SCIE Practice guide 09: Dignity in care

Overview of selected research - Introduction

This overview of selected research, inspection, policy and practice documents draws on British and international literature that relates to dignity in health and social care. It is not a comprehensive review, but aims to offer a window on some of the key issues and debates. Throughout, the principal focus is on what older people themselves have said about why dignity is important, and - often more easily described - what threatens dignity.

Section 1 fills in some of the public policy background, and describes a growing awareness of the importance of dignity to the well-being of service users. But what exactly is dignity?

Section 2 considers what dignity means. It outlines some of the many studies which have attempted to define dignity, list its characteristics and refine methods of analysing and evaluating care which supports it. The section ends with a summary of what appears to be the current state of knowledge about the meaning of dignity.

Section 3 outlines what protects dignity. It examines factors identified in the literature which support the dignity of older people in care settings. These include the inner strength and resilience of older people themselves, the range of rights which should protect them and the development of person-centred care, which puts the needs and wishes of the service user at the centre of care planning.

Section 4 considers threats to dignity. These are not just the everyday incidents which dent self-esteem, weaken autonomy and remove privacy. They emerge from fundamental ways in which society is organised, and require fundamental remedies. They include ageism and age discrimination, the range of disadvantages and discriminations that can multiply the effects of ageism, and abuse - the violation of an individual’s human or civil rights.

Section 5 moves on to dignity in practice, and considers the messages from the literature about a range of contexts - at home, in hospital, in care homes, in settings which care for older people with mental health problems, and at the end of life. There are issues common to all settings, but also some clear differences which have important implications for practice.

A brief final section summarises some of the apparent gaps in the current literature.

There are three conclusions that can be drawn from this selected overview of the literature. First, there are some themes which occur again and again, many of which coincide with the findings of the Department of Health’s online survey of people’s views and experiences of care (DH, 2006d).

Secondly, dignity itself has proved very difficult to define. Researchers have struggled to tackle what is in essence a philosophical idea, and to tie it down with observation, interview and analysis. Everywhere, the literature reflects tensions and questions of balance: between preserving privacy on the one hand, and avoiding silent isolation on the other; between acknowledging autonomy and resilience, while offering close support; between actual frailty and dependence, and the need for usefulness; between setting clear service targets, and leaving room for flexible, personal responses.

But, at the same time, there is one very clear message from these documents. 'Dignity in care’ obviously has meaning for older care users: this is the third key conclusion. Recognising and respecting what it means in terms of autonomy, privacy, respect, identity and sense of worth, and designing practice to support it, contributes to older people’s well-being and - ultimately - to what makes their lives worth living. Dignity is never simple, but always important.

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