Module 1: Introduction to Dignity Issues
Learning Outcomes
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Define dignity
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Have greater knowledge of dignity and its relevance to health and social care
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Know what is meant by “person-centred care”
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Explain the relationship between person-centred care and dignity
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Become familiar with various government legislation and initiatives relevant to
dignity.
1a What is Dignity?
Dignity is a difficult concept to describe: it is a very personal issue, and people have
their own interpretation of what constitutes dignity and dignified care. Dictionary
definitions range from “the state or quality of being worthy of honour or respect” to
“inherent nobility and worth” and “poise and self-respect.” These definitions are brief
and diverse. Further research has therefore been carried out in order to define this
concept, which is used frequently in health and social care settings.
Accident & Emergency Nursing (2005) produced a report which identified four key
aspects of dignity: respect, autonomy, empowerment and communication. Dignity,
therefore, appears to be about themes, a diverse concept with many overlapping
ideas. It was proposed that dignity should be thought of as a group of topics, rather
than as a term with a single definition. Such topics would include:
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independence – maintaining as much independence as necessary
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choice – having the ability to make choices
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respect – being respected by others
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privacy – having the right to privacy when required
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freedom from discrimination – having the right to be treated as an equal
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attention – being listened to, understood and respected
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safety – being and feeling secure
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confidentiality – having personal details protected
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individuality – having personal needs met
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uniqueness – having differences recognised and acknowledged
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contribution to society – realising that everyone has something to contribute to
society, and being supported in achieving this
It is possible we already know what dignity encompasses. Although we find the term
difficult to define, people do usually know when they are not being treated with
dignity.
Dignity as a Quality of the Inner Self
Everyone has psychological, social and emotional needs, which have a close
relationship to how we feel about ourselves, our self-esteem, self-respect and selfworth. This makes the idea of dignity more complex, as we all have different levels
of self-perception, and therefore different ideas of what is acceptable in a dignified
service. Our past life experience of how we have been treated will reflect the level of
dignity we think we deserve. Personal experiences and moral standing will play a
huge part in the level of dignity we expect and whether we believe this expectation
has been met.
Dignity is also about how we behave. How we look from the outside can be a key
indicator of our self-esteem and how we feel about ourselves inside. Maintaining a
dignified appearance is a good way to tell if an individual is being treated with dignity
by others. For example, if someone is unshaven, unwashed and not dressing himor herself, this indicates he or she might not feel good inside. The same applies in a
care setting: a dishevelled appearance can sometimes indicate that a client is being
neglected. Sometimes the cues are in body language, eye contact, low mood or a
change in behaviour. This is in contrast to a happy, confident and well-groomed
resident of a care home, one who gives the appearance of having being treated with
dignity and having a good sense of self-esteem.
Members of The Social Care Institute for Excellence (SCIE) carried out their own
research into the concept of dignity. They summarised a list of what dignity in care
meant to the public and to care staff, and proposed that services can do the following
to provide a dignified service.
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provide person-centred care – put the client in the centre of their needs and wants
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show patience to service users
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avoid patronising
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help people feel safe
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ensure people are free from pain
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tackle isolation and loneliness
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respect basic human rights, such as privacy and independence
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respect cultural and religious beliefs
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take the time to get to know people as individuals.
Based on this research, the SCIE came up with the following definition, which they
use as an official definition for reference to social care work:
“A state, quality or manner worthy of esteem or respect, and self-respect. Dignity in
care, therefore, means the kind of care, in any setting, which supports and promotes,
and does not undermine, a person’s self-respect, regardless of any difference.”
In summary, dignity is about both how people are treated and how they expect to be
treated. It is acknowledged that the expectations will differ. It is also known that
people recognise when they are receiving dignified care and when they are not, and
that the perception of dignified care will be diverse between different people.
1b Different Types of Dignity
Dignity and Older Europeans was a 2004 research project in which older people
were asked to identify a time they had not being treated with dignity. This led to the
classification of dignity into four categories, all of which are applicable to both
vulnerable adults and elderly care settings.
