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Supporting Guidance Standard 4.1

Health and Care Standards

Supporting Guidance

Standard 4.1 Dignified Care

 

What is this standard about?

This standard is about ensuring that all patients, service users, their relatives and carers are treated and communicated with in a manner that takes into account their dignity and respect.  Individual’s human rights to dignity, privacy and informed choice will be protected at all times, and the care provided will take account of the individual’s needs, abilities and wishes.

Staff also have the right to be treated with dignity and respect.

 

Who is it for?

All healthcare staff and patients in all settings.

In relation to the standard criteria (in bold) the following key questions need to be considered:

People are treated with respect, courtesy and politeness.

  • How do you ensure that all patients are treated as an individual with courtesy, good communication in a timely way?
  • Do all staff working in your organisation understand the importance of making a positive first and lasting impression through effective communication?
  • How do your services compare with the 10 challenges from the Social Care Institute for Excellence (SCIE) Guide on Dignity in Care?
  • How do you ensure the adequacy of staffing levels of registered nurses and health care support workers to enable the provision of safe, compassionate and dignified nursing care to patients at all times.?
  • How do you ensure that staff on A&E, acute medical, surgical, orthopaedic, care of the elderly, mental health (and other relevant) wards have received specific training in the needs of people with dementia, cognitive impairment and sensory loss?

People are able to access free and independent advice so they can make choices about their care and lifestyle.

  • How do you ensure that individuals are provided with objective information?
  • How do you ensure patients are able to understand the information they have been given so they are able engage to make decisions about their care and well-being?
  • What steps do you take to ensure that service users are communicated with in an appropriate, timely manner?
  • How do you involve carers and families in decisions, especially about discharge and transfer?
  • If the patient has a sensory loss, how do you ensure that you are acting in accordance with the All Wales Standards for Accessible Communication and Information for People with Sensory Loss to ensure that patients are able to understand and engage with conversations about their safety and well-being?

Individuals are addressed by their preferred name.

  • How do you ensure that individuals have the opportunity to express their preferred name and how they will be addressed?

Welsh language needs are responded to sensitively.

  • How do you ensure you make an active offer (providing a service in Welsh without someone having to ask for it) when providing information to Welsh speakers?
  • How do you ensure service users are asked for their personal preferences and opinions regarding the use of the Welsh language?
  • How do you ensure that people receive information about their care in Welsh?
  • Do you ensure that your ward or department has a bilingual environment and is welcoming for Welsh speakers?  For example are there Welsh language reading material / Welsh language radio and television services available?
  • Do you have a Welsh Language Officer? Do they provide effective help and advice?  Every LHB / Trust must have one.

Confidentiality, modesty, personal space and privacy are respected especially in hospital wards, public spaces and reception areas.

  • What measures are taken to ensure privacy, in terms of personal space; modesty and privacy in personal care; and confidentiality of treatment and personal information?
  • What consideration is given to provision for patients who have hearing loss?
  • Is there a private room for conversations needing privacy? Is this used when appropriate?
  • How do you ensure that you are acting in accordance with the All Wales Standards for Accessible Communication and Information for People with Sensory Loss to ensure that patients are able to understand and engage with conversations about their safety and well-being?
  • How are you monitoring arrangements for respecting the privacy and dignity of people who use the services, e.g. environments that do not compromise privacy or dignity such as availability of single sex bedroom accommodation, single sex toilet and bathing facilities?

People’s feelings, needs and problems are actively listened to, acknowledged and respected.

  • How do you promote all the elements of dignity - self-esteem, self-worth, identity and a sense of oneself, by choice and by being listened to and 'all the little things’ - a clean and respectable appearance, pleasant environments?
  • How do you capture the key issues in relation to the patient experience, both positive and negative, with a particular focus on issues raised by people living with dementia and cognitive impairment, people living with sensory loss and carers - including the specific action taken to address negative issues?
  • How do you ensure that staff understand the specific perspective of patients and their needs?

All care is recognised as holistic and includes a spiritual, pastoral and religious dimension.

  • How do you ensure that adequate training is provided to all clinical staff to ensure that all patients are asked about their spiritual/religious beliefs and pastoral needs?
  • Does this form part of the initial assessment on admission?
  • Is this revisited as appropriate during the course of the admission?
  • How do you ensure that any personal, spiritual/religious, pastoral needs expressed are acted upon?
  • How are patients informed of the availability of, and offered chaplaincy services?
  • How do you ensure that patients are referred to the chaplaincy service?
  • How does your organisation ensure that the directory of relevant faith and third sector organisations is kept up to date and available to staff on the frontline?
  • Does your organisation ensure that spiritual/religious/pastoral care provision is embedded within the care pathway?
  • How does your organisation ensure that the chaplaincy service is adequately resourced with an appropriate skill mix?
  • Are there clear pathways between chaplaincy, MDTs and the wider organisation and access to community resources facilitated to help meet the spiritual/religious/pastoral needs of patients
  • Is patient information and notes accessible to chaplaincy services (see Spiritual Care Standards for Health Care Provision in Wales (2010) Standard 2)
  • How does your organisation ensure compliance with the legislative requirements of the Mental Health Measure (Wales) 2010 Code of Practice:
    • to assess and where appropriate address the spiritual needs of patients accessing services under Part 2 of the Mental Health Measure
    • to ensure there is adequate chaplaincy resources available to mental health services
  • Do your patient experience evaluations routinely include questions relating to spiritual/religious/pastoral needs?

