Win Tadd, Alex Hillman, Sian Calnan, Mike Calnan, Tony Bayer and Simon Read
This paper reports on an ethnographic study to explore the experience of dignity in the acute care of older people in four acute NHS trusts. It explores the prevalent view that…
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This paper reports on an ethnographic study to explore the experience of dignity in the acute care of older people in four acute NHS trusts. It explores the prevalent view that acute care is not the right place for older people and the failure to acknowledge that the largest group of users are the very old, the frail and the dependent, which results in environments that are not friendly to older people generally, and are especially hostile to those with cognitive impairments. Added to this, a culture that is risk averse and defensive, where care is undervalued and where professional accountability and discretion are replaced by standardised checklists, pathways and audits, cultivates the attitude that if an aspect of care can't be measured it doesn't matter. Overall, getting the job done appears to matter more than how the job is done, so that the focus is primarily on the task rather than seeing the person. It describes how the failure of acute trusts to respond to the needs of the majority of their users ‐ older people ‐ results in the failure to provide dignified care and the impact of this on both the quality of care and patient outcomes.
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Tony Bayer, Win Tadd and Stefan Krajcik
This paper reports the findings of 89 focus groups and 18 individual interviews (involving 391 older people in 6 European countries) that were held to explore how older people…
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This paper reports the findings of 89 focus groups and 18 individual interviews (involving 391 older people in 6 European countries) that were held to explore how older people view human dignity in their lives. Participants were all aged over 60 years and 25% were aged 80+ years. They were from a range of educational, social and economic backgrounds. 72% were women and 17% were living in residential or nursing homes.There was substantial agreement about the meaning and experience of dignity in older people's everyday lives. It was seen as a highly relevant and important concept, enhancing self‐esteem, self‐worth and well‐being. Three major themes were identified: respect and recognition; participation and involvement; and dignity in care.The theoretical model of human dignity developed in the project was reflected in many of the findings from the empirical data. Of particular importance and relevance was the notion of ‘dignity of personal identity’, not least because it is perhaps most vulnerable to the actions of others. Menschenwurde (expressed as the innate dignity of human beings) was also important.For dignity of older people to be enhanced, communication issues, privacy, personal identity and feelings of vulnerability need to be addressed. Education of all professionals should pay attention to practices that enhance or detract from the experience of dignity. Policies and standards need to go beyond the merely mechanistic and easily quantifiable, to identify meaningful qualitative indicators of dignity in care.
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Win Tadd and Paul Dieppe
This paper describes the creation of the educational materials developed as part of the Dignity and Older Europeans Project. Following a discussion of the development process, the…
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This paper describes the creation of the educational materials developed as part of the Dignity and Older Europeans Project. Following a discussion of the development process, the materials themselves are described. The materials includes a poster of the dignity balance, which contains five core messages and illustrates the impact of both enhancing and violating individual dignity. The second product is a leaflet that also includes the dignity balance and lists of actions and approaches that will promote dignity or result in indignity. The final product to date is a multidisciplinary workbook which is described in some detail. The workbook Educating for Dignity provides a brief outline of the theoretical model of dignity, and four different sections based on the empirical findings:• understanding dignity• old age ‐ what is it like to be an older person?• dignity in care• the impact of the system.In each section quotations from participants, supplemented with images and cartoons, are used to illustrate various aspects of dignity. Readers are then set exercises to promote reflection about the issues raised. The workbook also contains a discussion of the exercises, an extensive bibliography and some policy implications. Finally, dissemination and use of the materials are explored.
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Sergio Ariño‐Blasco, Win Tadd and Josep Boix‐Ferrer
Professionals' views concerning the importance of dignity and how this can best be maintained is important for the planning and provision of appropriate services, especially for…
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Professionals' views concerning the importance of dignity and how this can best be maintained is important for the planning and provision of appropriate services, especially for older people.Dignity was described as an integral part of being human and closely related to respect. Overall, participants painted a negative image of the lives of older people, although clear distinctions were drawn between fit and frail older people. Indignities associated with old age arose from ill health, dependency, vulnerability, frailty and loss of competence. It was considered that technological advances and information technology had left many older people behind. However, many described working with older people as an enjoyable experience offering variety, intellectual challenge and satisfaction, while recognising that working with older people was often given low status.Professionals identified the following factors as essential to dignified care: promotion of autonomy and independence; a person‐centred and holistic approach; maintenance of identity and encouragement of involvement, participation and empowerment; effective communication and respect. Undignified care was associated with: invisibility; de‐personalisation and treatment of the individual as an object; humiliation and abuse; narrow and mechanistic approaches to care.Policy development and professional education should give greater prominence to dignity and a greater emphasis ought to be placed on living with dignity in old age rather than solely dying with it.
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This paper describes the methods used within the Dignity and Older Europeans (DOE) Project and in particular the approach involved in developing the bibliographical database, the…
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This paper describes the methods used within the Dignity and Older Europeans (DOE) Project and in particular the approach involved in developing the bibliographical database, the philosophical methods used in creating the theoretical model of dignity, together with the empirical methods involved in data collection with older people, health and social care practitioners and the younger and middle‐aged adults, will be described.The paper will attempt to provide the reasoning for the chosen methods and highlight some of the difficulties involved in carrying out comparative cross‐cultural research.
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This paper describes the findings from 89 focus groups held with 505 young (13‐39 years) and middle‐aged (40‐59 years) adults in the UK, Ireland, Spain, France, Slovakia and…
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This paper describes the findings from 89 focus groups held with 505 young (13‐39 years) and middle‐aged (40‐59 years) adults in the UK, Ireland, Spain, France, Slovakia and Sweden.There were many similarities across all countries and most differences were between the different age groups, rather than the different countries. Five major themes were identified from the comparative data: views of dignity; old age and ageing; views of older people's lives; across the generations and adding dignity to older people's lives. Many of these findings confirmed those of the focus groups with older people and health and social care professionals. Dignity was important to people of all ages but particularly to older people. Being treated as an individual was critical for the maintenance of dignity. In the participating countries older people were generally treated negatively and undervalued and seen as vulnerable, second‐class citizens.Old age was perceived as a time of physical and mental deterioration, poverty and dependency. Intergenerational activities were important for both individual self‐esteem and the ability to participate fully in society. Suggestions for enhancing dignity included greater public awareness about the dignity of older people and about existing care and support services for them. Health policies should tackle ageism in service provision and the development of standards in health and social care for older people could do much to improve dignity.