1. palliative care education conference Dignity in Care Julia Ryan Director of Research and Graduate Studies Senior Lecturer in Older Adult Nursing j.ryan@salford.ac.uk 0161 2952790

2. palliative care education conference What is dignity?  Isn’t it obvious?

3. palliative care education conference The Healthcare Commission identified the most common complaints they receive which impact on older people’s experience of dignity in care What do you think might in the Commission’s list? What do you think might in the Commission’s list? Spend two minutes talking to the person next to you about what you think. Spend two minutes talking to the person next to you about what you think.

4. palliative care education conference  Being addressed in an inappropriate manner  Being spoken about as if you are not there  Not being given proper information  Not being asked for consent  Being left in soiled clothes  Being exposed in an embarrassing manner  Not being helped to eat and drink  Being in mixed sex accommodation  Being left in pain  Being in a noisy environment at night  Lack of protection of personal property  Being subject to mistreatment and abuse

5. palliative care education conference Dignified care  ‘When you feel that they treat you with loving care, affection, attention, gentleness it makes you feel good. It makes you feel like a human being’  ‘They always find time to talk to me and treat me with dignity. It didn’t matter whether they were just passing, you were acknowledged and you were treated like the person you are.’  ‘They never make me feel like another old woman. They remember who I am, a mother, a grandmother, and that I bring another life with me’

6. palliative care education conference Undignified care  ‘He was, well, a sort of dignified man. Marvellous mind. And he had to go into hospital towards the end of his life and he did tell me, when I went in to see him once, and he told me that he couldn’t stand this business of ‘Come on love’ or them calling him ‘George’. That just wasn’t his language, he was very dignified.’  ‘The doctor and the nurse just chatted together while he put in the drip- it was awful. They just moved him as if he were an object. Not one word, not one smile, nothing’.  ‘They would not do any deliberate harm to her but they did a lot of negative harm in the way in which they treated her, because she was still able to make certain kinds of decisions for herself. But somehow even these were taken away from her’

7. palliative care education conference Why does dignity matter?  Positive health and social outcomes  Legal and professional requirements  Fundamentals of care  It is right

8. palliative care education conference Dignity: a Human Right? The right to life Freedom from degrading treatment The right to liberty The right to respect for private and family life Freedom of thought, conscience and religion Freedom of expression The right to peaceful enjoyment of your property The right not to be discriminated against in any of these rights or freedoms

9. palliative care education conference IT’S NOT ROCKET SCIENCE?  OR IS IT? What do you do to ensure dignity in care?

10. palliative care education conference Care which enhances dignity  Respect  Privacy  Autonomy  Sense of self

11. palliative care education conference The Senses Framework Nolan et al SecurityBelongingContinuityPurposeAchievementSignificance

12. palliative care education conference Relationships and sense of community  Pragmatic Task focused  Personal and responsive Resident focused  Reciprocal Relationship focused  Brown Wilson 2009 Residents Family Friends Neighbours Staff

13. palliative care education conference  Leadership Shared values  Teamwork Continuity and consistency Continuity and consistency  Mutual Trust Reciprocity

14. palliative care education conference Enhancing dignity Trust Fairness Respect Equality Independence Autonomy Participation Privacy Security Belonging Continuity Purpose Achievement Significance

15. palliative care education conference Do the mirror test! What do you see?

16. palliative care education conference  Selected bibliography  Abbott S., Fisk, S. & Forward, L. (2000) ‘Social and democratic participation in residential settings for older people.’ Ageing and Society 20: 327-340  Boyle, G. (2008) ‘Autonomy in long term care: a need, a right or a luxury’, Disability and Society 23: 229-310  Brooker, D. (2004) ‘What is person centred care in dementia?’ Reviews in Clinical Gerontology 13: 215-222  Cohen, L, O’Connor, M. & Blackmore, A.M.(2002) ‘Nurses’ attitudes to palliative care in nursing homes in Western Australia’ International Journal of Palliative Nursing 8(2): 88-98  Cook, G. (2006) ‘The risk to enduring relationships following the move to a care home’ International Journal of Older People Nursing 1(3):182-185  Dewing, J. (2004).’Concerns related to the application of frameworks to promote person centredness in nursing older people’ International Journal of Older People Nursing 13 (3): 39-44  DH (2003) Care Homes for Older People, National Minimum Standards The Stationary Office, UK  DH (2003) Care Homes for Adults (18-65), National Minimum Standards The Stationary Office, UK  Healthcare Commission (2007) Caring for Dignity: A national Report on Dignity in Care for Older People While in Hospital Commission for Healthcare Audit and Inspection, London  Help the Aged (2007) The Challenge of Dignity in Care: upholding the rights of the individual. Help the Aged, London  Jacelon, C.S., Connelly T.W., Brown, R., Proulx, K. & Vo, T (2004) ‘A concept analysis of dignity for older adults’ Journal of Advanced Nursing 48: 76-823  Katz, J, Komaromy, C & Sidell, M (1999) ‘Understanding palliative care in residential and nursing homes’ International Journal of Palliative Nursing 5(2): 58-64

17. palliative care education conference  MacKinlay, E. (2008) ‘Practice developments in aged care nursing of older people: the perspective of ageing and spiritual care’. International Journal of Older People Nursing 3 151-158  McCormack, B. & McCance, T. (2006) Development of a framework for person centred nursing ‘Journal of Advanced Nursing 56: 472-479  Nolan, M.R., Davies, S., Brown, J., Keady, J. & Nolan, J. (2004) ‘Beyond personal centred care: a new vision for gerontological nursing’. International Journal of Older People Nursing in association with the Journal of Clinical Nursing 13 (3a) 45-53  Royal College of Nursing (2008) Defending Dignity- challenges and opportunities for nursing RCN London  Royal College of Nursing (2008) Delivering Dignified care: a practice support pack for workshop facilitators RCN London  See http://www.rcn.org.uk/__data/assets/pdf_file/0008/191735/003285.pdf http://www.rcn.org.uk/__data/assets/pdf_file/0008/191735/003285.pdf  Who cares wins: leadership and the business of caring at  http://www.burdettnursingtrust.org.uk/public/documents/who_cares_wins_0 31006_1.pdf http://www.burdettnursingtrust.org.uk/public/documents/who_cares_wins_0 31006_1.pdf http://www.burdettnursingtrust.org.uk/public/documents/who_cares_wins_0 31006_1.pdf  Dignity and Older Europeans  http://www.cardiff.ac.uk/medic/subsites/dignity/index.html http://www.cardiff.ac.uk/medic/subsites/dignity/index.html