

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”

Page 11: Dignity Challenge

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”

Page 12: Dignity Challenge

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.”

Page 13: Dignity Challenge

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.”

Page 14: Dignity Challenge

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”

Page 15: Dignity Challenge

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

Page 16: Dignity Challenge

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

Page 17: Dignity Challenge

Evidence - How patients’ dignity is threatened or promoted in hospital (Baillie 2007)

Page 18: Dignity Challenge

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

Page 19: Dignity Challenge

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

Page 20: Dignity Challenge

Measuring Dignity – Help the Aged 2008

Personal Care (practical assistance) Personal Hygiene Privacy Social Inclusion

Page 21: Dignity Challenge

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

Page 22: Dignity Challenge

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

Page 23: Dignity Challenge

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

Page 24: Dignity Challenge

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

Page 25: Dignity Challenge

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

Page 26: Dignity Challenge

And Finally!

Not optional

“About attitudes, not resources”

“Dignity is everyone’s business”

Page 27: Dignity Challenge

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.