The ABC and D’s of Dignity in Care

There are a set of guides for putting the principle of Dignity in Care into action.  The framework was developed for those who have contact with patients and service users, and who therefor have the opportunity to support the dignity of people who seek help from the health care system.

The Guidelines are called the ABC and D’s and they examine how attitudes may affect actions, and how people can take conscious steps to adjust those attitudes and behaviours. They follow the familiar A-B-C pattern that many disciplines use as the foundation for basic learning.

 

Just as first responders and care professional know the ABC’s of emergency care (Airway, Breathing, Circulations), everyone working in health care remember the ABC and D’s of Dignity in Care.

Attitude

Behaviour

Compassion

Dialogue

Attitude

How do our preconceived ideas affect our actions?

The first step is to examine one’s personal attitudes and assumptions regarding patients. Everyone’s attitudes depend on the way they have been wired and conditioned to think about, or react toward, a certain situation.

These perceptions are subjective, and may or may not reflect the reality of the person seeking health care – and yet, they can have a profound effect on how people are treated and how health care is provided.

For example:

When dealing with a confused, homeless person, some people may automatically assume that the person is intoxicated before considering that a severe health problem may be involved.

When a person is very frail and elderly, some people may not realize that the person may be as mentally alert and intellectually active as they are.

Some people may assume that everyone else is upset by, or takes pleasure in, the same things that they do.

Questions to ponder

Taking an honest look at our own preconceived notions is a deeply personal but necessary exercise. People working in health care can ask themselves some basic questions to gain insight into how attitudes and assumptions can influence the way they deal with people.

Some questions to consider are:

·         How would I be feeling in this person’s situation?

·         What is leading me to draw those conclusions?

·         Have I checked whether my assumptions are accurate?

·         Am I aware how my attitudes toward the person may be affecting him or her?

·         Could my attitudes toward the person be based on something to do with my own experiences, anxieties or fears?

·         Does my attitude toward my job help or hinder my ability to treat this person with care, openness and respect?

Behaviour

Kindness and respect must be the basis

Once someone has become aware of their attitudes, they can more effectively manage their behaviour toward others.

Many simple gestures can make a patient feel more like a person, worthy of attention and respect – and less like a body to be poked and prodded, or an obstacle to be worked around. Small acts of kindness and respect can enhance trust and connection. In turn, patients are more likely to be comfortable providing doctors and caregivers with important information that can have a bearing on their ongoing care.

It’s also important to realize that the health care environment may be routine for those working in health care, but not for people seeking medical attention. Even under the best circumstances, clinical processes, examinations and intimacies of care can be strange and upsetting for many people.

Professionalism, kindness and connectedness are particularly important when dealing with people with advanced disease. At this critical time, the behaviour of those around the person can help ease the physical challenges of worsening illness while maintaining the person’s sense of self-worth and self-coherence.

Improving the tone of contact

·         Treat contact with patients as you would any important clinical interaction.

·         Always act and speak with respect and kindness.

·         Know that ongoing contact is an important aspect of care, regardless of whether there are options for a cure.

·         Small but powerful acts of kindness

·         Getting someone a glass of water

·         Helping with slippers

·         Getting the person’s glasses or hearing aid

·         Adjusting a pillow or bed sheets

·         Acknowledging a photograph, greeting card or flowers

·         Improving communication

·         Show that the person has your full attention.

·         Invite the person to have someone from his or her support network present, particularly when complex or difficult information will be discussed.

·         Raise personal issues in a setting that respects the need for privacy.

·         Try to be seated at a comfortable distance, at the person’s eye level.

·         Realize that illness and changing health status can be overwhelming. Offer patients and families repeated explanations.

·         Use language that the person can understand. When within hearing distance, never speak about the person’s condition in terms he or she cannot understand.

·         Always ask whether the patient has any further questions. Assure the person that there will be other opportunities to ask questions as they arise.

During clinical examination

·         Always ask the patient for permission to perform a physical examination.

·         Always ask for the patient’s permission to include students or trainees in the examination.

·         Take the time to set patients at ease and show that you have some appreciation of what they are about to go through. Useful phrases include:

o   I know this might feel a bit uncomfortable.

o   I’m sorry that we must do this to you.

o   I know this is an inconvenience.

o   This should only hurt for a moment.

o   Let me know if you feel we need to stop for any reason.

o   This part of the conversation is necessary because…

·         Limit conversation during an examination (aside from providing instruction or encouragement) until the patient has dressed or been covered appropriately.

Compassion

The secret of patient care is in caring for the patient

Compassion isn’t something a person knows – it’s something a person feels. It is a deep awareness of the suffering of another, coupled with the wish to relieve it.

This basic interest in humanity is an essential quality of patient care.

People can gain compassion through various channels. For some, it is a natural disposition – perhaps the reason they entered the health care field in the first place.

For others, compassion slowly emerges with life experience, clinical practice and the realization that we are all vulnerable to life’s uncertainties. There are many ways to consciously encourage the growth of compassion. Those who work in health care can choose whatever pathway works for them.

Once developed, showing compassion can be as quick and natural as a gentle look or a reassuring touch.

Developing compassion

·         Get in touch with the struggles faced by patients through stories, novels, films, theatre and art

·         Follow the example of compassionate role models

·         Looks for ways to identify with those who are ill or suffering

·         Simple ways to show compassion

·         An understanding look

·         A gentle touch on the shoulder, arm or hand

·         Some form of communication, spoken or unspoken, that acknowledges the person and the human challenges that accompany illness

Dialogue

Communication is the first step toward understanding

At its most basic level, good health care relies on the constant exchange of information. To provide the best care possible, health care providers need to gather accurate details about the whole person, and not just the illness. Dialogue with patients must acknowledge the person beyond the affliction, and the emotional impact that accompanies illness.

Here are a few examples of how a person’s life circumstances could affect the response to the illness:

·         A person with severe arthritis who is also an avid pianist

·         A person with terminal cancer who is the single parent of young children

·         A person with limited mobility who doesn’t know anyone in the community

Fostering a sense of trust, openness and honesty can increase the likelihood that someone will share these important details. Using some simple techniques, health care providers can develop a more complete understanding of how to support of the person.

Things to say to acknowledge personhood

·         This must be frightening for you.

·         I can only imagine what you must be going through.

·         It’s natural to feel overwhelmed at times like this.

Getting to know the patient

Health care providers can start the conversation by using the Patient Dignity Question (PDQ):

What should I know about you as a person to give you the best care possible?

This question can yield valuable information to improve the care approach. Here are some of the answers people have provided:

·         I’m frightened of authority.

·         I think people might not think I’m smart enough or important enough to deserve answers.

·         I don’t want to die alone.

Other important questions include:

·         At this time in your life, what are the things that are most important to you, or that concern you most?

·         Who else (or what else) will be affected by what’s happening with your health?

·         Who should be there to help support you? (friends, family, spiritual or religious support network)

·         Who else should we get involved at this point, to help support you through this difficult time? (psychosocial services, group support, chaplaincy, complementary care specialists)