Abstract
BackgroundWhilst 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.MethodsTo 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.Results192 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’.ConclusionFacilitators 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.
Highlights
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
This consisted of 22 questions, exploring health and social care professionals’ perspectives and experiences of dignified care and was modelled on the instrument developed by the Royal College of Nursing report [21] and informed by research which had taken place since the completion of that survey [22]
We integrate the results of both elements of our study to provide an integrated analysis of the facilitators and barriers to providing dignified care
Summary
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. There is a wealth of empirical evidence enumerating what patients and their relatives identify as the core elements of dignity in care namely: respect for personhood and the individual; communication and form of address; privacy; toileting; nutrition and feeding; cleanliness of environment; and staff attitudes [4,5,6,7] These are the dimensions of dignity that regulatory bodies, policy makers and researchers have attempted to turn into measurable standards, practice guidelines, targets for achievement and inspection regimes [2, 8, 9]. This forms part of a larger case study (survey, interviews and focus groups) investigating how dignified care for older people is understood and delivered by health and social care professionals and; how organisational structures and policies can promote and facilitate, or hinder, the delivery of dignified care
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