Preserving people’s dignity

Accessing health care can be a very undignified experience. People are routinely stripped, prodded, punctured and photographed. They have to reveal intimate details to complete strangers about their smoking, alcohol consumption and toilet habits. Their clothes are taken away and replaced with a gown which, if they’re lucky, actually has a fastener to close it. And they’re removed from the cosy security of their own home and plonked into a six-bedded ward with people on either side who can hear everything they’re doing and everything they’re saying.

It all adds up to a very unusual, and very unreal, experience. Often the only thing people have to cling on to in the middle of that experience is their sense of dignity – that they are individual people with families, friends, jobs, histories and futures, and are not just some cog in a giant health care machine. And everything you do as a health care assistant with and to these people has the power either to strengthen and restore that sense of dignity, or diminish and undermine it.

Look at that last sentence again. It uses the word ‘everything’. And it means ‘everything’, not just the ‘big’ things you do.

It means the way you approach the patient/client, whether you look engaged, interested and friendly, or whether you’re thinking you’d rather be somewhere else. It means whether you ask the patient’s permission to provide care or just get on and do it regardless of his or her wishes. It means the way you speak to people, whether you show in what you say and how you say it that you are genuinely interested, concerned and eager to help, or whether you are just going through the motions. It means the steps you take to ensure the person’s privacy and modesty are protected (closing screens, making sure the patient is covered and keeping your voice level down when discussing personal issues), or whether ‘getting the job done’ is uppermost in your mind. It means the way you respond when a patient/client asks you something or asks you to do something, whether you show you’re attentive and ready to help, or whether you’re far too busy to concern yourself with such trivial things (have a look again at communication to refresh on these vital issues).

All of these things, things which in the midst of a busy day you might not even notice, will certainly be noticed by the person on the receiving end – your patient/client. He or she is in a particularly vulnerable position, which means their sensitivity to the signs you give out will be heightened. Positive signs from you will do much to boost their morale and confidence. Negative signs from you will feel like complete rejection.

Your biggest resource in terms of maintaining people’s dignity is therefore yourself. Your attitude, your manner and your enthusiasm are the three ‘tools’ you can use to bolster people whose self-esteem is low, encourage people whose mood is negative, support people whose confidence is ebbing, and restore to people a sense of dignity. Use them wisely, and with care.

The specific issue of dignity in caring for people with learning disabilities, a group who can be particularly vulnerable to abuses of dignity, has also been addressed by the RCN. See: Dignity in health care for people with learning disabilities.

In the meantime, there are three areas around which dignity is an especially important issue, and we’ll look at them in end-of-life care, dementia and people with bladder and bowel problems.

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