Dignity, alongside respect, person-centred care, choice, control and independence are all, in my view, part of the basics of care and support.
We all want all of the above for ourselves, so why wouldn’t any person with care and support needs want likewise?
It’s often assumed that professionals working in health and care will know what each of these fundamentals looks like in practice, but that’s not always the case, particularly in relation to dignity. Knowing that we want dignity for ourselves and that we want to provide dignified care and support is a great starting point, but it’s what that looks like practically that is vitally important.
What is dignity?
Much like trying to pin down what wellbeing is and looks like in practice, I have found that trying to pin down what dignity is and looks like in practice can be tricky for some people. The dictionary definition of dignity is:
“The state or quality of being worthy of honour or respect.”
While in my dementia care training sessions, participants have said in relation to dignity:
“It’s about ensuring a person is as covered as possible during personal care.”
And
“Making sure a person doesn’t spill food down their clothes.”
Again I think most of us would agree that both of these things would be what most people who have care and support needs would want. But for me truly dignified care isn’t confined to personal care interactions or mealtime support but about what happens all day and night, every day and night.
Dignity in end of life care
In end of life training I delivered recently for MacIntyre’s Dying to Talk Project, I gave these examples in relation to dignity and privacy (which are two often intertwined themes). They point to the fact that dignity needs to pervade everything that we help and support a person with:
- Ensuring every aspect of a person’s wishes are adhered to, even if this is to the exclusion of people who feel they should be involved in the person’s end of life care.
- Ensuring every interaction you have with the person uses respectful language, and honours their status and qualities as a person in their own right.
- Ensuring the person has the time and space they need to conduct their day as they wish, and in a way that makes sense to them.
- Ensuring the person has absolute privacy when they need support with personal care, or when medical interventions are needed.
- Ensuring that you have the knowledge, understanding and confidence to advocate for the person in situations where their voice needs your support.
- Ensuring all of the above at all times, including when the person may be unresponsive and close to death.
Whilst end of life care is a time, unlike any other, when we have just one chance to get dignified care right, I would say that all of these principles can also apply to anyone who needs care and support at any point in their life, especially those who struggle to have their voice heard, perhaps because of dementia, brain injury, a learning disability or any other health condition.
The Dignity Do’s
Thinking back to my dad’s care, there is only one awareness campaign I remember being promoted in the care home where he spent 8+ years – Dignity Action Day. It falls on 1 February every year and is:
“An annual opportunity for health and social care workers, and members of the public to uphold people’s rights to dignity and provide a truly memorable day for people who use care services.”
Despite the promotion of it within my dad’s care home, I would say that his care wasn’t universally dignified. It had elements of what is dignified, but much poor practice existed too.
Of course, one day of awareness raising is never going to ensure that everyone who needs health and care services has dignified care and support 24/7, 365 days a year. But what the campaign does do is provide a raft of resources that any care provider can use throughout the year to regularly remind staff about dignity and check in with them on their dignity practice.
Amongst these resources is the 10 Dignity Do’s , which despite the fact they aren’t new many staff I work with haven’t heard of.
The 10 Dignity Do’s are:
- Have a zero tolerance of all forms of abuse
- Support people with the same respect you would want for yourself or a member of your family
- Treat each person as an individual by offering a personalised service
- Enable people to maintain the maximum possible level of independence, choice and control
- Listen and support people to express their needs and wants
- Respect people’s right to privacy
- Ensure people feel able to complain without fear of retribution
- Engage with family members and carers as care partners
- Assist people to maintain confidence and positive self-esteem
- Act to alleviate people’s loneliness and isolation
Universal dignity for all
Whilst the 10 Dignity Do’s are more overarching statements than practical examples, they give us all a framework that is invaluable in our care and support provision. They also provide a clear level of expectation that any individual or family member should have of any health or care service that they are accessing.
Just because dignity is seen as a basic element of care and support doesn’t mean we should ever lose sight of the need to understand what it is and actively practice it. Care and support professionals should never assume they are always getting it right, that they know everything about dignity already, or that it’s too basic to bother with. Actively thinking about dignity, and reflecting on how dignified our care and support has been, are all vital to keeping dignity front and central in our minds and our actions.
In 2022 dignity isn’t universally applied to all care and support – we need to get to a point where it is.
Until next time…
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