The Preservation of Dignity for Patients - Assignment Example

Dignity and respect for older people is paramount to the delivery of effective person centred care. Discuss with reference to your own observations and current DOH initiatives, how dignity and respect can be maintained in a variety of health care setting. Dignity is a fundamental human right that must be afforded to every individual (Amnesty International, 1948). It is an essential factor for the well-being of people in every society. Every individual has the wish to have their dignity suitably upheld, irrespective of the situation they are in (Seedhouse, 2000). However, this desire is particularly important within a health care setting. Literature and research in the health and social care sector constantly shows that patient dignity is of vital importance, and one of the most important considerations when interacting with a patient (Matiti & Trorey, 2008). This sentiment is upheld by the Amsterdam declaration on the support of patients’ rights, which recognises that the preservation of the dignity for patients is a fundamental consideration (WHO, 1994). In the UK, there has been a growing importance towards patients’ rights to be treated with respect, privacy and dignity (Department of Health 2007, 2006, 2001a, 2001b, Human Rights Act 1998), and therefore it has been deemed that nurses, especially as they are the frontline of care, have a professional duty to show respect towards their patients and to maintain their privacy and dignity (NMC, 2004; International Council of Nurses, 2001; Matiti and Sharman, 1999). Baillie (2007) defined dignity for patients as ‘feeling valued and psychologically comfortable with their physical presentation and behaviour, their level of control and the behaviour of the other people in the environment’ (p.30). Striving to maintain dignity through the implementation of person-centred care in an emergency setting with older patients under the governments current legislation to achieve four-hour targets in accident and emergency, within their policy of dignity and privacy for patients in a single-sex environment, is a hard task to manage. Webster and Byrne (2007) state that while nurses have shown apprehension about being too busy during their shifts to be concerned about showing dignity and respect for all their patients needs, development in policies have been implemented to help them achieve these objectives in a very busy emergency ward. However, they state that sometimes the working environment nurses find themselves in is often a less than ideal one in regards to being able to maintain fully dignity and respect to their patients as set forth by policy-makers (Webster and Byrne, 2007). Nevertheless, no nurse would deny that respect, privacy and dignity being shown to each individual patient are still their core objective, through the provision of person-centred care. In the Nursing Older People (2004) journal it has been put forward that the emergency care given to older patients still needs to be further improved, despite recent policy changes. Some major conflicts which arise in this setting are created by four-hour accident and emergency target implemented through Department of Health stipulations for NHS acute wards, where patients need to be treated and then either admitted or discharged within this time limit (Oxford Radcliff Hospitals, 2009). These targets mean that on occasions a patient may have to be moved to another before a task such as giving them a bath has been completed, which then threatens the care they are receiving and subsequently their dignity is threatened (Parish, 2008). In addition to the burden of these four-hour targets in accident and emergency wards, there is now extra pressure to separate patients into single-sex bays or wards. The government has recently announced that it will penalise hospitals which retain mixed-sex wards from next year, with the exception of special situations. Mixed-sex wards are seen as one of the biggest obstacles in threatening the respect and dignity of patients (Nursing Standard, 2009). In particular it has been evidenced that older people feel that their dignity has not been maintained when placed on a mixed-sex ward more acutely than other patients in a younger age range (DOH, 2007). However, while the government’s policy does not include either intensive care or accident and emergency wards in their targets for single-sex wards, there is still pressure to maintain this standard within these departments (Nursing Standard, 2009). The Department of Health policy in this area focuses on the importance of dignity and respect and how to apply these factors within an acute care setting; it describes the government’s position in respect to privacy and dignity within a mixed-sex ward. It also communicates what NHS patients and the public at large would like to see in the hospital and stipulates good practice ideals (DOH, 2007). While the report suggests that NHS treat their patients with dignity and respect it also puts forward that being admitted into hospital can a traumatizing event. Therefore, nurses need to apply every assistance in order to protect the patients’ privacy and to treat them with dignity and respect to help maintain the patients’ modesty (DOH, 2007). While the Healthcare Commission’s (2007) annual surveys illustrates that the majority of patients feel that their privacy was respected, they also commented that being given respect and dignity the members of staff amounted to a much more complicated scenario than just being placed in a single-sex ward. Nevertheless, in some situations where a patient has not been placed on a single-sex ward, a great deal of distress and anxiety has been caused to the patient (DOH, 2007). This reports states that the public and the patients want their