People's individual needs can easily be forgotten when it comes to the practicalities of toileting and continence in care.
Care for people with such problems is a very sensitive matter, and it is important to preserve a person's privacy and dignity during such care. Lack of focused guidance has led to inconsistent practice and mismatch between the care provider's view and the person's experience.
The Royal College of Physicians and the Centre for Health Service Studies at the University of Kent carried out a study to find out what factors were important to nursing home residents and hospital patients in maintaining their dignity during continence care.
The project was conducted in nursing homes and hospitals in Kent and London. Participants were aged 65 years and over and they had bladder and/or bowel incontinence, or required assistance with toileting or continence care. The project aimed to provide a definition of dignity and to identify characteristics of dignified bladder and bowel care, the findings were helped by 30 interviews with older people. The findings formed the basis for developing an observation schedule for use in nursing homes and hospital wards. During the study 56 toileting episodes were recorded.
There were four major themes as a result of the study, these were;
- Communication and Relationships - Effective communication is essential in making them feel they were seen as individuals. Building a relationship with a person was often a first step in providing dignified care. Simple introductions by carers, friendliness and chit-chat made participants feel human and helped to maintain their dignity, reassurance and sensitivity in carers is valued.
- Choice - Having and being able to express a choice in toileting care helped maintain dignity. Choices helped participants to feel more in control of their care and were important for keeping their independence, which helped to promote dignity. Participants did not always feel able to express their opinion as they did not want to appear to be causing problems or creating extra work for carers. Routine helped participants as they found comfort in knowing what to expect.
- Privacy - Maintaining a participant's privacy during toileting and continence was fundamental. While dignity is more abstract, based on emotions and feelings, privacy is a physical and can be recognized through sight and sound, such as closing a door and speaking softly however, too much privacy when it is not needed can lead participants to feel isolated and lonely.
- Hygiene - Being clean and having continence products hidden helped participants to feel confident that their continence problem was not noticeable to others. It was important to those with continence problems that staff recognized and acknowledges that accidents were not their fault. When accidents did happen it was important for people that they be cleaned up with a minimum of fuss.
Person centred care enhances dignity and is expressed when people are talked to like equals, when they are given choices and allowed to express preferences, when their privacy is respected, and when they are clean and comfortable. Caring is either dignified or not.
Vulnerable adults need to be encouraged to express how they really feel, not being concerned about being a burden or a nuisance, and be supported to manage their continence issues where possible.