Enhancing dignity in the care of people with dementia Professor Lesley Baillie
Florence Nightingale Foundation
Chair of Clinical Nursing Practice,
London South Bank University and
University College :London Hospitals
Plan
Types of dignity
• Human dignity: the dignity that all humans have and cannot be taken away
• Social dignity: experienced through interaction - dignity-of-self and dignity-inrelation (Jacobson 2007)
• So for people with dementia:
• We must acknowledge and respect their human dignity
• We must recognise how their dignity is affected by how they feel and by our interactions with them
What is the meaning of dignity? How does it feel to have dignity?
How does it feel to lose our dignity? The meaning of dignity
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Student experience
Dilemmas in promoting dignity Scenario
• Marie goes in to visit her aunt Margaret who has dementia and lives in a care home. Marie finds that she has not been washed and has on yesterday’s soiled clothes. The staff say she did not want a wash or clean clothes today.
Questions
• Are the care home staff’s actions promoting
Margaret’s dignity through allowing her autonomy?
• Or have they diminished her dignity as Margaret previously took a pride in her appearance?
• What alternatives were there? Dilemmas in promoting dignity Scenario
• Tom (a former naval captain) is on an acute hospital ward and is constantly packing his bag trying to leave the ward as he says he has to go to sea. All morning there is commotion as staff try to get him back to his bed.
Tom is clearly agitated and the staff are stressed. Questions
• Are the staff justified in persisting with keeping
Tom on the ward apparently against his wishes? • Or are the staff diminishing Tom’s dignity by preventing him from being in control?
• What alternatives were there? Culture of the care environment
• Social norms and accepted practices
• Culture can have a positive or negative effect on how staff behave • Some wards/teams/ units/care homes have a culture of respect for patients and sensitivity
• Leadership is key
There 's a very(Patient) caring, respectful approach. The ward is friendly - there 's a nice feel about the
People who have dementia are not aware of requirements for living. They can forget to do the essential things that are vital. Taking medicines, hygiene and even eating are often forgotten. They can get lost or hurt and not understand what is necessary to correct a situation. Turning on the cooker or water and forgetting to turn it off again, locking doors, crossing streets etc can all be dangerous even deadly. In the same way as you would not think an infant capable of self care, a person with dementia cannot be either. Considering the facts that they cannot act in the manner of a
Dignity must be at the centre of everything we do if we are to achieve high quality person centred care and support, dignity focuses on the value of every person as an individual it means respecting others views, choices and decisions, not making assumptions about how people want to be treated and working with care and compassion. The principles focus on the key values,attitudes,skills and knowledge required to provide the best care possible, the principles give the workforce and those employ and train them clear guidance and practical tools to understanding how to place dignity at the
A basic part of modern age humanity is dignity. It is self-imposed pride that is susceptible to damage through the verbal and physical actions of others. Hospital and clinical settings can leave a client’s dignity vulnerable. It is where people, now clients, are weak and in some cases unable to function like they once did. This can wound their dignity, but it is the duty of nurses to preserve it. Through respect, support, and by relieving pain and suffering, nurses work to preserve the dignity of their clients. Likewise, nurses are able to easily damage the dignity and integrity of their clients through inappropriate behaviour, a lack of respect, and being irresponsible while on the job. A passage published by a hearing tribunal from the College
Dignity is an important aspect throughout ones life, but becomes particularly in jeopardy when one becomes elderly. This makes it important to uphold the dignity of elders. In my prospective career as a nurse practioneer, I will have ample amount of opportunities to preserve the dignity of elderly patients. As a nurse practioneer I will be able to achieve this in a variety of ways, by promoting autonomy and maintaining the patients self-dignity.
