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 people experiencing care themselves have said about why dignity is important, and - often more easily described - what threatens dignity. Research and practice have identified the special importance of dignity to older people, and their opinions and experience are central to this account.

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 (Department of Health, 2006d).

Secondly, dignity itself has proved very difficult to define. For more than a decade, researchers have struggled to pin down what is in essence an ethical concept that varies according to the cultural, historical and philosophical contexts in which it is discussed. But we are concerned here with the practical question of supporting dignity in care in the 21st. century. Research has identified - through observation, interview and analysis - a list of attributes of dignity or factors which indicate its presence in care provision. International comparative research has confirmed that it is possible to generalise across the EU and North America about many of these attributes. Some researchers have gone on to develop means of supporting and evaluating care that preserves or creates dignity.

Everywhere, the literature reflects tensions and questions of balance: between preserving privacy on the one hand, and avoiding isolation on the other; between acknowledging autonomy and resilience, while offering close support; between actual frailty and dependence, and the need for continued usefulness; between setting clear service targets, and leaving room for flexible, holistic, personal responses.

But, at the same time, there is one very clear message from these documents. 'Dignity in care' obviously has meaning for people using care services - especially older people: this is the third key conclusion. Recognising and respecting what it means in terms of autonomy, privacy, respect, identity and sense of self-worth, and designing practice to support it, makes a critical contribution to older people's well-being. Ultimately, it may define what makes their lives worth living, right to the very end of life. Dignity is never simple, but always important.