Diagnostics

If gowns are the issue, you could encourage patients to wear two, one facing and back and one facing front in order to preserve their modesty, or, in the letter they receive about their appointment, encourage them to bring their own dressing gown to wear while being in the sight of other patients when they are waiting for their procedure. If the patient requires assistance to change, someone should be provided to assist them in a quiet and unobtrusive manner

Hi,
Hi,
Without being too prescriptive I really think that to improve Dignity for all people using your service it is about how the staff in your department approach, address and communicate with the users of the services.
Most people understand that departments in hospital are really busy places but get upset of the little things such as:-
*Speaking "down" to a person.
* Speaking in a stereotypical manner i.e. using terms such as 'the elderly' and presuming that all older people behave in the same way.

So basically I think that training in attitudes and approach is often what is needed first. People can tell when a smile is not genuine and when 'have a nice day' is not sincere. So another aspect is that you need to right people to work there - people who care.
Root out the bad attitudes and use HR management effectively.

Just some thoughts off the top of my head.

1 A Dignified Revolution can undertake inhouse courses for your staff - do have a look at what we are doing on our website www.dignifiedrevolution.org.uk

2 The OU course K101 "Introducing Health and Social Care" is value based but not necessarily the right resource for all staff. Parts of it are free on our open learn web site. openlearn.open.ac.uk/

3 However, the OU is very interested in developing short open learning courses for employers in partnership with them - so do contact me if you are interested. It is possible to write a short course for use in your organisation. We are doing this for various other employers. A short course on Values and Attitudes around Dignity might be useful in many areas of practice!!

Regards and hope that my comments are useful.

Lorraine
A Dignified Revolution

Lorraine Morgan
Tiwtor Staff/Staff Tutor

Y Brifysgol Agored yng Nghymru/The Open University in Wales
029 20 262760/Mobile 07 827895862
Fax: 029 20 388132
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http://www.open.ac.uk/wales
http://www.open.ac.uk/hsc

Hi, Lorraine is absolutely right and to add to what she has just said I would say Do Not Assume. Just because a patient may have difficulty speaking, it does not mean they do not hear and understand everything being said around them and about them. I have noticed that some staff seem to forget that. And, in general, treat others like you would like to be treated, or you would like your family members to be treated. Just the thought that many patients are someone's parents, sisters or brothers shoudl be enough to make most staff stop and think about the way they are treating people.

And - Lorraine - thanks for the link!

Andrea Evans

In response to your comments about people treating people as they would like to be treated themselves or how their own family members are treated. I totally agree.

The problem is, I think some care staff or nurses take ownership over the residents and they just become their patient's and they forget that they've got, ears, eyes or feelings or even that they are people just like them.

I find that some people who work in care settings also seem to forget that the family members have rights to have a say or an opinion, and feel they have no business with their relatives care at all.

I feel that that once a person becomes a permanent resident in a home they feel that they own the person, and that they should be making all the decisions from now on. They seem to feel that relatives that are taking a lot of interest in their loved ones and keeping staff informed of their likes, gripes, or worries, are interfering or spying on them.

I think this is sad. I for one had my mother living in a care home, and we had a big family. The home accommodated us all at any time, I'm glad to say they were very friendly and very helpful. We would go there trying to encourage our Mum to eat when she wasn't eating and even buying our own food supplements sometimes, trying to keep her going. I would hate to think that any of the staff thought we were undermining them, or that my mum was now no longer any of our business.

Yet this is something that I hear all too often now I work in a care home. Comments such as "Oh here they come, checking up on us again" or "What they spying on us for this time" I find this sad. Just because our relatives go into a care home it does not mean that we do not love them or want them any more. In fact we quite often feel guilty that we have not been able to cope by our selves, and just like my family, would want only the best for our loved one, and we hope our loved ones recognise that we have not abandoned them.

If they lack such respect and compassion for the residents and their families, and feel it necessary to make comments like this, I think that either they are in the wrong job, or they have been in it too long. Maybe it's time to give up. Or maybe we need to teach or preach more about respect and compassion. Or simply remember, just like you said, Treat people as we would like to be treated ourselves. If only they stopped to take a moment before they acted or opened their mouths and just ask themselves how would I feel about this, if this was me, then maybe they would act differently.

I think the secret is to work and liaise with the families and make them feel as included as much as possible in the care and activities of their relatives. By keeping them informed, giving them opportunities to join in activities, and by showing them compassion too. Letting them know you understand how they feel, making them feel welcome when when they come to visit.

I feel this works to everyones advantage and creates or contributes to a feeling of trust and contentment for the residents, their families and the care staff within the home.

A little Courtesy and Respect goes a long way.

HI,
Sally - your comments are so well put.

