SCIE Practice guide 09: Dignity in care
Ideas from practice
Practice examples are self-reported and have not been evaluated.
Easy access to information and help (Caterham Dene Community Hospital)
As part of the hospital’s clear admissions process, all patients are given an information booklet when they are admitted. This booklet includes a section on how to complain if they are unhappy with the service that is provided to them. Staff are made aware of how to deal with complaints through the PCT complaints policy and associated training. The matron is based on the ward and can easily be accessed by staff for support.
For further information contact
Eileen Clark, Service Manager. Tel 01737 214846. Email eileen.clark@eastsurrey-pct.nhs.uk
Eat Well Feel Well (Heatherwood and Wexham Park Hospitals NHS Trust)
The Eat Well Feel Well project promotes a range of nutritional care improvements, including protected mealtimes, a wider range of ethnic menus, nutritional screening, a red tray system, link nurses to monitor quality of care and volunteers to help at mealtimes. The project also raises awareness through the use of posters, information videos, public awareness sessions and staff training.
For further information contact
Gay Lewis, Clinical Development Facilitator. Tel 01753 633764. Email Gay.Lewis@hwph-tr.nhs.uk
Effective action plan (Doncaster and Bassetlaw Foundation NHS Trust)
The matron in Critical Care put together an action plan which was fed back to the Essence of Care steering group. The action plan included
- education forums to raise awareness of privacy and dignity; these were locally run departmental sessions attended by nurses, sisters and healthcare assistants.
- posters displayed throughout the directorate with messages, for example, to promote bathtimes without interruption, to keep patients covered at all times and to close bedside curtains tightly.
- 'Do Not Enter signs for the curtains.
- colour-coded clothes pegs to ensure curtains closed properly (these stay in each bed space to comply with infection control). Some areas have used a traffic light system, e.g. red peg = Do Not Enter.
The staff received feedback at departmental meetings and directorate audit meetings. As a result of this work patient privacy and dignity has improved, and staff awareness has been raised - the posters have made staff think about their actions and all staff are empowered to make sure 'Do Not Enter’ signs and pegs are used. The multi-disciplinary teams, including doctors, have taken this idea on board and always ask to enter behind curtains if they are drawn.
These actions have proven so effective that the initiative is now trust-wide, and good practice is shared via trust communication newsletters and the Essence of Care steering group.
For further information contact
Rozz Jones, Sister, ITU, Essence of Care Lead.Tel 01909 502106. Email rosa.jones@nhs.net
Electronic feedback for constructive criticism (Partnership Health Group (PHG)
Through its commitment to quality, PHG views suggestions and complaints as essential for improving customer care. It believes there is a need to acknowledge the value of constructive criticism and complaints. Viewed positively, complaints are a valuable contribution to the development of high quality care. Dealing with complaints is therefore a priority within PHG and it is essential that they are addressed promptly. Key to this approach is early identification and rectification rather than reacting after patients have given their feedback.
PHG uses live electronic measurement of patient satisfaction (54kb PDF file), which starts with quality care rounds conducted by the unit manager.
- Staff ask patients for feedback and, where appropriate, bring portable devices to the bedside.
- The patient reads the questions, and answers by pressing the appropriate buttons, which takes 15 - 20 seconds.
- All responses are automatically downloaded daily to a secure server and information from across the entire hospital/trust/region is collated and analysed.
- Reports are created and automatically emailed daily (or weekly) to the relevant managers, with each report relating to that manager’s specific area of responsibility.
- The information contained in the ward/department reports is used as the basis for weekly staff meetings. Members of staff are kept up to date with patients’ views and current issues, and are encouraged to suggest ways of improving performance. This encourages participation.
For further information contact
Mona Van Wyk, Nursing Services, Specialist (Nursing Director), Partnership Health Group. Email: Mona.VanWyk@partnershiphealth.co.uk
Enhanced pathways into care (EPiC), Sheffield
The aim of the project was to build a partnership between a Crisis Assessment and Home Treatment team and the Pakistani Muslim Centre. This would enhance access to home treatment for Pakistani service users and reduce over-reliance on inpatient services, and it would enhance the cultural appropriateness of the Crisis Assessment and Home Treatment service.
A community development worker was employed to work with a Pakistani Muslim Centre and, together with a Crisis Assessment and Home Treatment team member, saw service users at home. This constitutes a shared care operational policy, with the development worker actively identifying Pakistani service users. The Pakistani Muslim Centre also developed support services of its own for people with mental health problems.
The outcome was a managed care pathway designed for Pakistani service users, who reported greater satisfaction with services. Inpatient length of stay was reduced for 12.5 per cent of Pakistani patients, and those experiencing relapses sought help earlier.
