Dignity Challenge

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  • 1. Dignity Challenge Andrew Gallini
  • 2. Background
    • Patients’ Dignity must be respected: legislation (Human Rights Act 1998)
    • Codes of Professional Conduct (NMC, 2004; ICN, 2001a, 2001b)
    • Health policy (DH, 2001a, 2001b; 2006a) including Launch of the Dignity Challenge by Ivan Lewis Care Services Minister ( 2006b)
  • 3. Defining Dignity
    • “… a state, quality or manner worthy of esteem and self-respect”
    • “Dignity in care means the kind of care which supports and promotes a person’s self-respect”
    • “ Being treated like I am somebody”
  • 4. Dignity – key elements
    • Respect
    • Privacy
    • Autonomy
    • Self-worth
  • 5. 10. Act to alleviate people’s loneliness & isolation 9. Assist people to maintain confidence & self-esteem 8. Engage with family members and carers as care partners 7. Ensure people feel able to complain 6. Respect people’s right to privacy 5. Listen and support people to express 4. Enable maximum levels of independence 3. Treat each person as an individual 2. Support people with respect 1. Zero Tolerance of Abuse Ten Dignity Challenges
  • 6. Lining up with key targets
    • National focus
    • Increasing focus on performance management of Dignity
    • Shift from Targets to Quality and Outcomes
    Organisational Values - Protected Meal Times - Adult Protection - Single Sex Bays Local Policies – Privacy & Dignity PEAT Essence of Care Benchmarks Standards for Better Health
  • 7. Communication Patient Care Environment Promoting Health Self care Personal Hygiene Mental Health Record Keeping Privacy & Dignity Pressure Ulcers Food and Nutrition Continence Essence of Care Benchmarks
  • 8. Evidence
    • However, patients are vulnerable to a loss of dignity in hospital (Seedhouse and Gallagher 2002; Jacelon, 2003; Matiti and Trorey, 2004)
    • The meaning of dignity as a concept is unclear (Tadd et al . 2002)
    • Dearth of research relating to patient dignity and few studies have explored patients' perspectives.
    • Most previous research relates to older people in long-term settings or terminal care.
    • Human dignity is an essential value of professional nursing (Jacelon 2004)
  • 9. Evidence – Discovery Interviews
    • Research undertaken to understand and improve the experience of patients over 75s, and their carers
    • Identified as a particular cohort of patients whose needs are often more complex, likely to wait longer in A&E and more likely to be admitted.
    • They are also the people least likely to complain and most likely to be overlooked or misunderstood.
    • Discovery interview approach explores what it is like to be the person or carer with a particular illness accessing services
  • 10. Evidence – Discovery Interviews
    • “ The environment could be changed, the noise when they let go of the rubbish bins, and some of the other noise is unnecessary, people are not aware of the level of noise they make when they are rushing around, and it can be terrifying for the patient suffering from dementia ”
  • 11. Evidence – Discovery Interviews
    • “ The staff were all very kind and put her very much at ease, they also explained everything but she’s also in pain so very unlikely to remember what was said or what advice she was given and a follow up phone call knowing her sight is poor is like what should I expect, apart from that I think the service was excellent”
  • 12. Evidence – Discovery Interviews
    • “ One more thing. And please take this to all the consultants. I think if some SHO comes to see you, each one of them should not ask the relative if you do or do not want to resuscitate. I think the first one should ask, they should put a sticker on the notes. With my mother, I was asked by three different young doctors, that caused me some distress, within the five hours that she was there.”
  • 13. Evidence – Discovery Interviews
    • “No, Nobody seemed to have done much. They were sort of buzzing about but the thing that absolutely got me was that I asked “ could I have a glass of water?” and they said “ No I’m terribly sorry we’ve run out of polystyrene mugs” So there was a cleaner man sort of shuffling around and I said “Couldn’t he go and fetch some?” and they said “ oh certainly not, we might have a strike on our hands” and that gave me a fierce fright. So I had nothing to drink, so that wasn’t very good.”