dignity and privacy respected when in hospital. The NHS has visibly affirmed their commitment to this by providing many more single-sex wards and accommodation, with a continued push to make it the norm, while stating it is the ideal for every word and they are striving towards this goal (DOH, 2007). However, the aim of the report is to show that while single-sex accommodation is important in regards to maintaining privacy and dignity, it is not the only factor which produces this. In situations where single-sex accommodation can not be provided, many other factors can be applied to help maintain the privacy and dignity of the patient. These other factors are identified as issues such as positive and compassion staff attitudes, a clean environment and good quality hospital food. The report indentifies these key factors and where improvements need to be done to improve the privacy and dignity shown to patients in an acute care setting (DOH, 2007). However, despite these positive results, the report states that problems are still being reported, due to patients still declaring that they have been put in a mixed-sex accommodation (DOH, 2007), and therefore there was an incongruence between what the Healthcare Commission (2007) surveys stated and what patients reported. Because of these incongruencies in December 2006, the strategic health authorities (SHAs) reviewed mixed-sex accommodation and found that while most trusts reported compliance, a ‘small number were clearly finding observance challenging’ (DOH, 2007, p.2). In order to establish what patients and the public wanted, the SMAs conducted further surveys, focus groups and face-to-face interviews on people’s views and needs in regards to privacy and dignity. The results showed that while single-sex accommodation was deemed important, other factors such as positive staff attitudes and a clean environment were considered more important. This was substantiated by findings gathered by Dignity in Care events where information gathered stated that the most important factors which the public felt damaged their dignity included ‘feeling neglected or ignored while receiving care, being made to feel a nuisance and being addressed in a disrespectful way’ (DOH, 2007, p. 3). These results were further backed up by research completed by a Picker Institute Study (2003) which found that patients ranked aspects in care in order of there importance out of 82 features. Single-sex accommodation was ranked 62nd, being given privacy while being examined was ranked 13th, and being shown dignity and respect by staff was ranked 28th. Therefore, single-sex accommodation must not be seen as the only important factor in showing dignity and respect to patients. This evidence suggests that other variables need to be looked at in regards to the importance of single-sex accommodation and the dignity and respect patients feel they have been shown. It has been found that those patients who came into hospital under an elective, rather than emergency admission are more concerned to be in a single-sex ward. In addition, older people and in particular women, are also less tolerant of being of being placed in a mixed-sex ward (DOH, 2007). Therefore, it is has been evidenced that for some people single-sex wards are the ideal, as they are for staff as well, providing the best solution in providing extra dignity and respect, however this is not a realist objective. The Department of Health (2007) have stated that one of the main reasons for this being an unrealistic objective, and why intensive care and accident and emergency wards do not have to met this objective as stringently as other wards, is because sometimes there is a need to place patients suffering from the same condition together so that they can receive specialist care from the same dedicated team. Nevertheless, no department is exempt from providing dignity and privacy to their patients, and all attempts must be made to segregate males and females (DOH, 2007). But in the emergency setting where peoples’ lives are in imminent danger, concerns for keeping the patient alive naturally come before dignity or privacy, such as placing them in a particular bay or exposing their bodies. The Department of Health acknowledges that these situations do at times happen, and priority of treatment must come before segregation. Though they carry on to state that attempts at segregation ‘should always be apparent’ (DOH, 2007, p.7), this places a lot of pressure on staff working in an emergency setting. The report gives recommendations for the occasions when it is possible for full segregation to occur. These recommendations should always focus on maximising the patients’ privacy and dignity. Nurses have a professional obligation to respect their patients’ dignity, but in the hospital setting patients are more vulnerable than ever of loosing dignity (Baillie, 2007; Jacelon, 2003; Seedhouse and Gallagher, 2002). This is found to be further threatened by the actions and behavior of staff members, particularly in an acute care setting. The results from the study show that patient dignity is supported when staff members offer privacy and employ personal and compassionate interactions which facilitate patients to feel comfortable, valued as an individual and in control of the situation. Therefore, ‘individual staff behaviour has a major impact on whether threats to patient dignity actually leads to its loss’ (Baillie, 2007, p.30). The study (Baillie, 2007) concludes that all members of staff must treat patients in a manner which promotes dignity in every interaction they have. The Essence of Care (DOH, 2001a) document addresses these issues, that an older person must be seen as an individual and treated and respected accordingly to the same privacy and dignity as anyone else. It is