Dignity in Practice: An exploration of the care of older adults in acute NHS Trusts (original) (raw)
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BMC Research Notes, 2015
Background: Whilst the past decade has seen a growing emphasis placed upon ensuring dignity in the care of older people this policy objective is not being consistently achieved and there appears a gap between policy and practice. We need to understand how dignified care for older people is understood and delivered by the health and social care workforce and how organisational structures and policies can promote and facilitate, or hinder, the delivery of such care. Methods: To achieve our objective of understanding the facilitators and to the delivery of dignified care we undertook a survey with health and social care professionals across four NHS Trusts in England. Participants were asked provide free text answers identifying any facilitators/barriers to the provision of dignified care. Survey data was entered into SPSSv15 and analysed using descriptive statistics. These data provided the overall context describing staff attitudes and beliefs about dignity and the provision of dignified care. Qualitative data from the survey were transcribed verbatim and categorised into themes using thematic analysis. Results: 192 respondents were included in the analysis. 79 % of respondents identified factors within their working environment that helped them provide dignified care and 68 % identified barriers to achieving this policy objective. Facilitators and barriers to delivering dignified care were categorised into three domains: 'organisational level'; 'ward level' and 'individual level'. Within the these levels, respondents reported factors that both supported and hindered dignity in care including 'time' , 'staffing levels' , training' , ' 'ward environment' , 'staff attitudes' , 'support' , 'involving family/ carers' , and 'reflection'. Conclusion: Facilitators and barriers to the delivery of dignity as perceived by health and social care professionals are multi-faceted and range from practical issues to interpersonal and training needs. Thus interventions to support health and social care professionals in delivering dignified care, need to take a range of issues into account to ensure that older people receive a high standard of care in NHS Trusts.
Journal of Clinical Nursing, 2022
Aims and objectivesThe aim of this study was to explore older adults’ perspectives about dignity and dignified nursing care during acute hospitalisation in Ghana.BackgroundMaintaining hospitalised older adults’ dignity is an essential component of nursing care and one of the most important determinants of wellbeing. To date, no study has been published on older adults’ perspectives of dignified nursing care in the African context.Study designA qualitative descriptive research design.MethodsTwenty hospitalised older adults were purposively selected from the medical and surgical wards of a teaching hospital in Ghana. Data were gathered through semi‐structured interviews between April and August, 2021, and analysed using reflexive thematic analysis techniques. The SRQR checklist was used to document reporting of the study.ResultsThe following four themes were identified: Effective nurse–patient communication, Maintaining patients’ privacy, Respectful and compassionate care provision an...
International Journal of Older People Nursing, 2012
Background. Few empirical studies have directly examined the relationship between staff experiences of providing healthcare and patient experience. Present concerns over the care of older people in UK acute hospitals -and the reported attitudes of staff in such settings -highlight an important area of study. Aims and objectives. To examine the links between staff experience of work and patient experience of care in a 'Medicine for Older People' (MfOP) service in England. Methods. A mixed methods case study undertaken over 8 months incorporating a 149-item staff survey (66/192 -34% response rate), a 48-item patient survey (26/ 111 -23%), 18 staff interviews, 18 patient and carer interviews and 41 hours of non-participant observation. Results. Variation in patient experience is significantly influenced by staff work experiences. A high-demand/low-control work environment, poor staffing, ward leadership and co-worker relationships can each add to the inherent difficulties staff face when caring for acutely ill older people. Staff seek to alleviate the impact of such difficulties by finding personal satisfaction from caring for 'the poppets'; those Ó 2012 Blackwell Publishing Ltd 83 patients they enjoy caring for and for whom they feel able to 'make a difference'. Other patients -noting dehumanising aspects of their care -felt like 'parcels'. Patients are aware of being seen by staff as 'difficult' or 'demanding' and seek to manage their relationships with nursing staff accordingly. Conclusions. The work experiences of staff in a MfOP service impacted directly on patient care experience. Poor ward and patient care climates often lead staff to seek job satisfaction through caring for 'poppets', leaving less favoured -and often more complex patients -to receive less personalised care. Implications for practice. Investment in staff well-being and ward climate is essential for the consistent delivery of high-quality care for older people in acute settings.
