SCIE Guide 15: Dignity in care

In this guide

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’.

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. The national minimum standards (DH, 2003b, DH, 2003a) also devote entire sections to the subject of privacy and dignity. 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 service user 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.

Key points from research and policy

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).

The national minimum standards refer specifically to privacy and dignity (Standard 8 for domiciliary care and Standard 10 for care homes) (DH, 2003b, DH, 2003a).

Standards for Better Health (78kb PDF file) sets out core standards which include environments that are supportive of patient privacy and confidentiality (DH, 2004e).

Practice points

Ensure there is a confidentiality policy in place and that it is adhered to by all staff (including domestic and support staff).

Make issues of privacy and dignity fundamental to staff induction and training.

Only those who need information to carry out their work should have access to personal records or financial information.

Where people have personal and sexual relationships, their privacy should be respected in conjunction with careful assessment of risk to vulnerable people.

Choose interpreters with the consent of the service user.

Ensure that all staff gain permission before entering someone’s personal space.

Ensure that access to personal possessions and documents is only via the owner’s expressed consent.

Ensure space is provided for private conversations and telephone calls.

Ensure service users receive their mail unopened.

Single-sex bathroom and toilet facilities should be available.

Provide en suite facilities where possible.

In residential care, respect people’s space by enabling them to individualise their own room.

If a person requires close monitoring or observation, issues of privacy should be carefully considered.

Ideas from practice

Practice examples are self-reported and have not been evaluated.

Other resources

Confidentiality policies: many organisations have developed policies that spell out how staff deal with aspects of privacy that involve confidentiality. See example provided by Southampton City PCT.

Essence of Care Eureka documents describe basic standards of communication, privacy and dignity. Download from the Clinical Governance Support Team website.