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'How difficult must it be for those who have incontinence?'

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Continence expert and Nursing Times blogger Frank Booth on the dignity and what it means for continence nurse specialists.

We are told that every year, the NHS admits 5.8 million people to hospital. They expect – and generally receive excellent clinical care. But they also expect to be treated with privacy, dignity and respect.

Patients want to minimise the inevitable difficulty of having to discuss personal and sometimes embarrassing conditions like incontinence with strangers. They want to be able to protect their privacy and maintain their modesty yet we need to understand and know many personal pieces of information if we are to attempt a continence cure.

Striking the balance can be difficult for the professional. How difficult must it probably be for those who have incontinence?

The Healthcare Commission’s recent annual surveys show that most patients do indeed feel that their privacy is respected. They also confirm that being treated with respect and dignity as a whole is more important than just being in single-sex accommodation. Nonetheless, the failure to provide single-sex accommodation in some cases can cause great distress to patients.

Do we consider how male patients feel being treated by a female nurse and vice versa for female patients? Surely there is nothing wrong with opposite sex staff dealing with all patients in general terms. But we do need to be aware and take steps to minimise any distress.

In the latest Healthcare Commission standards report, only eight out of 172 acute trusts were declared to have ‘not met’ standard C20b – ‘Healthcare services are provided in environments which promote effective care and optimise health outcomes by being supportive of patient privacy and confidentiality.’

Are we sure that we fully consider privacy and dignity as part of the continence care we give.

  • Do our clinic doors close properly?
  • Do they have a lock to prevent unexpected visitors?
  • Are the rooms fit for purpose and this includes suitable for children?
  • Are the walls neutral, no posters that perhaps an 8 year old or their parents could be embarrassed by?
  • Are there adequate and suitable toilet facilities?

Have you been a patient on a ward? Have you used a commode, been in the bed next to a commode user? Curtains are so thin aren’t they and they do not always close fully.

Educationalists, doctors, nurses and other practitioners should promote the importance of patients’ privacy and dignity within the NHS. This issue should be integrated into undergraduate and postgraduate healthcare curricula.

The UK’s first law protecting personal privacy of the population as a whole was announced in the Queen’s Speech on May 4 1997 and led to the enactment of the Human Rights Act 1998. Article 8(1) it reads:

‘Everyone has the right to respect for their private lives.’

However, Article 8(2) explains that the right to privacy is not an absolute right but a qualified right. That is, health professionals may interfere with the exercise of this right to privacy if they believe that it is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others’.

The Nursing and Midwifery Council (NMC) Code of Professional Conduct states that all registered nurses should respect the patient as an individual and promote and protect the interests and dignity of patients. Essence of Care outlines a benchmarking process to help practitioners.  This is an approach to sharing and comparing practice. It identified seven factors relating to privacy and dignity against which healthcare teams can benchmark practice.

Privacy and Dignity, Cultural Awareness Groups exist in many Trusts. The main purpose of these groups is to ensure that Trusts identify and meet patient’s needs and complies with national standards with regard to privacy and dignity and religious and cultural beliefs.

Do we really consider religious or cultural beliefs?

I dare say that if you work in a very mixed cultural area cultural awareness will be high on the agenda but in my Trust it was difficult as our ‘ethnic minority’ was less than ½ of one percent. As a consequence it was not something always in the forefront of one’s mind, it was something that we had to work hard to achieve.

The 2008 The Royal College of Nursing Congress had privacy and dignity as a main theme.

Many of the nurses (86% in the Congress survey) wanted privacy and dignity as a higher agenda item. Those of us who have been a patient realise how very important privacy and dignity is and how some colleagues care so much and yet others… perhaps need to review what they do. Just a simple kind word whilst undertaking observations is all it takes and don’t forget that when a nurse is a patient he or she is a patient first and a nurse second. Your knowledge when you are ill flies out of the window.

As a Clinical Nurse Specialist (CNS) you are a leader in your field and in the area of privacy and dignity you above all must be a serious driver of this agenda.

When we see patients, we talk openly about body parts, about the unmentionable ‘pee’ and ‘poo’.  We frequently ask people to undress and undergo the most intimate of examinations.

We do all this sometimes without thinking. It’s something we do, maybe 20 times every day.

Our watchword therefore must be to stop and think. To consider what we do so routinely and try to ask ourselves, ‘what if it was me?’ What would you want from your care provider?

Having been a patient in several areas in the last 2 years I have become acutely aware of the need for privacy and dignity and I do believe that we really do care, but sometimes, in our haste to get the job done, to improve efficiency we could be at risk of letting some things slip and as a CNS you can’t do that can you?

Clinician, educator or simply an expert in your area, your standards must not just be high but the highest.

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