SCIE Practice guide 09: Dignity in care
Ideas from practice
Practice examples are self-reported and have not been evaluated.
A multi-racial outlook (Birmingham and Solihull Mental Health Trust)
The trust has a diversity department that advises and supports staff, facilitates training and has Race Champions. Trust staff have access to interpreters for all languages who will come in and see patients and carers and will assist with assessments, consultations and ward rounds. In addition a BME (Black and minority ethnic) team offers support to patients and staff in providing cultural awareness training. There are information leaflets on wards available in a range of languages.
For further information contact
Linda Playford. Email Linda.Playford@bsmht.nhs.uk
A reassuring checklist (Burntwood, Lichfield and Tamworth Primary Care Trust)
The PCT has developed a simple checklist (17kb PDF file) which is used as part of the admission procedure. This document acts as a prompt to the nurse undertaking the admission to discuss with the patient (or the carer if this is more appropriate) certain aspects that are important to the patient - for example, knowing how to call for assistance, knowing where the toilet is, and being reassured that, if the ward accommodates male and female patients, these facilities are separate. Any relevant issues can then be transferred to the care plan so this is communicated to other staff. Relatives or carers often highlight areas they are concerned about, e.g. a patient prone to falls or not being able to use a call bell. This enables the nurse to explain to them measures that will be put in place and also discuss any risks that maybe relevant. It opens up communication between nurses with patients and carers from day one, and aims to make the patient and carer feel that they are able to approach staff at any time.
For further information contact
Dawn Llewellyn, Modern Matron. Tel 01827 263819. Email Dawn.llewellyn@ssh-tr.nhs.uk
Adopting the Behind closed doors leaflet (Southampton University Hospital NHS Trust)
The Essence of Care group is currently piloting on wards the Geriatric Society’s leaflet entitled 'Behind closed doors, using the toilet in private' (255kb PDF file). The plan is to roll out the work across the hospital.
For further information contact
Julie Dawes, Associate Director of Nursing. Tel 02380 798435. Email: julie.dawes@suht.swest.nhs.uk
Aiding communication (Derbyshire Mental Health Services)
Essence of care activity is undertaken throughout the trust, which involves benchmarking factors of privacy and dignity for each clinical area. This includes how staff converse with patients and carers, what information is given and provides a check that it is in a format they are able to understand. As a result, the service has developed a multi-cultural tool for staff to use and reference against.
For further information contact
Kim Shield, Essence of Care Coordinator. Tel 01332 362221 ext 3783. Email kim.shield@derbysmhservices.nhs.uk
Anti-ageism training course (Rochdale Metropolitan Borough Council)
In response to 'Rooting Out Age Discrimination’ (standard 1 of the NSF for Older People), one nursing home piloted a training course focusing on anti-ageism. An experienced trainer and the 'recruits’ - older people and a carer of an older person - developed the programme together. They explored definitions of ageism, issues of an ageist society and their own attitudes and feelings about getting older. They were also asked to think about their own care responses and how they would use this training and awareness to change their own practice. The manager of the home fully supported the initiative and felt the training had had a positive impact.
Key learning points
- Although a care team may be working together they do not necessarily share the same views - the pilot showed there were many differing views within the team.
- Full support from the home manager is essential.
- Recruit volunteers from as many groups as possible: the project demanded a time commitment and many older people are busy, and while supportive of the project could not commit to the whole process.
- There is a need to pay people the going rate to be involved in such projects, People needed to be encouraged to claim what they were entitled to, but sometimes benefit entitlement and paying tax can be a barrier.
- Clear selection criteria need to attract older people who have particular skills and experience.