Herd: Health Environments Research & Design Journal, 2018
Background: Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency. Purpose: This paper explores the effects of the physical environment in three acute care settings: Acute Hospital Site, In-patient Rehabilitation Hospital, and Intermediate Care Provision (a nursing home with some beds dedicated to intermediate care) chosen to represent different steps on the acute care pathway for older people and gain the perspectives of patients, family carers and staff. Methods: Semi structured interviews were undertaken with 40 patient/carer dyads (where available) and three staff focus groups were conducted in each care setting with a range of staff. Results: Multiple aspects of the physical environment were reported as important by patients, family carers, and staff. For example, visitors stressed the importance of access and parking; patients valued environments where privacy and dignity were protected; storage space was poor across all sites; security was important to patients but visitors want easy access to wards. Conclusions: The physical environment is a significant component of acute care for older people, many of whom are also frail, but often comes second to organization of care, or relationships between actors in an episode of care. 4 Executive summary of key concepts This paper presents the qualitative component of a larger study which explored the effects of the physical environment on UK settings delivering acute care to frail, older people. Frail, older people form a significant proportion of the acute hospital inpatient population. Interviews and focus groups were carried out with patients, family carers, and staff in three different settings providing acute care to explore their perceptions of whether the physical environment met their needs. Findings demonstrated that, while the physical environment often came second to environments reflecting human factors, such as organisation of care, and relationship between actors in an episode of care; several aspects were reported as being important. Patients valued environments where privacy and dignity were protected, while maintaining opportunities for company with others; storage space was poor across all sites; security was important to patients but visitors want easy access to wards; public transport to the sites was variable and parking was inadequate. Nevertheless, relatively inexpensive changes can be made to existing buildings during planned maintenance, and also by ward staff, and these small design changes can make a difference to the success of the built environment in hospitals in responding to the needs of frail, older inpatients. Implications for Practice The physical environment is a significant component of acute care for older people The physical environment often comes second to organization of care or relationships between actors in an episode of care Acute care settings do not always meet the needs of older patients Human factors were more important than the physical environment
Development of tools to measure dignity for older people in acute hospitals
Journal of Clinical Nursing, 2018
Background: Dignity is a concept that applies to all patients. Older patients can be particularly vulnerable to experiencing a loss of dignity in hospital. Previous tools developed to measure dignity have been aimed at palliative and end of life care. No tools for measuring dignity in acute hospital care have been reported. Objectives: To develop tools for measuring patient dignity in acute hospitals. Setting: A large UK acute hospital. We purposively selected 17 wards where at least 50% of patients are 65 or over. Methods: Three methods of capturing data related to dignity were developed: an electronic patient dignity survey (possible score range 6-24); a format for non-participant observations; and individual face-to-face semi-structured patient and staff interviews (reported elsewhere). Results: 5693 surveys were completed. Mean score increased from 22.00 pre-intervention to 23.03 after intervention (p<0.001). Staff-patient interactions (581) were recorded. Overall 41% of interactions (239) were positive, 39% (228) were neutral and 20% (114) were negative. The positive interactions ranged from 17% to 59% between wards. Quality of interaction was highest for allied health professionals (76% positive), lowest for domestic staff (22% positive) and pharmacists (29% positive), and intermediate for doctors, nurses, Health Care Assistants and student nurses (40% to 48% positive). A positive interaction was more likely with increased length of interaction from 25% (brief) to 63% (longer interactions) (F[2, 557]=28.67, p<.001). Conclusions: We have developed a simple format for a dignity survey and observations. Overall, most patients reported electronically that they received dignified care in hospital. However, observations identified a high percentage of interactions categorised as neutral/basic care, which, while not actively diminishing dignity, will not enhance dignity. There is an opportunity make these interactions more positive. Summary Box What does this paper contribute to the wider global clinical community? • Dignity in acute hospital care can be monitored by surveys and observations.
Older people’s views of dignity and how it can be promoted in a hospital environment
Journal of Clinical Nursing, 2009
Aim. The study investigated the lived experiences of older patients who had been in hospital, to explore their views on dignity and the factors which promote dignity. Background. The UK government's new ambition for old age (New Ambition for Old Age: Next Steps in implementing the National Service Framework for Older People: A Report from Professor Ian Philip, DH) states that older people should be treated with dignity. The dignity in Care Campaign ('Dignity in Care' Public Survey, October 2006: Report of the Survey, DH) highlighted the need to raise staff's awareness and understanding of dignity. Design. A purposive sample of older people took part in semi-structured interviews which focussed on their recent experiences of hospital admission. Qualitative data analysis was used. Method. Ten participants aged 73-83 were interviewed by a nurse researcher at home. All of the participants had an unplanned admission and were discharged home.
Caring for Older People in Hospitals from the Perspective of Health Professionals: A Scoping Review
2021
A number of authors have raised questions concerning the quality of care and how older patients’ needs are met. Individual articles have generally sought to highlight any difficulties and deficiencies in caring for these patients [1-3]. Two factors in particular are addressed, namely the patient’s age and frailty. The findings and models of care presented in the literature and research projects can accordingly facilitate the developing of appropriate strategies and the allocating of resources to improve healthcare for older people [1-3]. As some authors point out, the quality of care for older people is a much broader concept than can by demonstrated by quantitative outputs such as morbidity and mortality [4-6]. In care for older people, the emphasis is not just on the quality and availability of healthcare, but also on other aspects of life such as values and religious beliefs, and human dignity and autonomy. A holistic and caring approach of carers is important, also as a support ...
BMC research notes, 2014
Despite well established national and local policies championing the need to provide dignity in care for older people, there continues to be a wealth of empirical evidence documenting how we are failing to deliver this. While we have evidence as to what older people and their relatives understand by the term 'dignified care' we have less insight into the perspectives of staff regarding their understanding of this key policy objective. This paper aimed to explore the meaning of dignified care from the perspective of health and social care professionals' working with older people. In-depth interviews and focus groups with health and social care professionals were carried out across four NHS Trusts in England, as part of a larger study, to investigate how dignified care for older people is understood and delivered. A total of 48 health professionals took part in in-depth interviews and 33 health and social care professionals participated in one of eight focus groups. Health...