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Abstract
AbstractThe concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted ‘behind closed doors’, largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the ‘dignity encounter’ through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home.
Highlights
The care of older people in the United Kingdom (UK) has demonstrated a significant movement away from hospital-based care towards community health-care models (Temmink et al, 2000; Markel-Reid et al, 2006), yet financial resources have not necessarily accompanied this policy-driven shift (Charles et al, 2018)
The experience of participants in this study suggests that dignity, in the context of community district nursing practice, is co-created across two interrelated planes, the geographical and the relational
Data obtained from observations and interviews facilitated a nuanced understanding and illuminating exploration into how dignity manifests in routine elements of district nursing care, highlighting the significance that often unnoticed care practices have on dignity outcomes
Summary
The care of older people in the United Kingdom (UK) has demonstrated a significant movement away from hospital-based care towards community health-care models (Temmink et al, 2000; Markel-Reid et al, 2006), yet financial resources have not necessarily accompanied this policy-driven shift (Charles et al, 2018). The concept of community nursing itself is an umbrella term used to describe an extensive range of nursing activities, including ‘any nursing care delivered “outside” the hospital setting, such as patients’ homes, or residential care or health centres’ (Spilsbury and Pender, 2015: 129). In the UK, district nurses provide a very particular type of community nursing care – nursing care in people’s homes where it is recognised that a significant proportion of their work involves older adults (Cornwell, 2012; Maybin et al, 2016; Dixon and Thompson, 2018; Quaile, 2018). It is the home nursing care experiences of older adults and the staff within a community nursing team with which this paper is concerned
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