A dignified environment

Whatever sort of health care environment you work in – a hospital unit or ward, a care home, a community clinic, school or person’s own home – all share some common features that are necessary to provide dignified care. The appearance, smell, sounds, organisation and atmosphere of our environments affects our confidence, well-being and dignity. Do you know what people think about your workplace? We know that first impressions count – what does your workplace “say” to patients, clients and carers when they first see it?

Think about these questions as you view the following animation to see genuine comments from service users. Would it be feasible to conduct a patient/visitor opinion survey? Who could you speak to in your workplace about this idea? You may wish to create an action plan to capture the ideas you come up with in response to these questions. Select the Action Plan (PDF 26KB) template if you would like to use this plan - see [How to access PDF files]. You may wish to save this document to your computer and upload it to your e-Portfolio as evidence of your continuing professional development.

Design

The design of new health care facilities, or the re-configuration of internal work spaces is a skill for specialist architects and facilities staff. Nursing involvement is essential from the start because a successful, dignified environment needs to accommodate the patient or client’s pathway through services and create a workplace that is safe, practical and pleasant for staff. The design incorporates everything, right down to the smallest detail: is there enough space for all the people, all the activities and all the equipment that needs to be accommodated?

Few buildings are perfect, and older ones can pose particular challenges. But too often problems are just accepted as part of the fabric of the building, when internal re-organisation and refurbishment could actually solve those problems. What’s needed is to bring them to the formal attention of managers and the person who is best placed to act as the spokesperson in your team?

Consider the image in the interactivity below. Although it's a bay in a ward, we've posed some questions which can easily be applied to most environments where health care takes place. If you have started an action plan, you may wish to add ideas you've had about the design of your work environment to it.

Mixed sex wards

The issue of single-sex accommodation hits the headlines frequently, and there has been much debate about it. Single-sex wards or single rooms with en-suite toilet and washing facilities are cited as the ideal. Often, single-sex accommodation is within a mixed ward – for instance, a bay for either men or women, but not both. In addition, patients should not need to pass through opposite sex accommodation to access their own area or washing facilities.

Although some exceptional circumstances exist, such as in emergencies or intensive care units, the NHS Institute for Innovation and Improvement states that this should never occur in mental health units. “Mixing of the sexes can often be avoided, can usually be reduced, and can always be managed better. There can be no excuse for doing nothing”. Their report contains self-assessment audits on which management boards should act (see the report on privacy and dignity in the 'Useful resources' section).

Privacy, modesty, confidentiality

The three concepts of privacy, modesty and confidentiality underpin so much of dignified nursing care. They can be defined as:

What do they mean in your work? Explore the animation below depicting how nursing staff in different setting view each of these concepts in the context of their practice. As you view the animation, compare their definitions with your own and think of an example of how each is modeled where you work.

Time and place

Not enough time! It seems to be the common denominator for health workers in every area of practice. Strong clinical leadership is a factor that can make a difference to the time nursing staff have to deliver care. A leader who can negotiate proper staffing levels, or close facilities when there is not enough time to provide a safe service. But sometimes there are small, practical changes that can be made to free time for caring, wherever you work. The NHS Institute for Innovation and Improvement recently launched the 'Releasing Time to Care' project to support you. Find out more about this project in the 'Useful resources' section.

Leadership

The solutions to all these contributors to undignified care start with individuals such as you. You can:

All of these actions are aspects of leadership, even if your post does not carry managerial authority or power. Refer to the Nursing and Midwifery Council (NMC) Code and the RCN's Principles of Nursing Practice - PNP (you'll find a link to the PNP in the 'Useful resources' section) when arguing your case or reinforcing your point. Nurses need to be firm about the way in which a clinical area is run. Then a safe and dignified way of doing things can become the culture, and others (like new doctors and students), can learn and absorb good habits.