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'Ensuring dignity in hospital care is not rocket science'

The 2009 report of the closed Mid Staffordshire inquiry identified privacy and dignity as particular issues at the trust.

Accounts of patient experience included cases of incontinent patients left in degrading conditions and delays in responding to requests to use the toilet.

As a consultant nurse for continence care, I hear stories of older patients who have suffered from indifference and, in some cases, poor nursing care in relation to privacy and dignity associated with using the toilet or incontinence.

When it comes to dignity, it is often the little things that count and make all the difference to patients’ perceptions. Elimination is a normal bodily function; adults are conditioned to manage their own bladder and bowels by using the toilet in private. This is taken for granted until admission to hospital, when both independence and privacy are compromised or threatened, causing embarrassment and distress.

Nurses must consider how they can improve ward environments to ensure privacy and dignity for patients when they need to use the toilet or conduct personal care. Using common sense when assisting people to use the toilet helps to maintain their dignity. This means responding quickly to requests to use the toilet and wheeling the patients to the toilet to minimise the use of bedside commodes where possible.

Getting this right is not rocket science. It’s about putting yourself in the patient’s shoes and being treated like you would wish to be treated. It doesn’t need to be complicated. However, the Royal College of Nursing considers that dignity is a complex concept, with a value and philosophy that is central to nursing and at the heart of nursing care. I would argue that dignity is more about little things that are hugely important, such as maintaining hygiene, personal appearance, having access to the toilet in private, being offered choices about what happens and being involved in decisions.

Concern is mounting within nursing as the Francis report looms and the profession braces itself to face criticism about evidence that many hospitalised patients and those in care homes are not being treated with dignity. The Care Quality Commission has reported that the NHS is failing patients in this area and called for immediate action to improve the culture around caring for older people to restore dignity. Chief nursing officer for England Jane Cummings also believes that the nursing profession needs to show more compassion to patients to provide better care. We should applaud her call for a rediscovery of compassion in nursing.

In relation to the fundamentals of care, if personal, private issues like using the toilet are not managed promptly or sensitively in hospital, it is likely to have a profound impact on dignity. Without sensitive and empathetic support, the potential exists for continence care to be undignified and impersonal. Respect for privacy and dignity must be a priority of care and must be at the forefront of nurses’ minds.

Karen Logan OBE is nurse consultant - head of continence services at Aneurin Bevan Health Board, Cwmbran

Readers' comments (19)

  • what are we supposed to say to patients who normally walk to the toilet during the day but insist of using urine bottles or bedside commodes overnight? that is not very nice for the other patients and how often do urine bottles get spilled which nursing staff have to clear up.

    Is it about time we did away with open back nighties and pyjamas with no fly buttons, do all patients need to wear bedclothes all day and why don't they wear underwear?

    We definitely need more toilets and bathrooms and surely all siderooms should be ensuite.

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  • The best way to treat anyone with dignity is to imagine yourself in their position.

    Would you like to balance on a bed pan in a ward where everyone can hear and smell you?

    Would you like your body to be treated like a piece of meat with no regard to modesty?

    Would you like to be stripped of your clothes and bathed or showered by a nurse of the opposite sex?

    Preserve a patients dignity and modesty at all times. Treat the person not the illness.

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  • It is difficult to disagree with anything which Ms Logan says.

    It is a pity therefore that she seeks to align herself with the 6C nonesense and disapointing that Ms Logan does not acknowledge that Mid Staffs was a management led disaster.

    Registered nurses were deliberately removed from the hospitals staffing establishment and the nursing skill mix was destroyed in favour of "care assistants.

    It is surprising that what few nurses were left managed to provide any care given the appalling patient care environment which "management" created.

    Take a close look Ms Logan at a hospital near you will discover patients are without doubt being exposed to risk and are recieving poor care. This is not because nurses do not care but because there are not enough nurses and the few available are tasked with the impossible as well as a mountain of paperwork !

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  • i would like people to know that I did not design or build the hospital where I work, I did not take the decision that three toilets for 28 patients would be sufficient.

    someone has mentioned nurses of the opposite sex washing patients, I am assuming here that they mean male nurses washing female patients, female nurses have been washing male patients since the year dot.

    i try and answer buzzers as soon as possible but when there's only two of us on the ward we can only do one thing at a time, despite what others may say.

