Caring with dignity

The nursing care that we give demonstrates to others how we value dignity. In all the myriad of things that nurses do to provide care for their patients and clients, only a small few examples can be included in this section – but they illustrate the principles that can be transferred to any field of health care, and wherever you work.

Care processes should be conducted in ways that maintain a person's dignity but there are some tasks, places, and illnesses that many people might consider to be undignified – whether they are or not is largely up to the standard of your nursing care, and the dignity with which you can imbue a situation. Consider the views of three people talking about what is or isn't undignified. You may want to find out what your colleagues think about these statements too.

“I don’t think any illness or procedure is inherently undignified. Any person, any diagnosis, any procedure can be treated in a dignified way. Dignity is only lost when others demonstrate that they find something distasteful, embarrassing, or otherwise not worthy of respect – so enemas, suppositories, colostomies, can all be dignified.” 

“Some illnesses definitely strip people of their dignity. Conditions such as motor neurone disease, Alzheimer’s, Huntingdon’s chorea take away some or all of a person’s ability to communicate. Bizarre behaviour due to mental illness makes others afraid of, or cause them to laugh or scorn the person exhibiting it. And some illnesses like HIV and AIDS carry huge social stigma – that’s an indignity.” 

“Lots of the things we do as nurses are undignified for people – such as enemas. They are concerned about the smell, noise, pain, being interrupted or overheard, being soiled – all this, and in environments where there’s very little privacy too. So interventions and places can both threaten the dignity of people.”

Procedures and tasks

There are certain procedures and tasks that some people feel are particularly undignified but there are always strategies that can minimise embarrassment and to protect dignity. Consider the tasks and procedures presented in this next activity by selecting the link: Preserving dignity (PDF 48KB) - see [How to access PDF files]. List as many things you can think of to promote dignified care in the two examples provided and then compare your list with our suggestions. You may wish to save this document to your computer and upload it to your e-Portfolio as evidence of your continuing professional development.

Places

Sometimes it is the place rather than the illness, procedure or task that feels undignified. Health care in prisons, detention centres, for armed forces out in the field, or first aid in a public place can all make an experience far less dignified than in a designated place such as a hospital or home. In all circumstances, including these environments, it is the conduct and attitude of the person providing the health care that can add dignity to a difficult situation.

Dignity in death and dying

Sometimes the circumstances surrounding a death bring the concept of dignity into sharp focus. Issues about resuscitation often stimulate such debate – for instance, blanket rules to always resuscitate, or conversely, to not resuscitate, risk the dignity of individuals whose own decisions or preferences are not heeded. Decisions about when to stop resuscitation, or witnessed resuscitation are also complex and require sensitive handling. The issue of nurses deciding on such matters was addressed by the RCN in 2002 (see the 'References' section).

Consider the two case studies presented below. The sister took action to preserve the dignity of the deceased patient and their family. Think about her actions and how you would have responded. Do you think her seniority made it easier for her to challenge the attitudes and behaviours of the other senior colleagues involved. If you think this was a factor, what steps could a junior member of the nursing team take to raise concerns about this breach of dignified care?

Preserving dignity in death

"My relative was dying in ITU of organ failure. He was conscious. The nurse who had been caring for him all day was about to go off after a 12 hour shift. She had developed a close bond with him and said (knowing he would probably die that night): 'Is there anything I can do for you before I go?' He jokingly said, 'A port and brandy would be nice.' She looked thoughtful and said she would do what she could. She rang round the hospital but no wards had any port or brandy. She left and then came back about half an hour later, bringing a small glass of brandy and port from home. She used sponge mouth sticks to put it on his tongue so he could taste it (he couldn’t drink). He said it was wonderful. He died about two hours later. Our family were so touched at her compassion and that she had done this for him."

Salvaging dignity in death

An older person who was very ill passed away at six am. The night nurse practitioner arrived to verify their death, then stated to the ward nursing staff that 'Good, that’s freed a bed for an admission who’s waiting in the medical admission unit.' The nursing staff who had cared for the person over many weeks felt that this was an inappropriate and undignified comment to make within minutes of the death.

"On commencing my shift as the night sister, the handover was given and I learned the relatives were on their way to the ward. I received three telephone calls within half an hour: one from the bed manager asking me how long it would take 'to remove the body', one from the MAU sister to ask how long the 'body was expected to be on the ward' as she was under pressure from the Sister in A and E to take a patient who would breach the four hour wait. The third call was from the A and E sister asking what the delay was!

My solution was to question the attitude and manner of those senior people who were obviously under stress and pressures of targets and bed availability. How soon we forget in such times of pressures that patients are people and not packages. Yes, we work in a system, and it’s the system that lets patients' dignity down. We need dignity champions - especially senior people - who actually are role models; yet at present these people are putting junior staff or less experienced staff under pressure. If junior staff had dealt with this situation then this patient may have been taken to the mortuary in a rush and undignified manner without the relatives being given the time to visit the ward area and grieve appropriately, with staff who knew the patient and the relatives."

Observation of care

In this and in previous sections people have commented on their observations of care. The RCN Clinical Leadership Programme (CLP) use a structured approach to observing care and translating those observations into practical ways to improve care (there’s a link to CLP in the 'Further learning' section). When formally observing care there are issues to consider such as whether people behave differently or alter practice as a result of knowing they are being observed. A skilled CLP facilitator is important. The potential benefits to patients, clients and service users are that possible areas of improving care are highlighted, and systems can be re-designed to meet their needs more effectively. The potential benefits to staff are that good practice is identified and acknowledged, and useful experience in receiving feedback and problem solving is gained. Explore the animation below to view the cyclic process for formally observing care.