Dignity is the state or quality of being worthy of honour or respect. If you talk about someone’s condition and joke about it then you are not giving them dignity. Treat everyone as a unique person. If you laugh or joke around about their condition to their face tor ridicule them this is not giving them the dignity they deserve. Some people if they are being cared for may feel like they are losing dignity as they cannot dress or clean themselves. Some nurses make fun of the patient. This can lead to them losing confidence. If someone does lose confidence then you should still respect them and treat them with dignity. Some people might get angry if they have someone else washing them as it could be seen as
During my placement during at an aged care facility, it was an important process to ensure that nursing interventions were carried out to ensure a respectful behaviour of a resident’s dignity, culture, values beliefs and
In 2008, the Royal College of Nursing (RCN), published its definition of dignity, which is related to how people see their worth and how they act and behave towards that perceived value. This encompasses the profession’s focus on the individual person. Therefore, a registered nurse must not consider each person as a “case” or identify them as a disease process. Rather, individual needs should also be taken into account. Being able to offer choices, determine the course of their treatment, providing meaningful independent activities, and spending one-on-one time with the patient are just some of the activities that a nurse
There are, however, barriers to maintaining a patient’s dignity. In a survey of over two thousand nurses’, carried out by the RCN (2008), it was found that nurses’ come across several boundaries in relation to maintaining a patient’s dignity. These boundaries were identified as pressures on bed spaces, shortages of staff and a purpose or target centred culture (RCN, 2008). The caring environment can have a huge impact on dignity, it has the ability to maintain a person’s dignity or degrade and devalue them (Gallagher, 2004). Torjuul and Sorlie (2006) acknowledge that overcrowding and mixed-sex accommodation are barriers to maintaining patients’ dignity and privacy. A caring environment that is spacious, clean, with good facilities promotes dignified care (Baillie et al., 2009).
After defining dignity, he begins applying the term to himself. He claims that he has dignity because throughout his many years of working as a butler, he has always put his job first especially on that “turning point in his life,” which consisted of him forsaking his dying father to go and tend to some diplomat with blisters (Ishiguro 70). While he may think that in some way this action is “dignified,” the rest of the world disagrees. It does not make sense for a man to spend his father’s last moments serving wine to guests and getting doctors for blisters. In fact, it shows a lack of “dignity” and a lack of priority.
Micheal J. Fox once said, “One’s dignity may be assaulted, vandalized and cruelly mocked, but it can never be taken away unless it is surrendered.” Human Dignity is a very essential principle. The Catholic social teachings stress that every single individual has a value, is worthy of respect, and has the right to be free from slavery. Through The Enemy Within by Eva Colmers, the loss and gain of human dignity is clearly presented. Humans are the only creatures that are created in “His own image; in the image of God He created him; male and female He created them” (Genesis 1:27).
Nurses spend most of their time with their patients and it is important to show the patient that he or she matters to us by treating them with dignity and respect. According to Yea-Pyng, Watson, and Tsai, in the article “Dignity In Care In the Clinical Setting. A Narrative Review”, “Nordenfelt proposed that the meaning of dignity is ‘grounded in the rationality of human beings and their ability to achieve a moral status’ (p. 100), and that dignity is categorized into the following four types: human value, merit,
Maintaining dignity is not only meaningful in the first stages of caring for an individual, but essential throughout a patient’s care; by giving the element of control, it will help promote patient independence. Promoting dignity can be achieved more easily if the patient and nurse establish a good working nurse-patient relationship, further enhanced by treating each individual equally, regardless of protected characteristics, (e.g. age, culture, race, religion, etc.), to ensure everyone is given the same level of care and importance.
I agree that humans should be treated with dignity right from birth. However each person values different things differently and thinks about self-worth in a different way. One might feel his/her loss of dignity when they have to give up their own clothes and wear a hospital gown whereas, other might feel that their dignity is adequately maintained. Since Canada is a pluralistic society, people from different part of the world reside here. So, whenever a patient arrives in hospital, nurses are obliged to respect their values and beliefs. The way anyone treats people is the reflection of the respect one feels for them. In nursing care, recognizing the vulnerability of the patient to loss of dignity is a primary ethical obligation. Supporting patient dignity is an important aspect of nursing so, the role of nurses in preserving and promoting dignity of vulnerable population is not only crucial but also challenging. These are the ways that nurses can preserve dignity in
Dementia care offers support and services to an individual affected by the disease itself, which is dementia. It addresses the right and needs of the person with dementia and their families. Improving quality of life and changing attitudes towards dementia is the main goal of dementia care. Dementia care also provides quality of care, maintain dignity and promote health, security and comfort in consideration with the standard of care and ethical guidelines (Adams & Manthorpe, 2003).
Human dignity goes along with my expression of altruism in my life. I express human dignity very similar to the way I express altruism, but I express this value further in my work. One main way I express this is through the provision of modesty and privacy in all ways possible while caring for patients. It is as simple as using least exposing methods and being respectful and professional when providing care. I also respect human dignity by giving my patients the power of choice and respecting the wishes that they express. I believe this is important because the hospital environment leaves people vulnerable to have their dignity ignored. Nursing researchers Papastavrou, Efstathiou, and Andreou (2017) describe this problem by stating “threats to health were considered more important than those to dignity and the older people endured threats to dignity in favour of treating the health problem” (p. 94). With this in mind, I work particularly hard to find ways to uphold human dignity always in my work and throughout my life.