This article from the Everybody Matters Team encourages dignity champions either working in, or accessing, a care environment to consider how working practice of the medical staff can encourage and enhance the understanding of dignity and need in the people that are cared for within that environment. The article, from the Nursing Times, examines the idea that the the term "involvement" has meant engaging with people and the issues that are important to them. People come into hospital because they need the expertise of staff to help them recover, or manage, their illness or condition as best they can. However, the research shows that how we deliver hospital care is as important to patients/family experience as what we do to or for them.
· Enhancing shared decision making in "everyday" care - it can be perceived that pressure of work encourages staff to focus on a list of tasks to accomplish. As a consequence, patients and their families can become passive receivers of impersonalised clinical activities;
· Putting the "personal" back into personal care - washing, using the bathroom, deciding what clothes to wear and food to eat are highly personal activities. While patients and families recognise that routines are necessary for hospitals to operate, part of the process is to think with staff about "good enough" dignity when it is not possible for personal needs to be met in the way that patients most desire;
· How staff offer personal care is important - the team have been reflecting with staff about this and why some patients may feel uncomfortable or even refuse help with activities. Some feel embarrassed at having to ask for help and become angry with staff who remind them of their dependence. Others find that experienced nurses assume that because they are in hospital they cannot do anything:
· Engaging patients whose condition/context challenges involvement - people with particular needs, such as communication difficulties, are at greater risk of non involvement in hospital. During this project the team worked with nurses to enhance involvement for such patients.
The following extract from field notes illustrates something of the complexity associated with negotiating care with a woman diagnosed with dementia:
"Yvonne was very frail. She was sat in bed, constantly plucking at her bed sheet. I went to introduce myself, she clutched at my hand, whispered something unintelligible to me and then began plucking at my sleeve. I spoke again asking if I could take her blood pressure and she clearly said: "Who will talk to me?" I replied (surprised) I would, and she said something incoherent, moved her hand away from my arm and began to pluck at the sheet. I hesitated as to whether to take her blood pressure and kept looking at her but she didn't return my gaze and spoke incoherently for a moment then closed her eyes, I talked to her about my day, the ward, anything that came to my mind. She stopped plucking at the sheets and fell asleep." (The patient's name has been changed)
Involving people in care decisions is not always possible but the team consider that it is always feasible for nurses to connect with other members of staff and people in their trust to support them and help promote involvement. Involving people at different levels of the trust requires a range of tools and languages. It is not always easy for staff or patients/families to communicate their experience.
Below are three interventions used in the project to help people to engage with the experience of being in hospital.
· Pocket postcards to engage with patient/family/staff stories of care:postcards with phrases or pictures can act as a support for a conversation that is different from recounting a clinical history.
· Emotional touchpoints: use feelings at key points (touchpoints) of a story as a way of understanding experience. The patient/family or staff member is asked to select from a range of emotional words those that best describe their experience and are then invited to explain why they felt this way. In our project that level of depth has been reached through using emotional touchpoints with staff.
· Introducing listening posts to hear and celebrate good care, and collect areas for development: listening posts were devised to facilitate staff and lay stories of dignity in real time. Postcards inviting responses to the statements "Tell us what we do well" and "Tell us what we could do better" were given to patients, staff and carers. Responses were posted in boxes in the hospital concourse area.
The team conclude by suggesting that dignity in hospitals requires engagement by patients, carers, nurses, multidisciplinary teams and the wider organisational leadership. The team comment thart small changes give time for our current working practices and support structures to grow with us and thus make the change sustainable.
So the Everybody Matters Team end this series with a challenge: what is the smallest change you can make to enhance dignity in your place of work?"
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