Information and care are always provided with compassion and sensitivity.  Ensuring that people and their carers have the freedom to act and decide based on opportunities to participate and on clear and comprehensive information.

  • How do you ensure patient autonomy, including freedom to act and freedom to decide, based on opportunities to participate, and clear, comprehensive information?
  • How do you ensure the patient is able to understand information given?
  • How do you ensure that you are acting in accordance with the All Wales Standards for Accessible Communication and Information for People with Sensory Loss to ensure that patients are able to understand and engage with conversations about their safety and well-being?
  • How do you ensure compliance with the Older People’s Commissioner’s Best practice Guidance for Engagement and Consultation with Older People on Changes to Health Services in Wales?

Consideration is given to people’s environments and comfort so that they may rest and sleep.

  • How do you ensure that people’s normal sleep patterns are identified?
  • How do you ensure that a clinical area will allow for a period of 'quiet time' rest/sleep period?
  • What measures are taken in the clinical area to allow for lighting to be adjusted during periods of rest and sleep?
  • What measures are used in the clinical area for the noise levels to be adjusted during periods of rest and sleep?
  • What considerations are given to discharge arrangements so as to avoid discharging older people from hospital between the hours of midnight and 6am?

People are helped to be as comfortable and pain free as their condition and circumstances allow.

  • How do you ensure that a patient's pain has been discussed and assessed using an appropriate pain assessment tool?
  • What measures are taken to ensure that a patient with pain has an up to date plan of care?
  • How do you ensure that the care plan is being implemented, evaluated and has been reviewed within the agreed timescale?
  • What mechanisms are in place to ensure that a patient's concerns/anxieties or fears has been assessed and discussed with the patient or advocate?

People are supported to be as independent as possible in taking care of their personal hygiene, appearance and feet and nails.

  • How do you ensure patients are supported to maintain their physical mobility and ability to self care whilst in hospital?
  • How do you ensure that a patient's hygiene, foot and nail care needs have been assessed and discussed with the patient or advocate?
  • Are there systems in place to ensure that there is evidence of an up to date plan of care addressing identified hygiene needs which is being implemented and evaluated and has been reviewed within the agreed timescale?
  • What measures are in place to ensure there age appropriate facilities for maintaining individual hygiene needs?

People are supported to maintain a clean, healthy, comfortable mouth and pain-free teeth and gums, enabling them to function as normal (including eating and speaking) and prevent related problems.

  • How do you ensure that help and advice is provided to reduce patients’ risk of preventable dental / oral disease?
  • How do you provide particular support to vulnerable people, including those who are in hospital or living in care settings?
  • Do you undertake oral health risk assessments and provide individual care plans?
  • How do you provide advice on how to access appropriate dental services?
  • How do you ensure that you are acting in accordance with the All Wales Standards for Accessible Communication and Information for People with Sensory Loss to ensure that patients are able to engage with conversations about their safety and well-being?

Continence care is appropriate and discreet and prompt assistance is provided as necessary taking into account people’s specific needs and privacy.

  • How do you/ what measures are in place to ensure older people are supported to maintain their continence whilst in hospital?
  • What mechanisms are in place to ensure that the patient's toilet needs/continence has been assessed and discussed with the patient or advocate?
  • How do you ensure that an up to date plan of care is being implemented and evaluated and has been reviewed within the agreed timescale?
  • How are staff using the All Wales Continence Care Bundle to ensure individuals have the most appropriate evidence based care?

People are supported to feel confident to talk through all aspects of their care including sensitive areas such as life expectancy.  Advanced care planning, end of life care and addressing the needs of the dying and as good a death as practicable for the individual and their family is a key part of dignified care.

  • How do you encourage people to have open and honest conversations about their end of life wishes well in advance, when they are in good health, within an environment which respects dignity and independence?
  • How do you provide extra support to those who are frail, lonely and/or isolated including those who live in care homes?
  • How do you support people on a GP palliative care register to plan for their end of life, ensuring that relatives and carers are made aware of their wishes?
  • Has your Health Board refreshed local delivery plans to take account of the End of Life Care Delivery Plan and its key priorities?
  • How do you ensure that you are acting in accordance with the All Wales Standards for Accessible Communication and Information for People with Sensory Loss to ensure that patients are able to understand and engage with conversations about their safety and well-being?

 

Legislation and Guidance

  

Good Practice Guides

 

RNIB – Top Tips for Healthcare Professionals. Accessing Care: Meeting Patients Needs

 

RCN publications:

  • Dignity Campaign Pack
  • Dignity Pocket Guide
  • Dignity Information Posters
  • Dignity: Small Changes Make a Big Difference Guidance
  • Defending Dignity: Challenges and Opportunities for Nursing Guidance

Social Care Institute for Excellence (SCIE) Guide 15: Dignity in Care

 

Useful Contacts