For further information contact
Sue Hammond, Team Leader, Project Support Unit, Department of Health. Email: sue.hammond@dh.gsi.gov.uk
Escort duty (Bucknall Hospital, Staffordshire)
Older People’s Services Assessment and Rehabilitation of Complex Needs have implemented a team to support service users when an escort is needed for patients undergoing medical investigations away from the ward. It was introduced when it was realised that escort duties were depleting staffing levels on the ward, resulting in a lack of continuity of care and a longer length of stay. The team assesses the patient using a checklist, to ensure they can meet the needs of the patient, knowing that safety, nutrition and dignity are paramount during time away from the ward. Patients say they feel safe and secure having a team member escorting them, and better informed about the expectations - as one lady said: 'The nurse told me exactly what I would have done to me and she stayed with me all the time - I felt less afraid.’
For further information contact
Lyn Charlton, Modern Matron, Combined Health Care. Tel 01782 273510. Email Lyn.Charlton@northstaffs.nhs.uk
Extra Care scheme for people with dementia (Portland House, St Helens)
Portland House is a small, eight-unit, Extra Care scheme for people with dementia, where staff recognise the value of tenants, their uniqueness and their personal needs. Individuals’ views are respected and accepted, providing the rights of other tenants are not infringed.
Staff take time to get to know individual tenants in order to understand their needs and gain knowledge of each person’s previous lifestyle, their likes and dislikes. Care and support is agreed with each tenant and provided on that basis. A staff-tenant ratio of 1:4 and a flexible staffing structure make this person-centred approach possible.
Staff take on the role of enablers in order to promote independence in all aspects of daily life and personal care. This in turn preserves dignity and encourages feelings of self worth. Staff support tenants to develop and maintain links with local facilities, and this helps to promote social inclusion.
The combination of the physical environment, philosophy and person-centred practice at Portland House has enabled the eight tenants to maintain their skills, build confidence in their own abilities and has boosted their self-respect. Information taken from the Dignity in Housing LIN Report, 2006 (417kb PDF file).
For further information visit
http://icn.csip.org.uk/housing/
Facilitating dignified communication (Ashford and St Peter’s NHS Trust)
The trust’s Communication Group looks at how the communication needs of patients can be met. Clinical care indicators monitor the fundamentals of care and the patient communication interview, undertaken by the Patients’ Panel, highlights any areas of concern or best practice in regard to patients’ communication. The group has undertaken extensive work to address the communication needs of individuals, in particular those with communication difficulties, and is currently building up a supply of equipment within the trust to facilitate more effective and dignified communication. These include RNID crystal loop listeners, wipe-clean A4 boards and speech amplifiers.
For further information contact
Harriet Stephens, Lead Nurse, Practice Development. Tel 01784 884940. Email harriet.stephens@asph.nhs.uk
Filming the family: Tracy’s story (Isle of Wight Advocacy Trust)
Tracy is 32 and has lived in the same residential home since she was 17. She has no relatives or friends on the Isle of Wight, and is funded by a mainland Authority. Tracy has very high support needs, and her behaviour is challenging. She chooses not to access day care services, and becomes extremely agitated when day care is suggested. Tracy was referred for an advocacy assessment following a review.
An experienced advocate spent time with Tracy creating pictures of her likes and dislikes. Tracy was able to communicate that being given regular injections, which were required for medical reasons, distressed her. These injections always followed her visits to the day centre and were, it seemed, related to her refusal to attend. The advocate met with staff, and it was agreed that another form of medication would be adopted; Tracy has since become far less aggressive towards staff.
It was evident that Tracy missed her family and the advocate requested that the care manager research residential homes closer to them on the mainland, two possible homes were found. It was agreed that Tracy may find the long journey stressful and so the advocate travelled with a video camera to film the possible new homes and members of Tracy’s family.
The DVD enabled Tracy to be involved in the choice of new home. The DVD worked well as a communication tool and this method can be used again in the future.
Learning points
- It is important to maintain and support family links
- Where communication is a problem it is important to look below the surface as the reason’s for a person’s distress may not be as they first seem.
- DVD is a useful resource for communication
For further information contact
Jan Gavin, Chief Executive, Isle of Wight Advocacy Trust, Quay House, The Quay, Newport, Isle of Wight PO30 2QR. Tel 01983 559299. Mobile 07734 448069. Website: www.iwadvocacytrust.org/
Five factors of privacy (Southampton University NHS Trust)
The trust’s Essence of Care Group, which carried out an audit to uncover areas of dignity in care that needed further work, identified five factors of privacy and dignity (206kb PDF file). Guidance was provided for all wards on the 'five factors’ and they also developed a charter for patients (23kb PDF file) informing them of the standard of care they should expect.
