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Enabling Dignity in Care

Dr Rekha Elaswarapu is an Advisor to Helping Hands; she is a dignity champion and an experienced professional who is passionate about quality improvement and better outcomes for people using services in health and social care.

With over ten years of experience in health and social care environment both in policy and regulation as well as research, Dr Rekha  has acted as a senior policy advisor and project manager specialising in older people, nutrition and hydration, dignity and privacy, end of life, long term conditions, user voice and age discrimination with significant experience of government liaison. She was a key player in the development of many national strategies such as Carers Strategy, Stroke Strategy, Nutrition Action Plan and Dignity campaign.

She recently spoke to Helping Hands about what Dignity means to her:

Q: What do you think determines dignity?

A: Dignity is a complex term, which has a variety of meanings depending on individual values and beliefs. People are more commonly able to determine a lack of dignity than explain the meaning of dignity. The Royal College of Nursing’s definition of dignity is:

Dignity is concerned with how people think, feel behave in relation to the worth or value of themselves and others…. To treat someone with dignity is to treat them as being of worth in a way that is respectful of them as valued individuals.

I think this is good definition.

 Q: What are the most common examples of failing to provide dignity in care?

Each person is different and something that one person considers undignified will not necessarily be thought of the same way by another person.  But I believe that a guiding principle of all carers should be to treat the person receiving the care as they would wish to be treated themselves.

Some simple examples of where dignity is not provided may include things such as:

• Being addressed in an inappropriate manner

• Being spoken to as if they were not there

• Not being given the proper information

• Being left in soiled clothes

• Being exposed in an manner which could cause embarrassment

• Not being given appropriate help with eating and drinking

• Having to use premises that are unclean and smelly

• Being in a noisy environment at night causing lack of sleep

These are basic elements of care which all carers need to ensure are never compromised.

Q: How should employers engage their care staff to ensure that both staff and customers are being well treated and cared for?

Poor quality of care most often derives from poor staffing levels, disjointed thinking , poor management and a lack of communication between front line staff and management.  This results in low morale and poor work environment which has a negative effect on the care being delivered to customers.

There are some simple actions which employers can take to ensure that risks are minimised; these include:

• Involve staff in the decisions about delivery of care in their care settings

• Provide staff with clear information about their roles and responsibilities

• Treat all staff well as individuals

• Enable staff to develop themselves and reward them for a job well done

• Having access to the right skills and competencies for doing their job

• Not being subject to unacceptable behaviour from customers or colleagues (such as violent and abusive behaviour or harassment and bullying)

• Having access to processes to raise concerns and unfair treatment, (whistle-blowing)

 Q.  There has been a lot of talk about dignity enablers, what exactly are they?

To me a dignity enabler is something which makes it easier to for care staff to treat their client with dignity.  It could be a person, a policy or a practice, but each of should be considered in conjunction with the others as they are intricately linked and have an impact on the quality of outcomes.

• Leadership and culture – a strong and robust leadership is a key indicator of dignified care in any care setting. Where there is a clear commitment from senior management to making dignity a high priority staff are much more aware of their responsibility. This is achieved by regular discussions about how to break down barriers to promoting dignity.

• Training and competence – Raising awareness about dignity is vital to ensuring that staff recognise the need to promote dignity as the fundamental step in ensuring dignified care.

• The caring environment – The physical and working environment can play a huge role in how staff feel about themselves and how they provide care in any care setting. Lack of equipment, facilities and not having clear information or not being able to express opinions can result in a task based approach and a decline in moral which will effect the care being delivered.

• Monitoring and recognition – Recognizing good practise and learning from poor practice is an integral part of any learning organisation. Care organisations should monitor how staff are treated and put necessary systems in place to support them to provide high quality care.

• Whistle-blowing – Incident reporting and whistle-blowing are effective ways of identifying poor performance and management must have clear procedures to facilitate this. Developing a culture of no blame and providing opportunities to raise concerns is a key determinant of enabling staff to feel well supported and valued.

Q Is there anything else you would like to add?

The frontline of dignity in care will always be the carer/client relationship and of course this is the is an area which receives a huge amount of focus from dignity champions but expecting staff to deliver care with dignity when they themselves do not fee valued or respected is detrimental to the cultural of any organisation.  Dignity needs to be engrained into an organisation’s culture from the top to the bottom, across all functions and departments; it is everybody’s responsibility.

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