  • 14. Evidence – Discovery Interviews
    • “ I think that, the staff in A&E, as part of their training, should be aware that patients with dementia may become aggressive. I think the staff should be aware of how to handle demented patients. They approach her bed, she doesn’t understand the language, she’s demented, she’s in a strange environment, and they try to change her and she lashes out, and they see it as assault”
  • 15. Evidence Case Study
    • Study looking at one ward and the staff within an acute Hospital on a surgical urology ward
    • 24 patient participants
    • Staff participants: ward based (registered nurses and health care assistants), visiting staff (specialist nurses, doctors and allied health professionals and senior nurses)
    • Range of methods used; Review of documentation, participant observation and interviews
  • 16. Case Study - Overview of findings
    • Patients’ dignity in hospital:
    • Feelings
    • Physical presentation
    • Behaviour to and from others
    • Threats to patients’ dignity in hospital :
    • environment
    • staff behaviour
    • patient factors
    • Promotion of patients' dignity in hospital :
    • environment
    • staff behaviour
    • patient factors
  • 17. Evidence - How patients’ dignity is threatened or promoted in hospital (Baillie 2007)
  • 18. Measuring Dignity – Help the Aged 2008
    • Four cross cutting themes:
    • Choice - support to make choices, personalisation and tailoring care
    • Control – respect for individual lifestyle preferences and involvement in decision making
    • Staff Attitudes – respectful attitude in relation to all aspects of care and courtesy and sensitivity in relation to all forms of communication
    • Facilities – availability and access to appropriate facilities/equipment and cleanliness of facilities
  • 19. Measuring Dignity – Help the Aged 2008
    • Nine domains
    • Autonomy – support to be involved in care if people want to be
    • Communication
    • Eating and Nutrition
    • End of Life Care
    • Pain
  • 20. Measuring Dignity – Help the Aged 2008
    • Personal Care (practical assistance)
    • Personal Hygiene
    • Privacy
    • Social Inclusion
  • 21. Development of Gap Analysis/Action Plan
    • Identifying gaps as well as best practice
    • Clear Trust wide and Directorate Leads
    • Key pieces of work around
      • PPI
      • Adult Protection
      • Improving care for patients with Dementia
      • Nutrition, Falls and Continence
  • 22. Dignity Workshops
    • Wide cross section of staff from range of different healthcare professionals, patients and members of the public and staff from local PCT’s
    • Group work exploring personal commitments to take away to change practice to improve dignity for patients
  • 23. Support to make it happen Quality Teams & Multiprofessional Leads Support for staff who have undertaken Dignity Workshops to deliver on commitments to change Directorate Quality Boards Receives reports from Lead Nurses on progress against action plans Trustwide Dignity Steering Group Gives leadership, direction and support to enable delivery of real change To improve dignity Healthcare Professional or Support member of staff who has undertaken Dignity workshop
  • 24. Summary of achievements
    • Executive Support from Director of Nursing Services
    • Trust wide Steering Group
    • Identifying Champions for Dignity to be able to change practice
    • Gap analysis and Action Plan for six of the Ten Elements
    • Dignity Challenge Workshops
    • Structure to support changes in practice
    • Robust PPI Action Plan
    • Collaboration with Health and Social Care Advisory Service and Kings Funds
    • Developing and integrating this work at Hammersmith Hospitals
  • 25. Next steps - Overarching aims/projects
    • Integrated work on the Dignity Challenge across St Mary’s and Hammersmith Hospitals sites
    • Involvement of patients and the public in focus groups, the steering group to give direction to the implementation of actions to improve dignity
    • Use of Discovery interviews to further inform ways to improve dignity
    • Work around Protection of Vulnerable Adults and
    • Project around improving care of patients with Dementia
  • 26. And Finally!
    • Not optional
    • “About attitudes, not resources”
    • “Dignity is everyone’s business”
  • 27. References
    • Baillie, L (2007) Unpublished PHD Thesis Southbank University, London
    • Dawood, M (2007) Discovery Interviews of the experiences of patients over 75 and their carers accessing urgent care, unpublished.
    • Department of Health (2001a) Essence of Care: Patient-focused benchmarking for health care practitioners . London: DH.
    • Department of Health (2001b) The National Service Framework for the care of Older People . London: DH.
    • Department of Health (2005) Research Governance Framework for Health and Social Care . 2nd Ed. London: DH.
    • Department of Health (2006a) A new ambition for old age: next steps in implementing the National Service Framework for Older People . London: DH.
    • Department of Health (2006b) About the Dignity in Care campaign . Available from http://www.dh.gov.uk/dignityincare
    • International Council of Nurses (2001a) Nurses and Human Rights: International Council of Nurses position statement. Nursing Ethics, 8 (3), pp. 272-273.
    • International Council of Nurses (2001b) The ICN Code of Ethics for Nurses. Nursing Ethics, 8 (4), pp. 375-9.
    • Jacelon, C (2003) The dignity of elders in an acute care hospital. Qualitative Health Research 13 (4), pp. 543-556.
    • Nursing and Midwifery Council (2004) The NMC c ode of professional conduct: standards for conduct, performance and ethics. London: NMC
    • Matiti, M.R. and Trorey, G. (2004) Perceptual adjustment levels: patients' perception of their dignity in the hospital setting. International Journal of Nursing Studies, 41 (7), pp. 735-44.
    • Seedhouse, D and Gallagher, A. (2002) Undignifying situations. Journal of Medical Ethics. 28 (6), pp.368-372.
    • Tadd, W.; Bayer, T. and Dieppe, P. (2002) Dignity in health care: reality or rhetoric. Reviews in Clinical Gerontology . 12 (1), pp.1-4.