Definition of dignity; the quality or state of being worthy of esteem or respect.(the free dictionary 2011).This definition seems short, however the concept of dignity is more profound, the nurse should use her inner tool thus being feelings , empathy, compassion and use these productively.(Haddock 1996). The reasonable expectation that an older person , may have of dignified, nursing ,care in clean surroundings in hospital is not being fulfilled in some cases This essay will discuss the concepts of dignity, and discuss the importance of dignity in nursing care. Illustrating the significance in protocols, and furthermore, giving the patient the best possible outcome. We shall examine the guidelines set by the Nursing and midwifery council (NMC) and how important it is for nurses to uphold these standards, when delivering care to the patient.
We shall also look at the aging process, and how illnesses cannot simply be put down to ‘age’, discussing how medication can affect the elderly and also how it can help. Highlighting the need for nurses not to become robotic at tasks as delicate as the one giving throughout this essay , the need to empathise and give the patient as much dignity as possible. Also looking at infection control, and how critical it is in the clinical setting for the health care team, and also for the patient’s health.
Following guidelines from National institute for health and clinical excellence (NICE), the Department of Health (DH) and several studies with regards to infection control , and health matters such as health promotion and how it can empower the patient which can help in their dignity. Looking at how the muti-disciplinary team help with the overall care and how important to work as a team to gain the best outcome. Reviewing my own personal journey as I have done research into dignity and reflect upon my own practice, and how it may change or enhance my future nursing care.
Len Chambers is an elderly gentleman in your care. He is not confused or disorientated but is anxious, hard of hearing and physically frail, needing assistance to walk. The doctor has just finished the consultation and tells you that “Mr. Chambers needs to go to the toilet”. There is a smell of faeces, Mr. Chamber’s trousers and shoes are wet with urine, and he appears agitated and upset. With reference to the NMC Professional Code of Conduct (2008) describes the actions that you will take to promote and maintain this client’s dignity.
The concept of dignity is an individual right, everyone has equal worth has human beings. To treat someone with dignity, is by giving that person worth in a way that values them as an individual, as suggested by Milburn patients like to be recognized and treated with respect (Milburn et al 1995), and with this being their birthright, it must also continue after death. Dignity should be applied equally to people who have the capacity or not, whether that is of a physical or mental state, what must be paramount is the individuals self value and worth. In care circumstances, the concept of dignity can be encouraged or weakened depending on factors such as environment and attitude of healthcare staff. By giving the patient dignity, this then empowers them to make choices, which then gives them confidence to make decisions on their care. (NMC 2008). The code of professional conduct (NMC 2008) will guide my actions, in giving the care for Mr Chambers.
The code of conduct states to treat the patient as an individual, and respect their dignity. Approaching Mr Chambers, I would introduce myself and ask him how he would like to be addressed; the rationale for this is to let Mr Chambers know who he is talking to and also gives him the respect of name choice, thus keeping in with the guidelines of the code and promotes autonomy. However reflecting back on my own practice and some male patients can be uncomfortable with a female nurse, I would ask him if he preferred a male nurse to assist him, and taking into account Mr Chambers body language, and the tone of his reply, and also being aware of my own aura at such a sensitive time. Mr Chambers has become incontinent of faeces and urine, an assessment of incontinence would need to be carried out by a specialist nurse, to establish if he is incontinent.
Urinary incontinence is a common and distressing problem, taking into account Mr Chambers is anxious, coming from a generation which can be proud in nature, so it is completely understandable why the need for sensitivity is required. Making sure this is fully explained (after nursing care as been given) to Mr Chambers, and gaining his full consent for a referral to the correct health professional, but before doing so a routine urinalysis test should be carried out, to rule out any infection present, firstly by doing a dipstick test and any signs of infection can then be sent to the correct department for further tests. The fact that Mr Chambers has difficulty walking maybe the only reason he was incontinent, simply because he didn’t make it to the toilet, however in most cases an underlying medical problem maybe present, and referring him to the correct department will be able to rule this out.
