SCIE Practice guide 09: Dignity in care
Ideas from practice
Red Tray system
Many hospitals have adopted this system for identifying patients who require assistance at mealtimes. Food served on a red tray provides an effective signal to staff without compromising the patient’s dignity. The system is being monitored and refined, but has been found helpful in to promoting individual care and staying alert to changing nutritional requirements. Designating patients who receive a red tray is part of initial and continuing assessment, and a daily updated list of patients due to receive food on red trays can be included in shift handovers and provided for kitchen staff. A red tray is also a simple reminder to staff to check the patient’s notes for guidance on any specific help or nutritional needs. In several hospitals the red tray system has been linked with protected mealtimes (see below).
Raising the bar on hygiene and cleanliness (Caterham Dene Community Hospital)
Special new blinds and bed curtains have been installed in the inpatient areas. These are coated with anti-bacterial agent, and the bed curtains are dated so that they can be changed every six months (or sooner if there is a patient with an infection nursed in that area). The cost is comparable to traditional curtains and blinds.
As part of the move to improve hygiene, cleaning standards are monitored and regularly reviewed to ensure that the contracted work meets the needs of the hospital. There is a regular schedule, and audits are carried out to ensure that procedures are being followed. Several formal audits will be carried out for very recent improvements and it is planned to hold patient focus groups with the support of the PPI manager.
Key learning points
- Consult with and involve frontline staff at all stages of any change as they can be your champions in implementation.
- Encourage staff to question and challenge any change - it allows them to understand the rationale behind new developments and move forward with them.
- Talk with other organisations, as most will be prepared to share their experiences and that way it will avoid the time-consuming repetition of mistakes.
For further information contact
Eileen Clark, Service Manager. Tel 01737 214846. Email eileen.clark@eastsurrey-pct.nhs.uk
Setting goals (Oldham Intermediate Care Team)
The care team are piloting a system of goal and treatment planning which was developed and introduced by one of their occupational therapists (OT), Luke Roberts. The tool is evidence-based and also provides an outcome measure loosely based on the Canadian occupational performance measure (COPM) (Law et al., 2005). On admission the patient and OT together set the goals and the patient receives a folder which contains these goals, to help monitor progress and reinforce a sense of purpose. The team intend to evaluate this method and, if successful, roll it out to other areas of intermediate care in Oldham. It is expected that this method of involving people in their own care will ensure that they feel informed, listened to and treated as an individual. The very functional approach ensures that patients are actively engaged in occupations that will restore their ability to carry out daily activities when they return home.
For further information contact
Tracy Acton, Clinical Specialist OT. Email t.acton@nhs.net
Single-sex bay areas (Caterham Dene Community Hospital)
The hospital ensures that bay areas on the ward are never mixed sex. There is a mix of large and small bay areas, which includes some single accommodation. The majority of patients tend to be female (census data and historical evidence also support this), so the larger bays tend to be allocated to women, although there is flexibility in this arrangement if necessary. All bathroom and toilet facilities are designated as single sex to avoid embarrassment or discomfort for patients.
For further information contact
Eileen Clark, Service Manager. Tel 01737 214846. Email eileen.clark@eastsurrey-pct.nhs.uk
Small, effective changes, not changing the world (Manchester Mental Health and Social Care Trust
The Older People’s Essence of Care team believe essence of care should be about small, significant improvements that patients have highlighted, not about changing the world, and have found that involving the whole multi-disciplinary team ensures that this service is consistent throughout their locality. Here are some of the developments and improvements they have made, which all disciplines and clinical services must follow:
- induction packs, which include information relating to privacy and dignity, awareness of discrimination (age, culture, sex), confidentiality and record-keeping
- patients to be asked what they prefer to be called on admission/referral, and this to be documented
- patients to be asked for consent to share information on admission
- all areas to provide rooms for private conversations/interviews/phone calls
- patient orientation, including information about quiet areas, privacy and confidentiality
- staff encouraged to challenge others’ negative attitudes.
The team is evaluating these improvements and awaiting patient satisfaction results.