The work that Mike Nolan (Senses Framework 2004) and others developed, as well as Prof Julienne Meyer and Tom Owen have done re the My Home Life programme reinforces what you are saying.
The Senses Framework model is ideal for all care homes (it has also recently been used and evaluated in hospital environments - research done by Sheffield - Faulkner and Brown et al ??? I think) . I really do think that the inspection agencies should base their inspections and the various governments - their minimum standards for Quality of Life on this model. Lots of resources on the My Home Life website and there is a new DVD just out - contact My Home Life for it.

How about it DOH ? - be radical and have a common framework for measuring quality of life in care homes. The new Green paper discussion might help too. Then at least we would not be having continuous convervations about the same things so much. A Common framework on quality of life and care - rather than just the Minimum Care Home Standards - based mainly on buildings, numbers and faciltities - means maybe that standards rise - expecially if it is linked to contracting and procurement. And I am not talking about performance management, more paperwork or tick boxes - but listening to families , visitors, other professionals and residents in homes.

I do know that there are star ratings but based on various different frameworks - we need one common one.

Regards,
Lorraine

This seems to be symptomatic of the NHS as a whole. I am tempted to ask all staff the following questions:

1. Why did you become a nurse?

2. Are you a dignity champion yet? If not, why not?

Lorraine , Sally
I agree with your comments.
Marie
Sheltered Housing and the Community .

Hi Sally
You are so right. I rely on families as a valuable source of information about patients' likes, dislikes, a bit of personal history that helps us to know and understand the individual person better. I have got to know family members very well over the past year and quite frequently have noticed how exhausted they are traipsing back and forth to the hospital. On more than one occasion we have been concerned about the health of the visiting family members and a cup of tea and a biscuit can be very welcome to that visitor who has often had to take more than two buses to visit the person in hospital.
If a patient has dementia or alzheimers and their communication skills are lacking it is very helpful when relatives can let us understand who that person was before their illness, their jobs, who their children are, their interests etc and that knowledge can help in creating a rapport that is so important to care.

Andrea Evans

Hi Sally, you are so right in what you say and I am pleased you achieved a good relationship with staff. We tried so hard to be included in my Mothers care but were treated like strangers. We were refused access to my Mothers Care Plan and not given any information on medication or any general day to day plans.
When I asked if my Mother could see a GP because she had complained of pains in her leg I was told it was up to them as to if and when she saw a GP.
When we complained that my Mothers teeth were not being cleaned they agreed.
When we complained that my Mother was wearing other peoples underwear they had to agree because they had given it to her.
They then locked us all out of the Home and refused us access to our Mother (my Brother and I, my Husband, my Brother's wife and 4 children).
Social Services were informed and chose to support the Home reducing all of us to very restricted and limited access to our Mother!
Is this in any way dignified for my Mother or her family?
This home has a high rating?????

Hi Julie,
I am astonished by what this Home did and also by Social Services. The only statutory agency you should deal with re this is the Inspection agency as I believe "locking you out -" or at least refusing you proper access to your relative is probably illegal - if not a denial of Human Rights.

What did you do about this situation?

Lorraine

Hi Julie

Standard 13 of the National Care Standards states that:

13.3 Service users are able to choose who they see and do not see

13.4 The registered person does not impose restrictions on visits except when requested to do so by service users, whose wishes are recorded.

13.5 Relatives, friends and representatives of service users are given written information about the home's policy on maintaining relatives and friends' involvement with service users at the time of moving into the home.

This is guidance on best practice .

So, the home could block your visits if your mother did not want to see you, (assuming she had capacity to make that decision). This should be recorded in her notes or care plan.

Your mother should have been given a copy of the service users guide for the home, which sets out the home's values in respect of visitors.

It is not clear why Social services have been involved;unfortunately a'them' and us' scenario can arise within a home, with regard to relatives, and it is easy to apportion blame to 'them' and lose sight of the individuals involved, who are presumably all after the same thing--the wellbeing of residents. It's worth trying to cut through that deadlock with some clear actions indicating positive intentions, for your mother's sake. A win/win outcome is usually best, if at all possible

Regards

Rose Fordham
Bingo and Beyond

Rose Fordham.

Hi Julie
I am so sorry to hear of the experiences you are facing with the home your mother is in. The good experience with my mothers care home was over 10 years ago. You would think things should be just as good if not better in this day and age. I can't understand why Social Services have acted in favour of the home, especially as it sounds as though you had a close relationship with your mother. I would want to know on what grounds I had been stopped from going in to see mum. I would definitely seek independent legal advice about the decision, as this could be an infringement on you mothers rights as well as yours if she wants to see you.

I do hope you can get this sorted for all of your sakes.

Regards

Sally

Hi Pauline

I agree, not only NHS, nurses need to be asked these questions though. Private nursing homes, nurses and care workers, should be asked these questions too.

regards

Sally

I have just been given the same remit.

To look at privacy and dignity in radiology. Identify what we do right, and what we do wrong, Work out what to do to remedy it.

Our main worry is a lack of space for trolley and bed in patients, and the fact that trauma patients get left on trolleys in a public throughfare