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  • having enough staff to look after patients properly isn't rocket science either.

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  • so it is true that in British hospitals facilities have to be shared by more than two patients. in the name of pt. care in medical facilities, hygiene, infection control and dignity of human beings this is inconceivable and totally unacceptable. and I fail to understand why qualified

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  • anon 11.51 - where do you work? how is the health system run? what do you fail to understand?

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  • Anonymous | 26-Jan-2013 6:08 pm

    sorry I fail to understand how I managed to post my comment mid-sentence. I can't exactly remember but I think I was probably going on to say that I fail to understand why qualified nurses allow such conditions for their patients.

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  • Elderly female patients should not have personal care carried out by male nurses.

    Elderly male patients should not have personal care carried out by female nurses.

    Just because you are a nurse and you "have seen it all before" and make comments like "you haven't got anything I haven't seen before" does not make a vulnerable patient feel better.

    Just because females nurses have been washing males patients since the year dot doesn't make it right or acceptable.

    Dignity starts with nurses treating their patients as people and not as sheep to put through the dip.

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  • Anonymous | 26-Jan-2013 11:01 pm

    Thirty odd years in nursing and I have never seen a patient treated the way you describe. I wonder who or where you are referring to?

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  • anon 11.01 - are you a nurse yourself? do you only care for patients of your own sex? have you ever actually heard a nurse say the things you describe?

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  • Andrea Browne

    I work on an acute stroke ward, we encourage patients to use the bathroom for toileting and showereing but many are reluctant to use them. I agree the staffing will never be right, Trained staff have more and more paperwork to deal with as well drugs to adminster. so most of the hands on care is down to the health care assistant. but like someone mentioned if there is only two of us to answer buzzers we can only answer one at a time. Time the management and government came and worked on the wards and see what it is really like.

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  • In an ideal world patients should have personal care carried out by nurses of whichever age/sex they prefer. However, in our less than ideal world, there are many more female nurses than male, and not enough of either of them - which is worse for your dignity, having care carried out by a nurse of the opposite sex, or not having it carried out at all?

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  • As a man I find it is all about approach and kindness.

    If I answer a call bell and its an old lady who requires some kind of personal assistance I will always give the lady a choice of my assisting or my asking a female colleague to help. It is only very rarely I have to involve a female colleague ,

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  • Anonymous | 27-Jan-2013 2:28 pm

    I agree. asking the patient (depending on staff available), is also treating them with dignity and respect.

    Unfortunately, our patients had to accept that there was not always a choice but handled with tact and diplomacy, and the respect they always received from us, it was usually not a problem.

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  • so, in an ideal world, we only have male nurses working on male wards and female nurses working on female wards - is that really ever going to happen.

    could patients be given the choice of how old they would like their nurse to be, how would that work? has any patient ever asked to be looked after by a nurse of their chosen age? - not in my 20 years.

    someone has said that 'elderly' patients should be looked after by their nurses of their own sex, so does that mean that younger patients are not to be given the same choice?

    nurses are professional, caring and compassionate - they are there to look after patients, a male nurse is no less professional than a female nurse. I couldn't care less how old or what sex my nurse is as long as they look after me properly.

    who do people think looked after male patients in the days when nursing was pretty much 100% a female profession?

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  • anon 2.28 - in your experience have any male patients ever been asked if they would prefer a male nurse or requested that a male nurse look after their personal needs?

    I am not a fan of commodes or bedpans and always encourage patients to use the loo, what should I do if both toilets are occupied and three patients are desparate - ask them to wait or offer a commode?

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  • to anon 11.01 - i work on a 30 bedded male ward, we don't have any male nurses at the moment so do you think it would be alright for our patients not to be washed or taken to the toilet anymore.

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  • My father recently died in a care home..i just received his notes today and time and time again he refuses to be washed by femLe staff and is abusive to he was left unwashed and not turned until he developed bed sores. He was assigned a male keyworker according to his notes which my family did not know. We only ever saw the male carer attend to dad for one full never called out or complained. It s a great shame that nurses do not ask if the elderly or anyone else for that matter ask if they would prefer a male carer when they refuse to be washed...we know and we told the care staff that dad was embarrassed at soiling the bed and having young female carers aged 18-20 cleaning him up...maybe we should all put ourselves in the patients would we like it!!

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