For further information contact
Julie Dawes, Associate Director of Nursing. Tel 02380 798435. Email julie.dawes@suht.swest.nhs.uk
Food and Nutrition Benchmark (St Michael’s Community Hospital, Aylsham)
The Food and Nutrition Benchmark at St Michael’s Community Hospital was put in place as part the Essence of Care toolkit. The ward housekeeper, together with a healthcare assistant, spoke to patients about mealtime practices and asked for ideas as to how they could be improved. Following patients’ suggestions, mealtimes were protected and made more of an event, with new cutlery and tablecloths improving the dining environment. Since the changes were made, patients have reported enjoying mealtimes more. Regular audits ensure the practices are still effective. Information taken from Essence of Care Eureka! Protecting Patients’ Mealtimes at St Michael’s Community Hospital.
Gauging patient satisfaction (The West of Cornwall PCT)
The trust conducted a patient satisfaction baseline audit (180kb PDF file) with regard to privacy and dignity within the Minor Injuries Unit based at Cambourne & Redruth Community Hospital. The aim was to demonstrate where best practice was being achieved and to highlight areas where practice could be improved. Subsequently an action plan was developed to address the areas where service improvement had been identified.
For further information contact
Jane Goldsworthy, Development Manager Communications. Email jane.goldsworthy@ciospct.cornwall.nhs.uk
Getting the message across (Southampton University Hospital NHS Trust)
The trust’s Essence of Care Group carried out an audit on dignity in care in the hospital to identify where further work needs to be carried out. This work is part of a two-year project, working with the local primary care trusts. As a result, all wards have been provided with colourful, graphic posters with advice to the staff on how best to communicate with patients. These include reminders on good telephone manners, tips on how to communicate well face to face and factors to bear in mind when speaking or writing to someone who has a communication difficulty, whether through a disability or because of a language barrier.
For further information contact
Julie Dawes, Associate Director of Nursing, Tel 02380 798435. Email julie.dawes@suht.swest.nhs.uk
Related document
- Communicating by telephone (380kb PDF file)
- Communicating face to face (406kb PDF file)
- Communicating with people who have diverse needs (170kb PDF file)
Help with strategies and projects (Unique Improvements)
Unique Improvements works to involve people in improving services in their communities, helping to make communities stronger and improving people’s lives. Unique Improvements places particular emphasis on working with people who face some of the biggest challenges. For older people it provides interactive approaches to:
- older people strategy development
- developing Partnership for Older People’s Project (POPPs) bids
- evaluating POPPs
- care home development programmes
- safeguarding adults programmes
For further information contact
Safe and Secure in Sheffield Programme with the Home Office and Sheffield Council. Tel 0151 480 2202 or email linda.henry@uni.gb.com
Hospital Book (Barnet Learning Disabilities Service)
The Hospital Book (89kb
PDF file) is a recording system developed by the
Barnet learning disability team. Its aim is to help
patients communicate their needs to staff who may
not be used to working with people who have learning
disabilities and communication difficulties. The
book holds details of the person’s
needs and preferences; recording, for example, food
likes and dislikes or whether support is needed with
personal care. The information can also be summarised
on a Health Information Card, which is used as a
brief version of the Hospital Book or an addition
to it.
For further information contact
Alison Pointu, Barnet Learning Disabilities Service. Email alison.pointu@barnet-pct.nhs.uk
'If only the experience could be different’ (Luton and Dunstable Hospital Head and Neck Cancer Services)
Luton and Dunstable has taken an innovative approach to the ongoing re-design of their service, which is putting patients and staff right at the centre of the process. A project sponsored and supported by the NHS Institute for Innovation and Improvement is co-produced with thinkpublic (a service design consultancy), anthropological researchers from University College London and, importantly, patients and staff. The objective was not to solve any specific problems but to improve the experience of visiting the clinic. A team comprising patients, carers, healthcare staff, researchers and improvement leaders identified parts of the clinic process that heightened anxiety rather than reduced it, or contributed to patients’ sense of helplessness. With thought, some small things could make a huge difference to the patients - for example, moving weighing scales out of sight of the waiting room: staff hadn’t noticed how embarrassing patients found it to be weighed in front of everyone. The layout of the waiting room left patients facing a wall full of official notices or looking directly at others, and the number of different professionals around could be bewildering, so they are now trialling a different approach: instead of the consultants having rooms that patients move in and out of, patients now have rooms and staff move to see them. (Information taken from 'Journey to the interface', a Demos booklet.
For further information
- The Journey to the Interface: How public service design can connect users to reform (2.9mb PDF file)
Related document
Improving first impressions (Stockport NHS Foundation Trust)
In 2004, Stockport NHS Foundation Trust established
an initiative to improve the dignity and respect
towards its patients via a campaign which centred
on a patient’s first impressions of the hospital.
