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Warmth and kindness to bring dignity in care

People feel their dignity is respected when the care they receive is delivered with human warmth and empathy. They are not: objects, burdens, numbers or aliens. They are us – cared for with kindness.

Other sections in this guide have looked at communication, relationships, rights, privacy and involvement – all important to social care which supports dignity. This section is concerned with feelings.

The undercurrent of grief and loss

Nurses and nursing staff treat everyone in their care with dignity and humanity – they understand their individual needs, show compassion and sensitivity, and provide care in a way that respects all people equally.

Royal College of Nursing, 2018 Principles of Nursing Practice

Over to you

Think about the following situations. Try to imagine how you would feel.

You can think of many more possible situations like the ones above. One writer has described them as the, ‘undercurrent of grief and loss’ in care homes and other settings, which may be unnoticed by care workers. Pain – physical or emotional – may go unrecognised and untreated. What’s missing here?

The report of Sir Robert Francis on the inquiry into Mid-Staffordshire NHS Foundation Trust was published in 2013. Among many other things, it emphasised the need for compassionate care. He said that patients ‘must receive effective services from caring, compassionate and committed staff working within a common culture’.

Qualities of compassionate care

Here are some definitions of compassion in care, taken from Compassion, dignity and respect in health care (Health Foundation, 2014).

  • ‘Compassion comes from that moment when we can see the world through somebody else’s eyes.’
  • ‘Compassion is about treating patients with dignity, respect and empathy.’
  • ‘I think it’s particularly powerful when we are feeling vulnerable, in physical or psychological pain, or when we are afraid.’
  • ‘The consistent theme is that it’s always the smallest things that make the greatest differences.’
  • ‘You hear so many stories nowadays of people being treated as a number.’
  • ‘Compassion isn’t just about talking to the patients – it’s making them feel safe in a nice clean environment, where they can feel at home.’
  • ‘I think that the most valuable gift that we can give each other, and give the patients, is the gift of time.’

The need for compassionate care was reflected in the personalisation debate, and in the discussion of the full implications of the Care Act 2014. The ‘wellbeing principle’ set out in the Act covered not just the practical elements of a good life, but also the feelings of the individual – their need for personal respect and emotional wellbeing.

Research has shown that people appreciate the qualities care staff bring to their work. For example, use of humour, respectful attitude and committed (What do older people want from their care services)

What would matter more is a wee bit of attention, not to be in such a rush. Now they do everything, and everything is done, but … well he wouldn’t feel that he was just a vegetable, that he wasn’t a person. It’s all about personality … the friendly touch.

Family carer (SPRU 2005, University of York)

What does the CQC look out for?

How does the service ensure that people are treated with kindness, respect and compassion, and that they are given emotional support when needed?
CQC C1

Quality conversations and relationships

In Commissioning home care for older people, Scie found that most people being cared for at home want a warm relationship with their paid carers and place a lot of value on conversation.

A friendly and sociable carer is regarded by people who use services to be a marker for whether they are a good carer or a poor one. Paid carers themselves complain that they often don’t have time to talk to their clients, and that this part of their role is not recognised as important.

A team from the University of Leeds has looked at the ways in which ‘good’ relationships develop in extra care communities, from the perspectives of residents, families and service providers. People participating in the study were asked to rank a series of statements that represented the elements of good quality relationships. They were organised under the headings:

  1. Integrity
  2. Respect
  3. Fairness
  4. Compassion
  5. Trust

Allowing time to listen has been shown to be crucial to the development of real relationships repeatedly, as well as a way of expressing empathy.

Over to you

Look at the examples below.

What are the possible effects for the person who uses the service, in relation to:

  • self-respect
  • safety
  • inclusion
  • autonomy
  • resilience
  • emotional wellbeing?

What qualities do you need as a worker in these situations?

Meaning of home

The meaning of home varies from person to person, but it’s striking how often the term ‘homely’ is used to describe what’s good about services that are built around people and are based on what they want. ‘Home’, of course, suggests comfort, safety, human company and warmth -it makes you think of human-sized rooms and domestic furnishings. However, it also means the flexible routines and freedoms of ordinary life.

Understanding the feelings of people who use services depends on the values of staff, the culture of the organisation, and – above all – on leadership.

Tools for commissioners and managers include:

What does the CQC look out for?

Is there a clear vision and credible strategy to deliver high-quality care and support, and promote a positive culture that is person-centred, open, inclusive and empowering, which achieves good outcomes for people?
CQC W1

Finally

This section has been concerned with the threats to a person’s dignity which arise from feelings that go unnoticed and pain which is not recognised. These may include:

  • Grief for the loss of a partner, or a valued way of life. By definition, older people in residential care may experience the loss of friends, including new friends made in the home. There is no evidence that many bereavements make them easier to bear.
  • Anger and frustration, which people may feel at their changed circumstances, and the impossibility of making themselves understood to their new carer workers.
  • Physical and mental pain, arising from multiple chronic and disabling medical conditions. These may be seen by care workers as ‘normal’ for an older person, instead of crises needing urgent treatment.

People in these situations need care that is based on empathy, sensitivity, warmth, transparency and time. They don’t just need one talented and kind individual – they need an organisation that recognises and rewards compassionate care.

Further reading