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Dignity in the healthcare setting.
In this essay i set out to achieve; defining the concept of dignity and discussing the importance of dignity within nursing care, to discuss how the code of practise NMC will guide my actions, describing the nursing actions i would take to promote and maintain all aspects of client dignity and reflecting on how my understanding of dignity will affect my future practise.
Dignity is defined asby the The American Heritage Dictionary as;
1. The quality or state of being worthy of esteem or respect.
2. Inherent nobility and worth: the dignity of honest labor.
3. a. Poise and self-respect.
b. Stateliness and formality in manner and appearance.
4. The respect and honor associated with an important position.
5. A high office or rank.
6. dignities The ceremonial symbols and observances attached to high office.
7. Archaic A dignitary.
My concept of dignity is that of treating someone as they wish to be treated within the social norms and values, within a nursing role this may be helping a client to comb there hair, take them to the toilet or enable them to do things they would normally do for themselves, as well as maintaining a high standard of care following normal nursing procedure. The concept of dignity is an essential value of nursing practise, working within a stroke rehabilitation ward on my current placement has given me insight into the barriers that can be created to orchestrating dignified care, especially for elderly patients. I believe dignified care can be better achieved by paying attention to the importance of dignity and by gaining insight into its meanings to the individual. Nurses constantly aim to provide holistic care to patients and their families. This is made difficult however by the current shortage of nurses and the high numbers of patients being admitted daily resulting in nurses feeling overwhelmed and angiuished. This means the window of opportunity is very narrow when creating a dignified clinical environment. When there is only a glimmer of dignity or it is absent completely, clients will feel worthless, lacking autonomy and feelings of embarrassment. Patients and clients can also experience dignity, or lack of it in what they wear and the environment in which treatment takes place. toilet facilities should be kept as clean and hygienic as possible, curtains between beds should be drawn to offer some measure of privacy, single sex bays within wards should be respected and gowns should be designed in such a way they do not expose th patient.
Scenario one has been chosen in order to highlght the actions I would, and have chosen to follow when in this situation. An elderly gentlemen has been put in the care of nursing staff, although he is not disorientated or confused he feels very anxious, is hard of hearing and physically frail needing assistance to walk. After the doctors finish the consultation, nurses are informed that Mr Chambers needs to use the toilet facilities. There is strong smell of faeces and the patients trousers and shoes are wet with urine. He appears agitated and upset. During my time on placement this siuation has occured on many occasions. To begin with the patient would need to be reassured, this can be done introducing yourself and explaining what you are about to do to rectify the problem. As Mr Chambers has a hearing impairment causing sounds to become blurred and indistinct this results in a communication barrier. To overcome this barrier I would make sure the patient could see me properly, not obscure my mouth, speak clearly and slowly whilst using lots of facial expressions and hand gestures as well as minimising the background noise. with this in mind i would
In situations where dignity was threatened, staff communication could prevent dignity being lost. For example Mr D related that when he was incontinent of urine, some staff promoted his dignity by reassuring him 'It's not your fault' while promptly changing his bed and nightclothes. Mr J said that the student nurse who inserted his suppositories (a procedure that he felt could have threatened his dignity) 'did it nicely' so he did not lose his dignity. Mrs Z identified that she could have lost her dignity in the bathroom but her 'bath had been handled well' because she had been given choicesthat promoted her dignity (Box 1). She said that if she had felt weaker she would have been happy to be bathed and that Nurse 4 had offered to help her and to wash her hair and it was 'nice to be offered these things'. Box1. Promoting dignity in the bathroom by offering choices (Observation fieldnotes)
'Nurse 4 asked Mrs Z if she'd like her to push her to the bathroom in a chair but Mrs Z wanted to walk. We walked with her slowly to the bathroom. In the bathroom we shut the door and Nurse 4 asked her if she wanted to use the bath hoist to get in and out but Mrs Z said no, she wanted to step in. Nurse 4 asked her to check the temperature of the water and Mrs Z said she wanted a bit more cold in so Nurse 4 put the cold tap on a bit more. Mrs Z then took her nightdress off and stepped into the bath. I passed her a face flannel and soap. Nurse 4 asked her if she'd like her to wash her back for her but she said she could manage. Nurse 4 also said, 'Do you want me to wash your hair?' but Mrs Z said 'Not today'. Nurse 4 then said would you like us to stay or would you like us to leave you for a bit and you can ring when you're ready? She said we could leave her so I handed her the call bell.