1. University College London Hospitals NHS Foundation Trust ENABLING DIGNITY IN CARE THROUGH PRACTICE DEVELOPMENT WITH OLDER PEOPLE Jonathan Webster Jonathan Webster Angela Dobson Eloise Horgan Eloise Horgan Funded by the Foundation of Nursing Studies and supported by Age Concern Islington

2. University College London Hospitals NHS Foundation Trust Why…..? National Campaigns – DoH, RCN, Age Concern… National Campaigns – DoH, RCN, Age Concern… Core to essential care. Core to essential care. Impact of undignified care on the person. Impact of undignified care on the person. Understanding dignity is complex and poorly defined (Woolhead et al 2004). Understanding dignity is complex and poorly defined (Woolhead et al 2004). Although high profile, challenges remain (Webster 2007). Although high profile, challenges remain (Webster 2007). Dignity work highlighted key areas (UCLH 2007). Dignity work highlighted key areas (UCLH 2007). Opportunity to learn and understand together. Opportunity to learn and understand together. Technical Vs Experiential learning? Technical Vs Experiential learning?

3. University College London Hospitals NHS Foundation Trust

5. The discussions allowed me to open-up and share experiences which have not been expressed previously. I was comfortable to get rid of the pain. The relief was immense. Weve travelled on a long fruitful road. We have been through all possibilities that can be done in order for patients to be allowed their dignity; hopefully older people will overcome their fears of being hospitalised as a result of this. There was space to make my views heard and respected. …a catalyst for action.

6. University College London Hospitals NHS Foundation Trust

8. Work Based Projects an illustration … Promoting increased effective communication between nurses and older people – use of patient diaries. Promoting increased effective communication between nurses and older people – use of patient diaries. Working with the multidisciplinary team to ensure that dignity in care is an integral part of team meetings. Working with the multidisciplinary team to ensure that dignity in care is an integral part of team meetings. Introduction of: Introduction of: –Please keep quiet notices –Review dividers to curtains –Performing theatre check lists in patients rooms –Ensuring patients are greeted on arrival in the department –Pre-operative visits to assess and meet patients Ward based notice board focussed upon raising awareness of dignity Ward based notice board focussed upon raising awareness of dignity

9. University College London Hospitals NHS Foundation Trust Work Based Projects (cont.)… Raising awareness of ensuring curtains are kept closed and that closed doors arent opened without seeking permission first. Raising awareness of ensuring curtains are kept closed and that closed doors arent opened without seeking permission first. Increased vigilance at meal times to ensure all patients (who need help) receive support to eat and drink Increased vigilance at meal times to ensure all patients (who need help) receive support to eat and drink Increasing awareness of the need to encourage patients to wear their own clothing Increasing awareness of the need to encourage patients to wear their own clothing Look at the environment of care – introduce music (as part of the Hospital Arts Programme). Look at the environment of care – introduce music (as part of the Hospital Arts Programme). Meet as a dignity in care group eight weekly to review progress and agree new actions. Meet as a dignity in care group eight weekly to review progress and agree new actions.

10. University College London Hospitals NHS Foundation Trust Themes The benefit of exploring dignity in an imaginative way. The benefit of exploring dignity in an imaginative way. Learning from and hearing experiences. Learning from and hearing experiences. Benefits of joint learning & working together. Benefits of joint learning & working together. Complexity of technical work based cultures. Complexity of technical work based cultures. Enabling communication through creative expression. Enabling communication through creative expression. Enabling understanding leading to change. Enabling understanding leading to change.

11. University College London Hospitals NHS Foundation Trust Reflections… Of the programme –High value of partnership working. –Buy-in & ownership was key. –The need to manage expectation & facilitate outcomes. –Understanding of work base culture. –Managing the relationship between technical Vs experiential learning. –The real world is challenging! –Skilled facilitation & leadership is imperative. More broadly –The need to define & understand what is being talked about – lived experiences. –Robust feedback mechanisms, reporting, performance & quality monitoring. –A piece meal approach will lead to limited outcomes. –Leadership (at all levels), ownership, & buy-in is key. –Ensuring sustainability is crucial.