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