Age is also a factor according to research , as we age we are more likely to need medication, for blood pressure for instance , and these medications can have an effect on the bladder (Avom.J et al 2003) so maybe a review of his medication can help. The frail elderly (age 65+) are likely to be more intolerant of drugs than their fit age group (Cussack.B.J 1989), and are particularly at risk from, adverse reactions (Williamson .J, Chopin J. 1989) These are the predictable, dose-dependent and common manifestations of toxicity that cause considerable morbidity in the frail population (Thompson JW, Rawlins MD)
Mr Chambers has difficulty hearing and this could affect his communication, which could lead to anxiety. By providing the right environment, making time so that the patient does not feel rushed, and Provide some privacy when talking about sensitive and important issues, ensuring the patient has any communication aids that they need e.g. hearing aid, when you are talking to them. (Leveson.R 2007).This upholds the confidentiality, privacy and dignity of Mr Chamber; this is working within the code of practice, of confidentiality and consent. Has Noted Mr Chambers is a frail gentleman who will require assistance with his activities of daily living, and may need to be referred to the continuing health care team to place a package of care for him, also the physiotherapy team to help with his mobility.
After gaining consent, and reassuring Mr Chambers we shall work together, offering him the choice of either attending the bathroom, or wishing to stay in the bay area. This is adhering to the code of collaborating with the ones in your care (NMC 2008). Mr Chambers appears agitated and upset, whilst faecal/urine incontinence can have a psychological affect on him. Studies have shown this can be; tearfulness stress, distress, anxiety, exhaustion, feeling dirty, anger, humiliation, depression, isolation, secrecy, frustration and embarrassment (Chelvanayagam S, Norton C 2000.) To avoid any further humiliation, and suggesting to Mr Chambers a shower would be appropriate, however before doing so, assist him to undress and wash in the bay area first, to avoid walking down the ward in his current circumstances. The rationale for doing this is to keep Mr Chambers dignity, thus avoiding more distress. Gathering the equipment required to carry out this task and following guidelines/polices of infection control.
Infection Control; It is estimated that health care infection (HCAI) affects one in 10 national health service (NHS) patients each year, and costs the NHS one billion per year. (DH 2003) The hands of healthcare workers can be one of the main sources of transmitting infection, therefore it is vital hands are washed at every patient contact, and any connection with contaminated equipment (DH 2001).However studies have been shown that the technique of hand washing is generally not carried out properly (creedon 2005). A selection of protective equipment should be based on an assessment of the risk of transmission of bacteria to the patient, and the risk of contamination of the healthcare practitioner’s clothing and skin by patients body fluids, secretions or excretions.(NICE 2003)
The rationale for following the protocols of infection control is to minimise /eradicate the risk of transmissions of infections, and reflecting back on my own practice ,this assures the patient that you are clean, and also prompts/promotes them to wash their hands which will reduce any infection. In the NMC code of conduct 2008 states to ‘make the care of people your first concern, treating them as individuals and respecting their dignity’ (NMC 2008). Keeping Mr Chambers dignity in thought, and maintaining health promotion, I assist him to undress and wash, asking his preferences and how he normally carries out this task, encouraging him when needed, this helps promote confidence in his own abilities. Gaining his consent, with regard to assisting him in bathroom to shower, and if he would like hospital garments if he has no clean garments, as he can be anxious about his soiled clothing.
Assisting , Mr Chambers to wash hard to reach areas ,however also to give him independence when necessary, having the patience and time to listen to his needs, and actively listening how he may have done things in his own environment, can help with dignity. Patient-centred nursing is a style of practice that demonstrates a respect for the patient as a person. Through ‘being with’ rather than merely ‘doing to’ the patient and offering personal support and practical expertise(Nursing Times 2005) Has Mr Chamber needs assistance when mobile, a referral to the physiotherapist will be required. Furthermore, to Use this opportunity to assess how Mr Chambers copes with his Activities of daily living (ADL). The rationale is to see how much assistance Mr Chambers requires, and to inform the correct health care professional of any progress, in addition to this making sure the correct data (e.g. Risk assessments, personal preferences), is transferred to his file and to avoid any inconsistencies, also to elude any awkward situations in his future nursing care.
