The Dignity factors: Privacy

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.