For further information contact
Rowena Vickridge, Joint Strategic Lead, Adults and Older People, Adult Care Services. Tel 01706 925383. Email rowena.vickridge@rochdale.gov.uk
Anticipating concerns before they become complaints (Addenbrooke’s Hospital, Cambridge University Hospitals Foundation NHS Trust)
Addenbrooke’s undertook an audit to ensure inpatient wards were meeting the requirements set out in the Addenbrooke’s Standards of Privacy and Dignity (142kb PDF file), which were developed by the Essence of Care subgroup. An audit pack containing the Addenbrooke’s standards, six patient questionnaires and a ward manager’s survey were delivered to 35 wards across the trust. Wards were asked to return the completed packs within two weeks. The findings demonstrate where best practice is being achieved against the standards set out, and generated a number of recommendations for the trust to implement.
For further information contact
Lyn McIntyre, Assistant Chief Nurse. Tel 01223 256221. Email lyn.mcintyre@addenbrookes.nhs.uk
Assessing standards (Dorset and Somerset Strategic Health Authority)
The SHA has developed an audit tool (112kb PDF file) which aims at achieving high standards of patient dignity and putting patient experience high on the agenda. The audit tool is a template covering five key themes
- patient environment
- privacy, dignity and modesty
- communication with patients
- promoting individual needs
- staff training.
It also contains a score card so progress can be monitored and lapses can be picked up quickly and acted upon, using an action plan template.
For further information contact
Sharon Waight, NHS South West. Tel 01935 384111. Email Sharon.waight@southwest.nhs.uk
Best Practice Guidelines (Harrogate Neighbours Housing Association)
The Harrogate Neighbours Housing Association have produced their own Best Practice Guidelines 212kb PDF file) for catering in residential homes and sheltered housing. It includes a philosophy statement on catering and a skills assessment of catering staff.
Catching memories (Lincolnshire County Council (LCC))
Heritage Services is training a representative of each of LCC’s older people residential care units in reminiscence skills. In addition, Heritage Services are helping the representatives to facilitate reminiscence group meetings, for which they supply articles and memory joggers to encourage members of the group to talk and reminisce.
For further information contact
Sheila Sibbons, Unit Manager, Adult Social Care. Tel 01522 750889. Email Sheila.sibbons@lincolnshire.gov.uk
Champions programme (the former Birmingham and Black Country Strategic Health Authority)
The aim of this project is to have a champion in all care environments where older people receive care. The champions, who are experienced nurses and allied health professionals, attend an intensive two-day workshop of master classes by expert speakers with a focus on addressing values, attitudes and dignity. Support is provided via resource packs, a dedicated website, mentors, a lead executive for each trust and champion network meetings. The intention is to improve care and support for older people; reduce stays in hospital; build reassurance and confidence in the care provided for older people in hospitals and other care environments; provide a proactive workforce to care effectively for a rising ageing population; and reduce the number of complaints.
Independent researchers will evaluate the Champions for Older People project (1.9mb PDF file) and the next stage is to roll the project out to the primary care trusts and mental health trusts.
Key learning points
- Ensure that the Essence of Care benchmarks are included in the master classes and that the sessions all relate to dignity, values and attitudes for older people.
- Ensure that key stakeholders are on board from an early stage and that a support network is in place for the champions
- Ensure that long-term sustainability is built in.
For further information contact
Andrew Hindle, SHA Lead for Older People Services. Tel 0121 695 2562. Email andrew.hindle@westmidlands.nhs.uk
Communicating Choice (County Durham and Darlington NHS Foundation Trust)
The Trust has introduced a range of menus in different formats to help patients who cannot communicate what they would like to eat. This includes a multi-cultural pictorial menu to suit Halal, Afro Caribbean and Kosher diets and braille menus. Deaf patients are assisted by the chef, who is a qualified signer.
For further information contact
Alison McCree, Associate Director of Estates and Facilities. Tel 01325 743022. Email alison.mccree@cddft.nhs.uk
Cooking with Care (Barchester Healthcare)
National care home provider, Barchester Healthcare, has initiated a Cooking with Care campaign, supported by the celebrity chef Paul Rankin, to ensure that mealtimes are enjoyable, dignified and fun. Chefs spend time in the dining room with residents to ensure that food is beautifully presented and to find out about residents’ likes and dislikes.
