University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

ENABLING DIGNITY IN CARE ENABLING DIGNITY IN CARE THROUGH PRACTICE THROUGH PRACTICE

DEVELOPMENT WITH OLDER DEVELOPMENT WITH OLDER PEOPLEPEOPLE

Jonathan WebsterJonathan WebsterAngela DobsonAngela Dobson Eloise HorganEloise Horgan

Funded by the Foundation of Nursing Studies and Funded by the Foundation of Nursing Studies and supported by Age Concern Islingtonsupported by Age Concern Islington

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

Why…..?Why…..?• National Campaigns – DoH, RCN, Age National Campaigns – DoH, RCN, Age

Concern…Concern…• Core to essential care.Core to essential care.• Impact of undignified care on the person.Impact of undignified care on the person.• Understanding dignity is complex and poorly Understanding dignity is complex and poorly

defined defined (Woolhead et al 2004).(Woolhead et al 2004).

• Although high profile, challenges remain Although high profile, challenges remain (Webster (Webster 2007).2007).

• Dignity work highlighted key areas Dignity work highlighted key areas (UCLH 2007).(UCLH 2007).

• Opportunity to learn and understand together.Opportunity to learn and understand together.• Technical Vs Experiential learning?Technical Vs Experiential learning?

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

‘‘The discussions allowed me to open-up and share The discussions allowed me to open-up and share experiences which have not been expressed experiences which have not been expressed previously. I was comfortable to get rid of the pain. previously. I was comfortable to get rid of the pain. The relief was immense.’The relief was immense.’

‘We’ve travelled on a long fruitful road. We have ‘We’ve travelled on a long fruitful road. We have been through all possibilities that can be done in been through all possibilities that can be done in order for patients to be allowed their dignity; order for patients to be allowed their dignity; hopefully older people will overcome their fears of hopefully older people will overcome their fears of being hospitalised as a result of this.’being hospitalised as a result of this.’

‘There was space to make my views heard and ‘There was space to make my views heard and respected.’respected.’

‘…a catalyst for action.’‘…a catalyst for action.’

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

Work Based Projects Work Based Projects an an

illustrationillustration……• Promoting increased effective communication Promoting increased effective communication between nurses and older people – use of patient between nurses and older people – use of patient diaries.diaries.

• Working with the multidisciplinary team to ensure Working with the multidisciplinary team to ensure that dignity in care is an integral part of team that dignity in care is an integral part of team meetings.meetings.

• Introduction of:Introduction of:– Please keep quiet noticesPlease keep quiet notices– Review dividers to curtainsReview dividers to curtains– Performing theatre check lists in patients roomsPerforming theatre check lists in patients rooms– Ensuring patients are greeted on arrival in the Ensuring patients are greeted on arrival in the

departmentdepartment– Pre-operative visits to assess and meet patientsPre-operative visits to assess and meet patients

• Ward based notice board focussed upon raising Ward based notice board focussed upon raising awareness of dignityawareness of dignity

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

Work Based Projects (cont.)Work Based Projects (cont.)……• Raising awareness of ensuring curtains are kept Raising awareness of ensuring curtains are kept

closed and that closed doors aren’t opened without closed and that closed doors aren’t opened without seeking permission first.seeking permission first.

• Increased vigilance at meal times to ensure all Increased vigilance at meal times to ensure all patients (who need help) receive support to eat patients (who need help) receive support to eat and drinkand drink

• Increasing awareness of the need to encourage Increasing awareness of the need to encourage patients to wear their own clothingpatients to wear their own clothing

• Look at the environment of care – introduce music Look at the environment of care – introduce music (as part of the Hospital Arts Programme).(as part of the Hospital Arts Programme).

• Meet as a dignity in care group eight weekly to Meet as a dignity in care group eight weekly to review progress and agree new actions.review progress and agree new actions.

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

ThemesThemes

• The benefit of exploring dignity in an The benefit of exploring dignity in an imaginative way.imaginative way.

• Learning from and ‘hearing’ experiences.Learning from and ‘hearing’ experiences.

• Benefits of joint learning & working together.Benefits of joint learning & working together.

• Complexity of technical work based cultures.Complexity of technical work based cultures.

• Enabling communication through creative Enabling communication through creative expression.expression.

• Enabling understanding leading to change.Enabling understanding leading to change.

University College London HospitalsUniversity College London Hospitals NHS Foundation Trust NHS Foundation Trust

Reflections…Reflections…Of the programmeOf the programme

– High value of partnership working.High value of partnership working.– Buy-in & ownership was key.Buy-in & ownership was key.– The need to manage expectation & facilitate outcomes.The need to manage expectation & facilitate outcomes.– Understanding of work base culture.Understanding of work base culture.– Managing the relationship between technical Vs experiential Managing the relationship between technical Vs experiential

learning.learning.– The ‘real world’ is challenging!The ‘real world’ is challenging!– Skilled facilitation & leadership is imperative.Skilled facilitation & leadership is imperative.

More broadlyMore broadly– The need to define & understand what is being talked about – The need to define & understand what is being talked about –

lived experiences.lived experiences.– Robust feedback mechanisms, reporting, performance & quality Robust feedback mechanisms, reporting, performance & quality

monitoring.monitoring.– A piece meal approach will lead to limited outcomes.A piece meal approach will lead to limited outcomes.– Leadership (at all levels), ownership, & buy-in is key.Leadership (at all levels), ownership, & buy-in is key.– Ensuring sustainability is crucial.Ensuring sustainability is crucial.