Dignity in care
Dignity factors - Privacy
Staff knock before entering. Dignity means being able to go to the loo and close the door; dignity means when you have a bath, not having fun poked at your body
Privacy in practice
- Ensure a confidentiality policy is in place and followed by all staff (including domestic and support staff).
- Make issues of privacy and dignity a fundamental part of staff induction and training.
- Ensure only those who need information to carry out their work have access to people’s personal records or financial information.
- Respect privacy when people have personal and sexual relationships, with careful assessment of risk.
- Choose interpreters with the consent of the person using the service.
- Get permission before entering someone’s personal space.
- Get permission before accessing people’s possessions and documents
- Provide space for private conversations and telephone calls.
- Make sure that people receive their mail unopened.
- Ensure single-sex bathroom and toilet facilities are available.
- Provide en suite facilities where possible.
- In residential care, respect people’s space by enabling them to individualise their own room.
- Consider issues of privacy if a person requires close monitoring or observation
Ideas you could use
- Use an enuresis pad to maintain dignity despite incontinence
- Look at what people are wearing and how it affects their dignity
- Use ‘Do not disturb’ signs to respect people’s privacy
- Provide single sex facilities
- Introduce an action plan to improve privacy and dignity
- Make small, effective changes that add up
- Enable people who use services to choose
- Find out how you are doing on dignity and develop tools to promote improvement
- Remind staff and visitors about privacy by putting door knockers on internal doors
These practice examples are self-reported and have not been evaluated.
Care Quality Commission - what the regulator says
The CQC is the independent regulator for health and social care services. They have set out Essential Standards of Quality and Safety (CQC, 2010) for all those registered to provide health and social care services. There are 28 outcomes relating to the different aspects of care provision.
What CQC outcomes say about PrivacyOpen
These are the outcomes that relate to privacy.
Outcome 1: Respecting and involving people who use services - Requires that suitable arrangements are made to ensure the dignity, privacy and independence of people using the service
Outcome 10: Safety and suitability of premises - Requires that:
- the premises protect people’s rights to privacy, dignity, choice, autonomy and safety
- there are sufficient toilets, and where necessary bathroom and bathing facilities, that take into account people’s diverse needs and promote their privacy, dignity and independence
- access to toilets, baths and showers that enable people to maintain privacy and dignity that are in close proximity to their living areas.
See all outcomes in the Care Quality Commission Essential Standards of Quality and Safety (PDF file)
Privacy and dignity - key points from policy and research
- Article 8 of the Human Rights Act (1998) gives the right to respect for private and family life, home and correspondence.
- Some hospital staff need additional training on the issues of dignity, respect and privacy. 'This is particularly true of staff caring for older people with mental health needs’ (Commission for Healthcare Audit and Inspection, 2006).
- Older people prefer single-sex facilities (Woolhead et al., 2004, PRIAE/Help the Aged, 2001, Cardiff University, 2001-2004, DH, 2006d).
- The Department of Health has given a clear public commitment to eliminating mixed-sex accommodation for hospital inpatients.
- Essence of Care (384kb PDF file) offers a series of benchmarks to ensure privacy and dignity in hospital (DH, 2003c).
Privacy and dignity - policy and research in more detailOpen
Privacy is closely related to respect and features as a prominent issue throughout the related literature. People responding to the Department of Health (DH) online survey (DH, 2006d) raised the importance of being medically examined in a private area, having an acceptable amount of personal space and being dressed in clothes which do not expose your body. An analysis of UK data from the Dignity in Older Europeans study (Woolhead et al., 2004) found that self-respect can be undermined 'by exposure, lack of privacy in personal care, and mixed wards’.
Eliminating mixed-sex accommodation for hospital inpatients has been difficult to implement. The Department of Health states that 97 per cent of NHS trusts meet single-sex accommodation standards but this may include those with divisions within wards and patient groups continue to campaign on the issue (DH - Privacy and dignity).
The National Service Framework for Older People (DH, 2001) acknowledges that privacy can be undermined in hospital, and Essence of Care (384kb PDF file) (DH, 2003c) has a series of benchmarks relating to the subject. A recent study (Woogara, 2005) found that Essence of Care benchmarks were not being met and that: 'the 'little things' which would protect the patients’ privacy and dignity were often forgotten’. Aspects of privacy include:
Modesty and privacy in personal care - ensuring that people receive care or treatment in a dignified way that does not embarrass, humiliate or expose them. The desire for single-sex wards has been highlighted in a number of studies (DH, 2006d, Woolhead et al., 2004, PRIAE/Help the Aged, 2001, Cardiff University, 2001 - 2004) and is of particular concern to some minority groups (PRIAE/Help the Aged, 2001).
Confidentiality of treatment and personal information - ensuring that personal files and records and financial information are kept confidential, and only shared with the consent of the person concerned. Discussions about a person’s well-being, treatment and any personal information should be carried out where others are unable to hear. Conversations of a very confidential nature, for example about medical diagnosis or toilet arrangements, should be discussed in a private space and not with only a curtain between the individual and others. Privacy of conversation with family and friends should be facilitated through access to a private room or telephone and personal mail should be received unopened. Particular care should be taken to ensure privacy when using interpreters. In small communities the person and interpreter may know each other or have common friends. This can cause a great deal of anxiety in terms of confidentiality and alternative solutions should be sought. A study of people who use interpreting services (JRF, 2004) found that many people prefer to use family members or to have the same professional interpreter on each occasion so that trust can be built.
Privacy of personal space - staff should gain permission to enter and demonstrate respect for personal belongings and boundaries. It is important to achieve a balance so that vulnerable people are not either isolated by privacy policies or put at risk, for example through providing privacy for personal and sexual relationships. My Home Life: Quality of life in care homes (Owen, 2006) reports that: 'offering couples space for intimacy and privacy and using skilled observation and emotional literacy to understand their needs will help residents feel they have the right to express their sexual identity' (Forte et al., 2006, Heymanson, 2003, Springfield, 2002). Staff need appropriate training to ensure relationships can be positively, respectfully and safely supported.