Clinical placements

Enabling a patient to go to the toilet with dignity is a key component of good care

By actively listening to the patient I anticipated her needs

By actively listening to the patient I anticipated her needs


Picture: Getty

In my second year of nurse training I was on placement in a rehabilitation hospital where I helped to care for a woman in her early sixties, who I will call Helen.

Helen was recovering from extensive road accident injuries, including a fractured spine and pelvis, severe bruising and a fractured jaw.

Following surgery to her jaw, Helen would dribble quite a bit, which made her feel embarrassed, and she was still experiencing a lot of pain.

Helen had to attend frequent outpatient appointments in the main hospital, which made her extremely anxious – she often struggled to speak because of the pain and had difficulty mobilising alone.

In need of support

She told me being unable to communicate her needs effectively made her feel isolated and that her limited mobility made her feel like a burden. This made her tearful and I realised she needed a lot of support, physically and emotionally. I asked my mentor if I could attend Helen’s outpatient appointments with her to provide the extra support she needed.  

During one of these visits I realised just how difficult this was for Helen. We were transported to the main hospital by ambulance, and after her appointment we had to wait  more than an hour for the ambulance to take us back to the rehab hospital.

While we were waiting, Helen needed to use the bathroom, but there were no healthcare support staff around, only reception staff. I knew I would need extra help in getting Helen to the bathroom because she was in her wheelchair and unable to weight-bear.

'The enormity of the situation hit me – how would Helen have coped if I hadn’t been there?'

In the rehabilitation hospital, we had been using a rotunda to assist with mobilising. I asked the reception staff if they had one in their department and one was finally found. But it was still a real struggle getting myself, Helen, her wheelchair and the rotunda into such a small bathroom, which was not suitable for wheelchair users.

I gave Helen some privacy to use the toilet and while I was waiting for her, the enormity of the situation hit me – how would Helen have coped if I hadn’t been there to help her?

Loss of dignity and sense of agency

When I returned, Helen was clearly upset. She said she felt undignified and helpless, and that if I hadn’t been there to assist her she would have been in a bit of a mess.

Addressing a patient’s continence needs is an important part of fundamental nursing care. It is vital in maintaining a patient’s dignity, enabling them to feel like a person, not just a patient.

Treating people as individuals and upholding their dignity also forms part of the Nursing and Midwifery Council (NMC) Code, which states that nurses and midwives should ‘treat people with kindness, respect and compassion,’ and make sure they are delivering the fundamentals of care effectively.

Before her accident, Helen was independent and fully mobile, so not being able to go to the toilet by herself was causing her great distress. She was worried about the embarrassment an episode of incontinence would cause, as well as the discomfort.

Action to protect skin integrity

Patients who experience urinary or faecal incontinence have an increased risk of dermatitis. This can cause a moisture lesion, where skin becomes damp and potentially saturated due to the exposure of excess moisture. It is essential nurses and healthcare support workers do all they can to protect patients’ skin integrity, and gain advice from tissue viability specialists where necessary.

During her recovery, Helen also needed help with other activities of daily living. She told me she had lived a normal, happy life before her accident, but was starting to feel depressed that she could no longer wash and dress herself, even brush her hair or eat, without needing assistance.

'Small acts of kindness and compassion can make all the difference to a patient’s recovery – seeing an initially tearful and anxious patient smiling and much happier was wonderful'

When helping her with these tasks, I made sure to treat Helen with compassion and empathy to minimise her embarrassment, encouraging her to do as much as she was able. I also asked if she needed assistance with certain tasks, rather than assuming what she was and wasn’t physically capable of.

Working with Helen was a rewarding experience in so many ways. It demonstrated how small acts of kindness and compassion can make all the difference to a patient’s experience and recovery, and seeing an initially tearful and anxious patient smiling and much happier was wonderful.

Importance of active listening

On the final day of my placement I received a letter from Helen thanking me for being her eyes and ears in her time of need, and for showing such compassion when caring for her.

As nurses, we are constantly busy and fighting against the clock. But this experience reminded me of the importance of actively listening to patients and treating them with the respect they deserve when addressing their fundamental care needs.


Hayley Ford graduated from the University of Nottingham in September 2018 and now works as a staff nurse on an acute nephrology and transplantation ward in Nottingham @Haylesmg_84

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