First Impressions took the top three issues raised
by patients in the national patient satisfaction
survey - patient
correspondence, staff attitudes and the environment,
and set about improving them.
Patient correspondence
The letters we send are often the first point of contact for the patient with the trust and should provide information in a reassuring, timely and accurate manner.
The First Impressions work lead to the development of a consistent approach to patient correspondence, implementing standards for letters which reinforced the trust’s image as a professional and caring organisation and inspired patient confidence in the services provided. It led to further work in improving the general information sent out to patients prior to coming into hospital, and the same information in video format on Patientline.
Staff attitudes
Widespread focus groups with staff lead to a list of seven behaviours we would expect all staff to demonstrate. These have become known in the trust as the Dignity and Respect standards and staff have received training in how to meet them and how to train colleagues. They are:
- A tidy and professional image
- Personal introductions
- Listening and informing
- Taking responsibility for patients and customers
- Valuing staff and being a role model
- Telephone standards
- Treating patients according to their needs and beliefs
Large posters depicting these standards are placed around the trust with a telephone number inviting the public to let us know how we are doing.
The environment
This workstream concentrated on the public areas of the hospital, improving the appearance of the corridors, public toilets, waiting areas, entrances and outside areas.
The trust has now built on this by using Patient Advice and Liaison Service volunteers to ask patients for their views on their experience of the hospital. The issues raised, together with key issues from complaints and the national patient satisfaction survey, form the basis of a ward indicator framework which allows the Board of Directors to keep updated and assured of quality on a regular basis. In this way we aim to develop 'Ward to Board’ reporting.
For further information contact
Judith Morris, Deputy Director of Nursing, Stockport NHS Foundation Trust, Tel. 0161 419 4049.
Improving the mealtime experience (Methodist Homes for the Aged)
Methodist Homes for the Aged (MHA) have introduced a range of initiatives across their care homes and housing schemes to improve the experience of mealtimes. The initiatives include a catering manual for catering and care staff with a clear set of standards, the introduction of routine nutritional screening, and assessment of residents’ eating capabilities by speech and language therapists. In one particular home, staff have looked at ways to ensure residents’ rights to privacy during mealtimes. Improvements have included the introduction of pleasant background music and fresh flowers at the dining table.
For further information contact
George Sampson, Head of Hospitality. Tel 0773 4151988. Email George.Sampson@mha.org.uk
In Touch (Gloucestershire Rural Community Council)
In Touch provides support and advice on services for older people in the county’s rural communities. When changes in social services criteria and closures of some day centres led to loss of services, In Touch worked with older people to identify what they would miss and need after services changed. The ideas of the older people were simpler, more cost effective and more acceptable to them than the original services and led to a range of social activities in a sheltered housing complex, informal lunch clubs, and a community minibus providing trips for regular shopping and lunches further afield. Social services staff call on In Touch to make connections between isolated older people and local groups and activities.
For further information
Involvement Workshop (Ashfield Community Hospital)
Mental Health Services for Older People at Ashfield Community Hospital ran an involvement workshop in July 2007. The aim was to:
- Raise the profile of mental health services for older people by presenting the service in a positive and pro-active way.
- Bring the wider community closer to the work carried out by the service and demonstrate how it works in partnership with agencies like the Alzheimer’s Society to fight for the dignity of older people with mental health issues.
The workshop featured singers and small reminiscence displays, a poet and an organ grinder. People were asked to send in mementoes such as pictures, poems and coins to be mounted on giant jigsaw pieces. These would in turn be hung on the walls leading up to the inpatient wards an installation that would encourage people look back positively and celebrate an exciting and positive future.
For further information contact
Deborah Thompson, Modern Matron, Nottinghamshire Healthcare NHS Trust. Email Deborah.thompson@nottshc.nhs.uk
Involving residents (Dorset County Council)
Adults with learning disabilities in residential care are now involved in developing their own care plan as part of Dorset County Council’s dignity in care at mealtimes. Residents are nutritionally screened on admission and at monthly intervals, and are surveyed regularly about meals and mealtimes so that menus can be adapted accordingly.
For further information contact
Sue Hawkins, Catering Services, Adult and Community Services. Email s.hawkins@dorsetcc.gov.uk
It’s good to talk (Community Network)
Some older people may be too frail to leave their home and a telephone conference call can be the only link to the outside world. The national charity Community Network aims to help organisations tackle social isolation through the provision of 'social telephony’. Local authorities and voluntary organisations have worked with Community Network to facilitate regular sessions linking up older people who are unable to get out and about as they wish due to their own frailty, mobility, location or transport issues. These Friendshiplink groups have provided a lifeline for a group of people who might otherwise be unable to have any other social interaction in the course of the week. This example of helping to overcome social exclusion comes from 'A sure start to later life' (SEU / ODPM, 2006)