To ensure that chefs are fully trained to support individual needs and tastes, Barchester Healthcare has developed the Barchester Chef Academy to offer training for all levels, from apprentice to Master Chef. The group has also introduced a system of 5 Star Dining to improve dining standards, particularly for patients with swallowing difficulties and those unable to feed themselves. Standards include offering the resident a choice of meal at their table (rather than pre-ordering), presenting food for people on soft diets just as beautifully as other dishes, and providing assistance in cutting up food discreetly.
For further information contact
Terry Tucker, Director of Learning, Development and Hospitality, Barchester Healthcare. Tel 07718 582139. Email terry.tucker@barchester.com
Developing a privacy and dignity policy (Guildford and Waverley PCT)
The PCT’s Essence of Care steering group carried out a privacy and dignity audit on the wards in December 2005, based on the Essence of Care standards. There were some significant findings, as a result of which they
- increased and improved access to diversity and equality training
- increased confidentiality and Caldicott awareness training for all staff
- added Velcro® fastenings to curtains
- reviewed the procedure on responding to a complaint of inappropriate behaviour towards a colleague or patient, and disseminated the results to all managers.
The group has also developed a draft privacy and dignity policy (47kb PDF file), stating the requirements and expectations the trust demands from staff.
For further information contact
Glynis John, Clinical Governance Facilitator. Tel 01483 782102. Email Glynis.john@nhs.net
Digging Deep
This scheme was identified in the Joseph Rowntree Foundation’s Older People’s Inquiry as one of the 'baker’s dozen’ of promising ideas to be pursued further. It involves older people teaching school children how to grow vegetables in school-based allotments. Volunteer older people tend to stay working with the school, and the scheme provides a valuable way of passing know-how down to a new generation while appreciating the knowledge older people possess.
For further information
Visit the Older People's Inquiry: 'That little bit of help' (108kb PDF file)
Dignity and Respect Training Project (John Coupland Hospital, Lincolnshire Teaching Primary Care Trust)
The John Coupland Hospital Older People project team has developed a Dignity and Respect Link Trainers Project (41kb PDF file) in order to establish good practice throughout the hospital. Designated trainers were identified from several departments, each of whom was given special training and materials. These trainers in turn ran sessions for staff within their own departments. All existing and new staff will participate in the training.
For further information contact
Maria Storti, Interim Operational Lead Intermediate Care, Lincolnshire PCT. Email maria.storti@lpct.nhs.uk
Do not disturb (Sheffield Teaching Hospital NHS Trust)
Sheffield came up with a very simple idea: they use plastic reusable Do Not Disturb signs which have been designed for curtains and doors. They have been found to be effective in reducing interruptions and are now being produced for use throughout the trust.
For further information contact
Related document
Other hospitals and NHS trusts have come up with similar measures. See the Southampton University Hospital NHS Trust’s curtain sign (13kb MS Word file).
Drama: fun with a purpose (North Dorset Primary Care NHS Trust, now Dorset PCT)
To alter the image of a 'minding’ service, the trust redeveloped their day care service for older people with dementia. They used 'Drama as a powerful clinical tool: fun with a purpose’ (113kb PDF file) as a teaching tool for staff, who have since developed activities for people with dementia and expanded community links. The many improvements include
- a very positive environment and workforce to promote a philosophy of independence, individuality and well-being
- actively reaching the person behind the disease, communicating via drama, dolls as therapy, puppetry, music and dance
- improvement in many people’s speech, confidence and self-esteem
- using drama techniques/skills and diversion with constructive occupation rather than medication to help positive behaviour changes
- an active promotion of person-focused care.
The service has been evaluated through the use of user/carer questionnaires. It has received letters of appreciation and has won many regional and national awards including The Queen’s Nursing Institute/Alzheimer’s Society Award for Excellence and Innovation in Dementia Care 2003 and The Dorset and Somerset Modernisation Awards 2004. It has also been presented at many regional and national conferences.
For further information contact
Lesley Benham, Team Leader. Tel 01305 762508. Email Lesleybenham@dorset-pct.nhs.uk