For further information contact
Sheila Kasaven, Modern Matron. Tel 0161 291 6806. Email Sheila.Kasaven@nhs.net
Sole Mates (Age Concern)
Sole Mates provide a footcare service, including foot massage, for people over 50 who cannot cut their own nails or tend to their feet safely. It is provided through Age Concern in a number of counties and was among the 'baker’s dozen’ practical steps praised in the Older People's Inquiry: 'That little bit of help' (108kb PDF file) (JRF, 2005).
Steps towards greater dignity (Derbyshire Mental Health Trust)
The trust has implemented Life History Work/Diaries, led by person-centred link nurses and taught by a dementia care specialist. This considers what people would like and how they would like to be treated, including invasive treatments and procedures and how to alleviate any distress. They also use Dementia Care Mapping, a validated tool which is able to identify illness/well-being for patients who may not be able to verbalise their thoughts. The trust has also introduced customer care into their induction programme and a specific customer care training day that looks at attitude, and maintaining privacy, dignity and modesty of all client groups
For further information contact
Kim Shield, Essence of Care Coordinator. Tel 01332 362221 ext 3783. Email kim.shield@derbysmhservices.nhs.uk
Success through the Single Assessment Process (Leasowes Intermediate Care Centre, Smethwick)
Leasowes is a bespoke 20-bed unit where patients (predominantly older people) can be assessed and rehabilitated. Often, they come in with complex needs and multiple medical conditions that may have culminated in a fall and they may have had difficulty managing at home. Staff believe that the use of the Single Assessment Process enables the whole team to deliver person-centred care. On admission, patients are asked what they want to achieve during their stay. Personal details such as how the person likes to be addressed, how they wish their privacy to be respected and issues of consent for information sharing with other organisations and partnerships are all an integral part of creating a respectful environment. The staff know that building a strong relationship with colleagues in the community ensures that good quality, person-centred services continues after the client has been discharged.
For further information contact
Marian Long, Email marian.long@nhs.net or Ruth Clarke, Email ruth.clarke2@nhs.net
Success with a DVD diary: Jane’s story (Isle of Wight Advocacy Trust)
Jane is a woman of 29 with severe learning disabilities. In October of 2005 her father died unexpectedly and her mother was diagnosed with a terminal illness. Jane was moved into a residential home without the usual preparation, planning and transition.
Jane was withdrawn, frustrated and very anxious and. Having previously suffered mild and infrequent epileptic fits these became frequent and more severe. Staff had little knowledge of epilepsy, and the continuity of care was poor. It was requested that the Advocacy Trust become involved.
The Trust met with Jane’s mother, care manager and staff from the home and day care services to discuss how they could work together to support her. It was agreed that staff at Jane’s home would receive epilepsy training.
An experienced advocate was allocated to Jane and her mother to make a DVD diary. Consent for the filming was obtained from those involved. The diary is in two parts: 'Me and my mum’ and 'Where do I want to live?’ Jane is able to use this DVD at her day centre, or at home with the use of a laptop computer. When Jane becomes anxious and distressed, the DVD has an immediate calming effect on her. Within the DVD, Jane’s mother talks of Jane’s likes and dislikes. This is a useful source of information for care workers now and in the future.
Learning points
- People with high support needs and communication difficulties benefit from an independent advocacy service.
- Advocates are well placed to challenge services that are not meeting the needs of service users.
- Use of Video/DVD is an effective way of empowering people, and is an excellent training tool.
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/
Tapping into knowledge and experience (Westminster Children and Community Services Department, London)
A significant number of development and training courses here routinely involve older people, who share their experiences and say how they would like staff to treat them. Many older people are already experienced presenters but, if any feel anxious, personal presentation skills training can be arranged. The department has also arranged presentation and assertion skills training for groups of older people who volunteer or work in the voluntary sector. The department has also held a number of successful consultation events with older people and developed a useful Older People’s Consultation Checklist (100kb PDF file). This and all development and training activities have been formally evaluated and changed in response to learners’ or managers’ feedback.
