Patient dignity has never had a higher profile. Yet in practice, we are struggling to deliver the level of care patients would like. Acknowledging that more work is needed, the government and the RCN have stepped up efforts to tackle the barriers to respect.
Last week the RCN launched its Dignity: At the Heart of Everything We Do campaign. The drive casts its net wide over all patient groups in the UK, while the government’s Dignity in Care campaign, launched in 2006, focuses on improving the treatment of older people in England.
The government last month launched a series of national tours to reinforce the dignity message and drive up recruitment of dignity champions to 3,000 by the end of this year. It also appointed broadcaster Sir Michael Parkinson as the national dignity ambassador for its campaign.
Junior health minister Ivan Lewis, who is leading the campaign, tells NT he wants the issue ‘to rage on every ward and in every care home’. He says while treatment scores highly in patient surveys, the area in which patients feel the health service
lets them down is not being treated with dignity.
This is where he believes nurses can do more. ‘Organisations have a responsibility to support nurses with the necessary resources but nurses have a responsibility to see that dignity is at the heart of care. We know that many nurses do this but equally we know that patients are saying they want to be treated as individuals,’ he says.
Last month’s announcement by health secretary Alan Johnson that nurses could in future be rated on such things as patient nutrition and falls reduction, as part of new government indicators to measure the quality of nursing care, may help to focus minds on treating patients with dignity.
But the consistent message from nurses has been that factors like staffing levels, targets and paperwork all conspire against delivering dignity in care.
An RCN survey of over 2,000 members, published in April, found that eight out of 10 nurses leave work feeling distressed because work pressures prevent them from treating their patients with due dignity.
The RCN campaign has taken this on board and focuses on steps nurses can take to improve dignity in care, while acknowledging the challenges they face.
‘Nurses are saying they are finding it harder to find the time to attend to the little things that make such a difference,’ says Pauline Ford, RCN dignity campaign lead.
The RCN survey found that a key barrier to delivering patient dignity is a lack of consensus on what dignity means in a diverse workforce and patient population. Staffing and a lack of resources, such as space for privacy, also make it difficult to create an environment that promotes dignity. ‘There is no end to the day-to-day challenges nurses face,’ Ms Ford comments.
To address these barriers, the college has launched an ‘e-learning tool’, which serves as a tutorial on what dignity means to patients. A DVD and ‘facilitators’ pack’, to be launched in the autumn, demonstrate good dignity practice and encourage nurses to reflect on everyday practice.
The campaign also aims to help nurses to become better influencers. To this end, a pack with tools and techniques in the art of influencing will be available in the autumn to help nurses persuade trust managers and commissioners to give them the resources they need to improve dignity.
Ms Ford hopes the campaign will increase cross-sector working. ‘It would be nice for nurses to step outside their specialty and work trust-wide on dignity, which is already happening in a lot of trusts,’ she says. To support this, the college is developing a website to enable people to share their experiences to ‘overcome what seems an insurmountable challenge’, she adds.
Jonathan Webster, older people’s nurse consultant at University College London Hospitals (UCLH), who helped to develop the RCN campaign DVD, says these profile-raising activities are vital to keep a complex issue at the forefront of nurses’ minds.
‘We have the Essence of Care benchmarks but dealing with issues around attitude and behaviour is very challenging when nurses are under such huge pressure,’ he says.
Mr Webster agrees with the RCN that half the battle is reaching a consensus on what dignity means to patients and nurses. He led a seven-month pilot at UCLH with charity Age Concern that brought older people and nurses together to explore and identify people’s expectations of dignified treatment.
Nurses used this feedback for reflective learning to look at how to apply the sessions to practice and peer training. Subsequent changes include greeting patients when they enter the ward, seeking permission before opening curtains, helping patients to wear their own clothing if they wish and helping them to eat and drink.
While Mr Webster admits this kind of pilot is uncommon in trusts, he hopes the RCN campaign will inspire nurses to take a more creative approach to improving dignity. At the same time he says organisations must support nurses. ‘The national work raises the profile of the issue but at the end of the day it comes down to buy-in from organisations. It is crucial that they embed dignity and have additional resources to support staff.’
Others are sceptical that campaigns alone can make a difference. Managers should take a hard line on bad attitudes, says Angela Kydd, senior lecturer at the school of health, nursing and midwifery at the University of the West of Scotland and member of the British Society of Gerontology.
‘Rather than having guidelines on how to treat people humanely, I would suggest a zero tolerance approach to any staff who treat patients in an off-hand or abrupt manner,’ she says.
Charlotte Potter, Help the Aged senior health policy officer, says that while it is important to raise awareness, ‘there is a danger of thinking of dignity in terms of celebrity’, referring to Michael Parkinson’s dignity figurehead role.
She adds that tangible and measurable steps on nutrition and privacy need to be taken to improve dignity. ‘Campaigns like the RCN’s can take things forward but ultimately it is the government’s responsibility.’
Mr Lewis counters that there have never been more measures in place to improve dignity in care and says this focus will only continue with the imminent publication of the NHS Next Stage Review being carried out by Lord Darzi, and forthcoming NHS Constitution, which he hints ‘will clearly signify an emphasis on respect’.
Mr Lewis does not think improving dignity requires more NHS funding. ‘People can’t demand ever more resources. Trust managers need to make the decisions, for example, by employing more staff on dementia wards because it takes more time to understand the patients,’ he says.
He points to the success of the NHS’ Productive Ward programme, supported by NT and designed to free nurses’ time for direct patient care, which he wants implemented in every trust. He says evidence from pilot sites shows the amount of time nurses have to spend with patients doubled, while time spent on handovers and paperwork reduced because of system-wide changes to ward practice, such as mealtimes and drug rounds.
He sees nurses driving forward its introduction after the government announced £50m last month to support the programme’s mainstream implementation.
‘Nurses should start asking managers why they haven’t got Productive Ward in their trust. There needs to be bottom-up pressure as well as top-down change.’
Practical steps to improve dignity