1. In the Snack Bar
Edwin Morgan

2. Loss in old age Loss of career Loss of health Loss of ability
Loss of independence
Loss of friends/partner
Loss of personhood

3. ‘The state of being worthy
Dignity
‘The state of being worthy
of honour or respect’

4. There’s a lot of it about
BGS
National Service Framework for Older People
Scottish National Care Standards
All highlight ‘dignity’ as a major objective of care

6. "Live with dignity, die with dignity"
Dignitas:
"Live with dignity, die with dignity"

9. Why are we so worried about dignity?

10. 82.5% of statistics are made up
80% of drivers ‘above average’
95% of doctors ‘above average’
99% of humans ‘above average’
self-enhancement

11. Utilitarianism vs. primacy of the individual

12. Primacy of the individual
Human rights
Religion

13. Dignity = recognition of self worth
self worth/humanity
how you see yourself as a person
spirituality
how you fit in to a bigger picture
what’s the meaning of my life?

14. Holistic care
Physical
Social
Psychological
Spiritual

15. Who needs spiritual care?
Low need
simple disease
non-disabling
far from death
little social morbidity
High need
complex disease
disabling
close to death
high social morbidity

16. Our patients Have a high need for dignified care
Are at high risk of not receiving dignified care
perceptions
environment
systems

17. Barriers to dignified care
Environment
Care of elderly in inappropriate setting
Staffing levels
Perceptions
Ageism
All elderly confused/meddlesome
Systems
Government targets
Medical receiving units
Mixed sex wards

18. Why should we provide dignified care?
Human rights
Article 2: right to life
Article 3: prohibition of inhuman and degrading treatment
Article 8: right to respect for private life
Article 14: prohibition of discrimination

19. Why should we provide dignified care?
Improves outcomes
degradation of self-worth leads to despair
hope is a potent therapeutic tool

20. Say ‘dignity’

21. Why should we provide dignified care?
A new ambition for old age: Next steps in implementing the National Service Framework for Older People (2006)
Three key themes:
dignity in care
joined-up care
healthy ageing

22. Shona Robison MSP ‘Dignity and respect in old age’
We all expect a dignified and fulfilling old age, and today's older people have the right to expect this too.
I am determined to make sure that this happens.
We have in place the National Care Standards

23. Scottish National Care Standards
Based on the following six principles -
Dignity
Privacy
Choice
Safety
Realising potential
Equality and diversity

24. C.E.O
Cost
Experience
Outcomes

25. HealthLeaders News, Sep 2007 Cleveland Clinic's 'Other CEO'
Scoff at her title if you will, but the Cleveland Clinic's new chief experience officer says she intends to do nothing less than set a new standard for patient satisfaction.
Duffy's main tasks are to focus on enhancing the patient and employee experience
The goal is to create an organization that's not only known for excellent clinical outcomes, but also for high levels of patient satisfaction.
"People will start seeking institutions to go to that will deliver on both clinical outcomes and experience”, she says.

26. Healthcare commission - Priorities for patients and service users
Patients tell us that the following are important:
Cleanliness
Timely and fair access
Good communication and information
Personalised care
Dignity and respect

27. Why provide dignified care?
Moral arguments
Clinical arguments
Political arguments
So…
How can we provide dignified care?

28. What can we do as individuals?
Dignity and the essence of medicine: the A, B, C and D of dignity conserving care. Harvey Chochinov. BMJ 335:184-7
Attitudes
Behaviours
Compassion
Dialogue

29. Attitudes
Empathy
Challenging prejudices

30. Compassion
Getting in touch with one’s own feelings requires the consideration of human life and experience
Reading novels/watching films/art
Discussion of narratives
Role models
Ways to show compassion
An understanding look
A gentle touch on the shoulder, arm or hand
Some form of communication that acknowledges the person beyond their illness

31. Acknowledge the person beyond their illness Acknowledge humanity
How would you define yourself?
Job
Accent
Background
Family

32. Barriers to dignified care
Perceptions
Ageism
All elderly confused/meddlesome
Systems
Government targets
Medical receiving units
Mixed sex wards
Environment
Care of elderly in inappropriate setting
Staffing levels

33. Addressing systematic barriers to dignity: Behind closed doors
Ignoring requests for toilet
Telling people to use pads
Insisting on commode when could be taken to toilet
Scolding/humiliating incontinent patients
Entering closed curtains without checking
Leaving on commode for too long
Leaving people in full view when using the toilet
Using safety as a reason to deny choice

34. What else? Toileting Feeding Management of confusion
Ability to exercise choice

35. Barriers to dignified care
Perceptions
Ageism
All elderly confused/meddlesome
Systems
Government targets
Medical receiving units
Mixed sex wards
Environment
Care of elderly in inappropriate setting
Staffing levels

36. Summary
Dignity
Why it’s important
How to provide dignified care