Reflecting on Mr. Chambers and the care provided how difficult it must be for an elderly to be independent all their lives then having a younger person to take over their care. This generation seems notoriously proud, and keeping within policies of care, and trying to give him his dignity, is quite hard to balance, an example of this would be infection control, having to wear gowns and gloves because of protocols, however this must be degrading in some respects for Mr Chambers. These procedures can have an effect on him psychologically, conversely he may understand if I explained to him why these measures are in place. Seeing Mr Chambers upset can be daunting at first, but to realise why he his upset is the key to a happy outcome. So communication is very important in this situation, and to actively listen to his concerns will also be very beneficial to me as a nurse.
For instance he may state how he keeps soiling himself, would suggest he has incontinence problems rather, other than he just couldn’t make it to the bathroom. Mr. Chambers mobility was an issue, and again this must be difficult to express to younger active person, it would most probably also be embarrassing, as they were young once, and after all it is the body that ages. My concern would be to try and empathise with him, and keep the communication open using methods such as eye contact and body language to help me, and maybe use an experience of my own, such as family members, which may help him relax some more, and hope that this helps my future practice .
When you feel dignified, you have the sense of self –worth, confident, happy , it also builds a trust with the person who is nursing you , without it you can feel devalued, no confidence, low self –esteem thus leading to patients unable to carry out tasks such as (ADLs) where they maybe of been capable of doing so before. I aim to enhance my Nursing care and hope that I learn something new in every given situation, to help build on my knowledge which in turn will give excellent care to the most important person the patient, and also to share my knowledge within the team of healthcare professionals, and in turn learn from others experience and value each patient like you would your own family regardless of their condition, mood ,ethnicity, religion we are all equals and sometimes this can be lost in organizations.
Nursing is lifelong learning matter, and patients can be unpredictable everyday is new, challenges will arise from patients, demands will have to be met, stressful situations will be dealt with, but this is the profession I choose to be in, and my future Nursing will always be to remain professional, Contrary to this what should be predictable, or should be practiced throughout the healthcare settings is the concept of dignity. I will continue to reflect on my own practice and learn more from every given situation whilst keeping within the code of conduct set out by the NMC.
Avom R (2003) principles of pharmacology newyork springer
Chelvanayagarns (2000) Quality of life with faecal incontinence problems. Nursing times 2000 pg 6 Creedon (2005) compliance with recommended guidelines. J adv nurs( pg 208-216) Cussack BJ (1986 ) special considerations in the elderly ;the practice of geriactrics Boston Department of Health (2001) Standard principles for preventing hospital-Aquired infection . J Hosp Infect.47-48 Department of Health (2003) Winning Ways: Working Together to Reduce Healthcare Associated Infection in England. London: DOH
Haddock (1996) Journal of Advanced Nursing 1996 Nov;24(5):924-31.
Levenson, R. (2007). The challenge of Dignity in Care: Upholding the rights
of the individual. Help the Aged: London. Milburn et al (1995) www.intermid.co.uk Accessed online (20/7/2011)
NMC (2001,2008) www.nmc-uk.org/) Accessed online (18/7/2011)
Nursing Times (2005) A systematic approach to the improvement of patient care. VOL: 101, ISSUE: 24, PAGE NO: 34-36
Nice (2003) w.nice.org.uk/nice/pdf/22_FINALpressrelease_infewwctioncontro. Accessed online (18/07/2011)
The free Dictionary (2011) www.thefreedictionary.com.dignity. Accessed online (20/07/2011)
Thompson JW, Rawlins MD. (1998) Journal of Medicine, New Series 68, No. 255, pp. 505-506.
Williamson J, Choplin J (1988) British Medical journal (Clin Res Ed). 1988 ; 296(6636): 1551–1552.