therefore suggested that the main way of making certain that a patients’ right to privacy and dignity is upheld is to ‘create “norms” in the way in which the team’ in that ward or unit work to ensure that this treatment is always afforded to patients, through the basis of team work lead by ‘expert clinical leadership’ (Webster and Byrne, 2007, p.39). Webster and Byrne (2007) suggest that needs of older people are becoming increasingly recognised and that policy and sense development is being improved and adapted accordingly. Dignity and respect have been shown to be very important to the older person. The paper ‘National Service Framework for Older People’ (DOH, 2001b) states that older people have not received the dignity or respect that is due to them. Dignity is a complex phenomenon and a wide range of definitions have been applied to it (Marley, 2005; Jacelon et al., 2004) but not many studies have researched it from the patients’ perspective. A study commissioned by the EU (Calnan et al, 2003) found that older people felt that a lack of dignity can be felt through various actions by staff. These actions include staff neglecting to help older people maintain their personal appearance, and using negative stereotypical labels, such a ‘bed-blockers’ or ‘geriatrics’. In addition to this other examples were given in the study where patients felt that their right to dignity and privacy had been violated. Holmes and Bethel (2007), believe that staff need to receive extra training in how to treat older people holistically. Webster and Byrne (2007) reinforce these views. Their research has reported where older people reportedly feel that their dignity has most been taken from them. These factors where dignity has not been afforded to older people through are by not sufficiently covering their bodies when using a hoist, not enquiring from the patient what name they want to be addressed by, through putting them in a mixed sex bay, and the mixing of medication into food ( Webster and Byrne, 2007, p38). Enes (2003) and Matiti and Trorey (2004) demonstrated that in a care setting patients alter their personal perception of what they feel will uphold their dignity, not only through their own values but according to how ill they are. Byrne (1997) suggests that patients in the process of being admitted to hospital are not only worried about the physical care they will receive, but also the psychological and social care that nurses will give them. Therefore nurses, particularly in the emergency setting where patients are often in shock from an accident or sudden illness, need to they show respect not just to the patients’ physical dignity, but also their psychological well-being. Matiti and Trorey (2008) state that patients’ have an expectation of how their dignity will be maintained while in hospital, and that it has long been understood that a consideration of patients’ dignity in the care setting is of upmost importance as this may help to psychologically assist recovery. The study reported that while many patients were satisfied with the dignity they were shown a significant number were not (Matiti and Trorey, 2008; Mairis, 1994; Haddock, 1996). One the most important areas where dignity could be threatened was through exposure of the body, therefore many procedures which involves this should be treated with as much respect as possible, included fully drawn curtains, for staff to ask permission to enter when the curtain is drawn and not to uncover body parts unnecessarily. Another important area identified was that due to the lack of space between beds, nurses need to lower their voices while in discussion with patients and relatives so that privacy is maintained. However this was identified as a particular problem when the patient is hard at hearing (Matiti and Trorey, 2008). The report states that while nurses strive to give dignity and respect, sometimes factors occur which makes this impossible to apply in practice. Parish (2008) claims that human factors such as over stretched staff can sometimes produce a situation where a patients’ dignity cannot be maintained. While this has been reported in the previous literature, this report also looks at how distressing these situations can be for the nurse, as well as for the patient. An example used is that while no nurse wants or plans to make a patient wait, for something like a bedpan, however in reality sometimes staff are so overstretched there is no choice but for staff to finish something more important first, before their needs can be met, and that these episodes are just as upsetting for the nurse, as they are for the patient. However, for patients these situations, though maybe unavoidable, may result in upsetting and sometimes degrading reminders that their welfare and comfort is not under their own control (Parish, 2008).  Baillie (2007) identified three areas, the hospital environment, staff behaviour and patient factors, where patient dignity could be either promoted or threatened, within the hospital environment dignity could be promoted through a favorable physical environment which promoted privacy and dignity on the ward, through effective leadership and thorough support for all patients. Dignity was threatened in the hospital environment, through the lack of privacy in the ‘physical environment, bodily exposure, mixed-sex environment, bed management and staff and staff workload and work patterns’ (p.31). Staff behaviour could promote dignity through factors such as ‘environmental privacy, privacy of the body, and auditory privacy’ (p.31). Therefore, in light of these findings Baillie (2007) gives the following recommendations to enhancing the dignity and respect nurses show to their patients. Nurses must ensure privacy is provided by fully closing curtains, not entering a bay where the curtain