Dignity of the Human Being
Dignity of the human being is based upon the principle of humanity. It is a moral
approach which assumes that everyone is equal and has the “inalienable” rights of
life, liberty and the pursuit of happiness. These rights belong to the individual and
cannot be taken away. We all have the right to be valued, and treating others with
dignity is a way of fulfilling this moral obligation. This is closely related to human
rights: human beings have the right to be treated equally regardless of age, social
background, criminal record, illness, disability, sexual orientation or any other
discriminatory factors.
Dignity of Personal Identity
This type of dignity is closely related to self-respect – which, in turn, forms the basic
structure of our relationships with other people. Individuals have their own sense of
self and a desire to be treated in a way which compliments this. People, especially
those with disabilities and dementia, may not be tuned into their inner self, but they
still have awareness of when they are receiving dignified care.
Dignity of Merit
Dignity of merit is concerned with the achievements a person makes throughout their
lifetime, and/or their position in society. When we achieve something as individuals,
be it a badge, certificate, merit, qualification or a medal, we expect it to be
acknowledged. This then forms part of our identity, part of who we are and how we
view ourselves. We would expect this recognition to continue if we went into care.
Honouring a person’s achievements maintains his or her self-esteem, and has the
added value of allowing care workers and others to see the person behind the
illness. It allows them to get to know the client better and see beyond the reason
they have entered into care. Honouring achievements can therefore be a good
icebreaker and a tool for communication and other activities.
Dignity of Moral Status
Dignity of moral status is a very individualised approach, which depends largely on
how we live our life. This type of dignity is earned rather than an inalienable right.
Since a moral status is earned, it can also be taken away. Often, a position or title in
society is what provides dignity of moral status.
For example, politicians elected as Members of Parliament (MPs) automatically have
been given merit, rights and status in society. They are respected and are expected
to act in a certain way because of their status. They have earned this right through
their studies, hard work, election campaigning and activities they support within their
constituency. A person who is not a politician but who still campaigns for change,
perhaps as a member of a political party, does not automatically have the moral
status and rights that the politician has, even though their activities might be similar.
If MPs are found to be involved in fraudulent activities when submitting expenses,
they lose the public’s support. They can also be criminally convicted and lose their
seats in Parliament. This means that they have lost their moral status and the
dignity and respect which come with it. A political activist, in similar circumstances,
would have no moral status to lose, as he or she did not have the title or stature in
society that the MP was automatically assigned. In contrast, the first type of dignity –
that of the human being – would propose that the politician is a person who is equal
to everyone else, and therefore has the inalienable right to be treated equally.
Dignity in Care
Dignity in care is about working together to place dignity in the centre of all care
activities. Dignity should be the core concept of every activity a care worker does,
an idea that is supported by the Royal College of Nursing (RCN). The RCN states
that a dignified care service should be compassionate about people’s needs, rather
than delivering a “technical” care service. It should also respect diversity and
privacy, and demonstrate sensitivity to service users’ needs. When compassion,
respect and sensitivity are not present in care activities, then the client feels
devalued, uncomfortable and out of control. Over time, this can lead them to lose
confidence and feel embarrassed, humiliated and ashamed.
The SCIE has come up with suggestions about the meaning of dignity in care. This
is presented in the form of a ten-point statement, which explains what carers should
do in order to respect the dignity of their service users:
1. Demonstrate zero tolerance of all types of abuse
2. Support people with the same respect you would want for yourself or a
member of your family
3. Offer an individualised service
4. Enable people to maintain independence and choice, and to control their lives
5. Encourage people to express their needs and desires, and listen to and
support them when doing so
6. Respect privacy
7. Give people confidence to complain without fear of retribution
8. Engage with family members, carers and care partners
9. Help people maintain confidence and positive self-esteem
10. Act positively to alleviate loneliness and isolation.
Module 1 – Introduction to Dignity Issues
Activity 1
Write your own definition of what you think dignity is. Explain what dignity means to
you.
Activity 2
Think of a time in your own life when you have not been treated with dignity. How did
this make you feel?
Activity 3
Describe in your own words what person-centred planning is.
Activity 4
Identify a task you usually carry out with a client in your workplace. Describe how
this can be done in a task-orientated way and in a person-orientated way.