Communicating with dignity

"We lose dignity if we tolerate the intolerable."
Dominique de Menil, 1908-1998, American civil rights campaigner.
 
Language is an essential tool – it shapes our thoughts and feelings and forges our relationships with other people. Language is both verbal and non-verbal – our body language can confirm or contradict the words we are actually saying. Dignified communication is about what we say, how, when, where and why we say it, and who we say it to. Health care professionals can be guilty of using jargon, which, if the person they are speaking to does not understand it, is alienating, or even unsafe. At other times, understanding the language used by patients and clients – even if it is not what you would use in your natural speech – is important in order to forge a therapeutic relationship.

View the following communication examples that are very common across all health care settings. Roll over each paired example and consider how they promote or undermine dignified communication.

Communicating with dignity applies to our written records and letters, computer records and templates too. Authorities such as the Nursing and Midwifery Council and the General Medical Council issue guidance and standards for record keeping, and blatant derogatory and judgemental statements about patients and clients should be a thing of the past.

We also communicate through the concepts of silence, equality, and autonomy:

• Silence - a rare commodity in busy health care settings, and in discussions it can make people feel very uncomfortable, as if it were a void that must be filled. But there are occasions when it is a really powerful nursing technique in promoting dignity.
• Equality - has specific meanings within the law, society and the workplace. Here we use the term to explore why some nurses don’t treat all people with equal dignity. The phenomenon of a nurse –often someone senior – who treats patients well but is a bully or a tyrant to fellow nurses, is just beginning to be recognised.
• Autonomy - is the right to self-determination, to make decisions for yourself. It is fundamentally linked to dignity. In nursing, it can be translated into practice by making sure that every patient or client is given options and choices that are appropriately explained so that they can make the best decision for themselves.

Explore the following animation to see examples of how these three concepts contribute to dignified communication.

Consent

It is essential that, in the opinion of the health care provider, the person is competent and capable of making decisions and understanding the nature and consequences of their decision. Exceptions may sometimes include people with learning disabilities or mental illness, and those suffering from dementia or impaired consciousness. In these situations, health care providers should act in the best interests of the patient at all times. The best interests will, of course, depend partly on the context, but is likely to include discussions with close relatives or carers. Providing people with choices, information, and actively seeking their freely given, informed consent, is about respecting their dignity and autonomy in both a legal and a moral sense.

The Mental Capacity Act applies in England and Wales to everyone who works in health and social care. Mental capacity is defined in terms of whether a person is able to make their own decisions because:

• They understand the information given to them.
• Retain it for long enough to make a decision.
• Weigh up the available information and options.
• Make and communicate their decision.

Challenging undignified communication and systems

The first step towards challenging undignified care is to recognise that it is happening. Maybe this sounds obvious but sometimes people fail to “see” it – why do you think this might be? Sometimes the indignity is inherent in the system or organisation. We need to prioritise people over processes in order to provide dignified care. If you identified something that needed changing – perhaps the lack of confidentiality because private discussions are held behind curtains - how would you go about it? Some guiding principles are:

• Manage complaints or problems quickly, and at the lowest hierarchical level. Don’t let them fester or escalate unnecessarily.
• Use skills of assertiveness, not aggression.
• Seek help when needed.

Organisational issues often need a co-ordinated approach. It may not be possible or appropriate for you to take action on your own. The following interactivity provides some suggestions for enlisting the help of key people when tackling systems that undermine the provision of dignified communication and care. Explore the interactivity below and consider the reasons presented for why undignified communication can go 'unnoticed' and who can help to make changes for the better.

Assertiveness versus aggression

Understanding the difference between these two approaches to a request or a demand is key to achieving a successful outcome with therapeutic and/or working relationships intact, and avoiding an unpleasant (undignified!) showdown. There are three responses that are typical when we witness (or experience) a breach of dignity: remaining passive; becoming angry or aggressive; or - the preferred response - being assertive. A really useful way to manage challenging or confronting situations in an assertive, yet dignified way is to apply the CER technique:

• Comment - make an objective comment to raise the issue of concern. For example, "I think calling older people 'Pet' or 'Love' can be demeaning.
• Emotion - describe the feelings the situation has generated. For example, "It can make older people feel patronised or diminished somehow."
• Request - make a resonable request to seeking a solution to the issue. For example, "Let's make a decision as a team to outlaw the use of terms like 'Pet' or 'Love' when we address our patients from now on and use their preferred name instead."

Think about how you might use this technique in your own work setting.