So, where to go from here? As the Pink Floyd song goes, have we, in terms of loss of dignity, become âcomfortably numbâ, disconnected from the recurring reports of this issue? How do we get off the merry-go-round of loss of dignity in older person residential care settings?
It is critical that we start looking at additional and alternative ways moving forward to ensure that older persons and their familiesâ dignity is preserved. As a gerontological nurse working clinically, I experienced dignified care in nursing homes, and I asked myself why more of this care was not happening.
I thought if we examined dignified care further, hearing stories from residents and staff, we could learn from this and apply this knowledge and patterns of behaviours, in turn, preserving dignity in areas of care that were deficient. This led to a PhD study exploring dignity in an older person residential setting.
No doubt the profit-driven model of many care organisations, which causes operatorsâ primary focus to be on securing balance sheets rather than securing the interests and dignity of residents and their families, is not serving us well. Accountability is a key element here.
Furthermore, in relation to staff, there can be conflict between oneâs professional caring with dignity and the organisationâs interests. We cannot remain comfortably numb with dignity. There is a constant challenge between financial and care decision-making for professional caregivers.
Efficiency is âdoing things rightâ, whereas effectiveness is âdoing the right thingâ. Efficiency and effectiveness can be the difference between a task-oriented culture and a dignity-oriented one. More action-oriented approaches involving owners of the organisation, as well as staff, residents and their families, to reflect the daily practices that strengthen the interdependence of safety for realising a culture of dignity in healthcare organisations are required.
To nurture care with dignity, a culture of open minds is required at both organisational and staff levels. This enables participants to come together, participate, reflect and move away from feelings of blame shifting and defending, a culture that had previously been noted for patterns of shielding and refutation.
Ongoing education
Whilst it is critical for residents and families in nursing homes that we do not bury our heads in the sand by failing to address reports of loss of dignity, it is also important that we hear about experiences of dignified care.
Some international evidence has shown that energy evaporates from organisations when there is a focus only on problems. When there is a focus on what works well rather than on problems, opportunities arise to raise staff and public confidence and disrupt interventions that erode dignity, and there is learning in this.
To secure a culture flourishing in dignity, organisations must lead with mindsets that provide educational environments with safe spaces where staff can constantly reflect on situations and their actions and continue to strengthen their knowledge on promoting dignity.
Strategies such as ongoing education can assist care and nursing professionals to understand how and why they do things. It will also enable them to use their newly acquired understanding as a strategy to resist profit-making organisationsâ ideas, instead influencing dignified practices in older person residential care settings.
In other words, staff will be empowered to provide effective care with dignity, meaningfully and safely, rather than just efficient, safe care – âdoing the right thingâ versus âdoing things rightâ.
Talking to residents, staff and managers about their positive experiences and stories of dignity and finding out what dignity means to them was a different approach, and moved away from examining and scrutinising poor dignified care.
Listening to individualsâ stories increased an understanding of dignity:
Residentâs voice: âI am very slow walking, and my sight is poor, and I like my own company, but the staff never make a big deal of this, and they speak to me like an equal and that is important. They do not rush me when walking and always tell me to take my time, that makes me feel safe.
“I notice how they care for others; one lady she gets very confused, and her daughter says that she loved her style, and the staff speak to her about her lovely clothes, they recognise her and speak and treat her as a person rather than identifying her because of her confusing moments, it all adds upâ.
Nurseâs voice: âIt is so important that the resident is at the centre of care. I know some days, when I go into the residentâs room, I want to make the bed quickly, but I cannot rush the resident. The bed or task can never become more important than the resident.â
Consequently, residents and staff stories about their positive experiences of dignity informed the design of care in collaboration with staff and residents in the nursing home to instil actions that promoted:
the value of dignity;
feelings of safety;
living and working together in a trusting culture of care with dignity.
To understand their practices and behaviours, staff require the support of the organisation and leaders they trust, who are visible and empower them to stand up against poor practice and problem solve and enable âdoing the right thingâ versus âdoing things rightâ.
What we are even more sure of than ever, is finding a way to reconcile confidence in nursing homes and dignified practices. There is a need for ongoing scrutiny of dignity; with legislative bodies, organisations responsible for strategic planning, staffing levels, and financial accountability engaging collaboratively with staff as well as hearing, listening and responding to residents, their families and advocates of positive ageing.
Dignity is a basic human right, not an entitlement. Acknowledgement must be paid to the leading advocates from reports such as Leas Cross and the inception of inspection bodies such as Hiqa and the excellent staff in older person residential care settings who continue to advocate and action dignified care for older persons.
We need to be uncomfortably shocked and call for immediate legislation and continuous education. We might not think about dignity when it is present, but when loss of dignity happens we can find ourselves in unforgettable situations which are heartbreakingly sad, instilling hurt and guilt in individuals and families, cutting through the core of basic humanity which some may never recover from.
We need ways to fix this now before the merry-go-round brings us all around once again to further loss of dignity.
Dr Jill Murphy is an Associate Professor at University of Limerickâs School of Nursing and Midwifery and a Registered General Nurse