For further information contact
Jane Simms, Principal Commissioning Officer, Westminster Children and Community Services Department. Tel 020 7641 2079. Email jsimms@westminster.gov.uk
The Haven Project (North Essex Mental Health Trust)
The Haven Project provides day and crisis services to people with severe personality disorders. Service users play a central role in shaping and running the project; in addition to forming an advisory group, 50 per cent of those on the Haven board of directors have used mental health services.
The success of the service has been impressive. There has been an 85 per cent fall in the admission of Haven Project clients to hospital and the use of A&E services is down by 60 per cent.
Hazel was diagnosed with a personality disorder nine years ago. In 2004 she was referred to the Haven project. Commenting on the help she has received, Hazel said: 'The Haven has given me a future and a life, rather than an existence. I am finally in a position where I can see a happy and useful future. The Haven is the family I never had. It’s a place where I feel safe and able to explore my path to recovery.’
For further information contact
Benedict Knox, Strategic Communications Advisor, Department of Health. Email ben.knox@dh.gsi.gov.uk
The Sunshine Project (Help the Aged)
Help the Aged set up the Sunshine Project in order to increase opportunities for those living in care homes to make new friends. Two schemes have been taking place in care homes in the East of England: a befriending scheme and a computer training scheme. The purpose of both is to increase social contacts, reduce isolation and improve quality of life. Computer training introduced people to information technology and to using email as a means of communicating with family and friends.
An interim evaluation by a research team at Essex University was funded in partnership with the local PCT, which was interested in how the project might lessen the strain on its services. The report was very positive, concluding that:
'Findings [of the evaluation] also reiterate the importance of non-family social interactions, previously documented by studies (McNeil, 1995) which indicate that social relationships and activity per se appear to confer health benefits through psychosocial pathways. Health and social care agencies need to recognise the non-clinical aspects of ageing and work together to maximize well-being in all areas of daily life by whatever means they have at their disposal. This evaluation can be used to build an evidence base to guide ongoing work in this area.’
For a copy of the report, contact
Dorothy Seymour. Tel 01255 477939.
Transport with care (Lincolnshire Teaching Primary Care Trust)
The Trust has set up a transport service, to ensure older patients not requiring hospital admission can be driven home after their visit, rather than make an unnecessary overnight stay. This service provides a responsive, needs-led wheelchair access vehicle to drive hospital patients from one care setting to another or to return them home. Working in partnership with the Discharge Rehabilitation Team in Accident and Emergency, the service transports patients safely and settles them home, with provision of a basic grocery pack. The service maintains a social care approach and perspective, putting the individual at the centre.
For further information contact
Maria Storti, Interim Operational Lead Intermediate Care, Lincolnshire PCT. Email maria.storti@lpct.nhs.uk
Volunteers and Mealtimes project (United Bristol Healthcare NHS Trust)
The Trust has introduced a range of initiatives to improve nutrition and dignity at mealtimes, including the Volunteers and Mealtimes project, established on one ward to provide more assistance to elderly patients. The project set out to recruit volunteers to make mealtimes on the ward a more social occasion. Following its success, more mealtime volunteers were recruited, each one attending a multi-professional half-day programme of training. The Hospital is considering extending the idea to other wards.
For further information contact
Jayne Weare, Occupational Therapy Manager. Email Jayne.Weare@ubht.nhs.uk
Whistleblowing (Hyndburn short break service)
At Hyndburn short break service for people with learning disabilities ensures staff feel confident enough to blow the whistle on bad practice by:
- providing support to blow the whistle during supervision
- ensuring the manager is approachable and responsive
- displaying numbers of Welfare Counselling
- Issuing all staff with a credit-card sized whistle blowing card with a confidential helpline number to ring with concerns about practices in the workplace. It comes with a brief leaflet which outlines what whistle-blowing is and what the council's policy is.
For further information contact
Rebecca Toman, Short Breaks Manager, 98 / 100 Gloucester Avenue, Accrington, BB5 4BG. Tel: 01254 395060