is closed without asking consent, and reducing bodily exposure to the minimum. Also staff need to interact with patients in a manner which ensures the patients feel comfortable, through the use of appropriate humour, friendliness, but professional and by giving reassurance (Baillie, 2007). They should also ensure that the patient feels in control by informing and explaining conditions and treatments, offering them choices, helping patients retain their independence as much as possible and be always obtaining consent. Lastly, nurses need be eve more heedful of these factors on the occasions where loss of dignity is at a greater risk, such as when an intimate procedure is taking place, or when patients are critical ill and not able to protect their own dignity (Baillie, 2007). This particularly is relevant within an emergence setting where the elderly patient is likely to be very ill, or majorly incapacitated. In conclusion there seems to be consensus across the board as to what factors promote and threaten dignity and show respect to patients in a health setting. The main factors identified by the literature which promote dignity and respect are a positive and helpful staff attitude, a clean environment, professionalism from staff, and giving reassurances. In addition, factors which threaten the patients’ dignity and respect are negative labeling, curtness or authoritarian attitude, bodily exposure and not being addressed in an appropriate way. Therefore, new policies can be implemented by the relevant bodies and organisations in order to change the situations in which these issues occur and therefore ensure that all patients are treated with dignity and privacy which they deserve to receive, within a person-centred approach, which is still within policy guidelines.          REFERENCES Amnesty International (1948). Universal Declaration of Human Rights. [Online] Available at: http://www.un.org/Overview/rights.html [Accessed l8 March 2009]. Baillie, L. (2009).Patient dignity in an acute hospital setting: A case study. Nursing Times, 103 (34), p.30-31. Bryant, H. (2007). Boards eye view. Emergency nurse, 15 (8), p. 39. Byrne, G. (1997). Patients anxiety in the accident and emergency department. Journal of Clinical Nursing. 6, (4), p. 289-295. Calnan, M., Woolhead, G. & Dieppe, P. (2005). Views on dignity in providing healthcare for older people. Nursing Times; 101 (33), p. 38-41. Department of Health (2006). A New Ambition for Old Age: Next Steps in Implementing the National Service Framework for Older People. London: DH. Department of Health (2007). Privacy and Dignity – A report by the Chief Nursing Officer into mixed sex accommodation in hospitals. London: DH. Department of Health (2001a). Essence of Care: Patient-focused Benchmarking for Healthcare Practitioners. London: DH. Department of Health (2001b). The National Service Framework for Older People. London: DH. Enes, S.P.D. (2003). An exploration of dignity in palliative care. Palliative Medicine, 17, p.263-269. Gallagher, A. & Seedhouse, D. (2002). Dignity in care: the views of patients and relatives. Nursing Times, 98 (43), p.39-40. Haddock, J. (1996). Towards further clarification of the concept dignity. Journal of Advanced Nursing, 24, p.924-931. Healthcare Commission (2007). Caring for Dignity: A national report on dignity in care for older people while in hospital. London: Commission for Healthcare Audit and Inspection. Holmes J, Bethel J (2007) A different kind of care. Emergency Nurse, 15 (7), p.9-12. Human Rights Act 1998 (chapter 42). London: HMSO. International Council of Nurses (2001). The ICN Code of Ethics for Nurses. Nursing Ethics, 8, p.375-379. Jacelon, C.S. et al (2004). A concept analysis of dignity in older adults. Journal of Advanced Nursing, 48, p.76-83. Jacelon, C.S. (2003) .The dignity of elders in an acute care hospital. Qualitative Health Research, 13, p.543-556. Mairis, E.D. (1994). Concept clarification in professional practice - dignity. Journal of Advanced Nursing, 19, p.947-953. Marley, J. (2005). A concept analysis of dignity. In: Cutliffe, J.R., McKenna, H.P. (eds). The Essential Concepts of Nursing. Edinburgh: Elsevier, Churchill Livingstone. Matiti, M.R. & Sharman, J. (1999). Dignity: the study of preoperative patients. Nursing Standard 14, p.32–34. Matiti, M.R. & Trorey, G. (2004). Perceptual adjustment levels: patients’ perception of their dignity in the hospital setting. International Journal of Nursing Studies 41, p.735–744. Matiti, M. R., & Trorey, G. M. (2008). Patients expectations of the maintenance of their dignity. Journal of Clinical Nursing, 17, p.2709–2717. NMC (2004). The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics. London: NMC. Nursing Older People. (2004). Emergency care for older people needs improving . Nursing Older People, 16 (3), p.4. Nursing Standard. (2009). Cautious welcome for pledge to eliminate mixed-sex. Nursing standard, 23 (22), p.11. Oxford Radcliffe Hospitals (2009). The Four Hour Target in Accident and Emergency. [Online] Available at: http://www.oxford.gov.uk/files/meetingdocs/27833/item%207.pdf [Accessed on 18 March 2009]. Parish, C. (2008). Campaign will aim to promote dignity through leadership. Nursing Standard, 22 (37), p.15. Picker Institute (2003). Improving Patients’ Experience: sharing good practice. [Online] Available at: http://www.pickereurope.org/Filestore/News/resp_priv_dign_newsletter_feb03.pdf [Accessed 18 March 2009]. Seedhouse, D. (2000). Practical Nursing Philosophy: The Universal Ethical Code. Chichester, UK: Wiley. Webster, J. & Byrne, S. (2007). Strategies to enhance privacy and dignity in care of older people. Nursing Times, 100 (8), p.38 WHO (1994). Declaration on the promotion of patients rights in Europe – Amsterdam. Copenhagen: World Health Organisation Office for Europe. Read More