1. The Association for Care Training
“Dignity in Care”
Victoria Preece &
Clair Rogers
The Association for Care Training
Good morning all. Welcome to this session on Dignity. I am Victoria Preece, ACT Partnership Manager. ACT is the Association for Care Training and we are a charity based organisation that works across health and social care services to promote good practice through training. We try to make sure that people like you who have a desire to work in the care sector have the right training available to you to be able to do your job to the best of your ability and with the right support. We work with the Council, PCT and lots of other private care providers to make sure that patients, service users, clients - whichever term we use, receive good quality care that meets their needs. That is the key – it isn’t just about receiving care services – it’s making sure that those services meet the needs of the individual person. With me to present facilitate this workshop today ids Clair Rogers, who will tell you more about her role.
You should have three things in front of you – A dignity newsletter, paper and a pen – anyone not got any of these? We’ll need them as we go.
Most of you will already have an idea of what Dignity is? On the paper you have please just take 60 seconds to write down your own idea of what Dignity is. It’s not for sharing but at the end I will want you to look at it again. I am sure you all know what it is but hopefully in the next two hours we will get you to question whether or not you really know what it is and what it means to you. We hope that by the end of the session you will be able to describe what it is to someone else and also recognise when someone is working with Dignity at the centre of their practice.

2. Groundrules Fire Exits Questions Respect Each Others Views
Confidentiality
Mobile phones

3. Purpose of the Workshop
 “Dignity in Care must be everybody’s business. I hope people will step up to this challenge and do whatever is in their power to make a difference”
Sir Michael Parkinson,
National Dignity Ambassador
I’ve already briefly outlined what we want to achieve with you today but if you turn to the Dignity in Care Newsletter you will see on the front Michael Parkinson. He is the National Dignity Ambassador and said The Dignity Challenge provides frontline staff with knowledge and understanding to improve their practice to ensure that the care they provide respects people’s dignity. It asks health and social care workers to promote Dignity in their place of work, to ensure people are treated as individuals, given choice, control and a sense of purpose in their daily lives.
This gives us a bit more insight into what we are talking about. Over the last year or so we have been asking people to sign up as Dignity Champions – if you want more information about that go to the website on the front. We hope you’ll read the newsletter and see some of the examples of good practice across the West Midlands and get some ideas (some might be useful for future assignments!) – if you turn to page 2 you’ll see our Worcestershire examples. The dignity song is something Worcester CC commissioned from a young songwriter locally and I just want to play it to you before we move into more discussion about what Dignity is.

4. What is Dignity? Our Aims today;
we will be looking at what dignity means to
each of us
what we believe it may mean to others
how we can recognise when dignity is
compromised
be aware of some of the theories that underpin
our ‘need’ to maintain our dignity
Maintaining our Dignity is one of the most fundamental of our human needs. How many of us have tripped over, felt embarrassed, had a quick look to see who saw all because we felt our dignity was compromised. Is that the kind of thing you meant when you wrote down your own definition a few minutes ago?
Do we accept as a basic idea that your idea of dignity for you might be different to the person sitting next to you? Or your Mum’s idea, or your Uncle, or your neighbour? We have to keep this in mind.
How do we know when Dignity is compromised if it’s different for everyone? It may all be slightly different but there are some core values we will all recognise. We will do an exercise in a few minutes that will demonstrate that.
Finally we want to cover some broad ‘theories’ that you may come across as you go through your training. They are theories that underpin ‘care’ and why we have a need to maintain our dignity - most of what we do in caring roles rests on these theories. We haven’t got enough time to describe them all in detail but if we give you an overview of them you will have them to build on as you see them again – if that makes sense!

5. The Meaning of ‘Dignity’
‘Dignity’ is a term which is used in two major ways.
Dignity is a quality of the way we treat others as human beings.
Dignity is quality of a person’s ‘inner self’.
- Personal dignity and self image (self-esteem/self-respect)
Expectations of being treated with dignity
Appearing dignified (looking and acting dignified)
Based on what we have just looked at with choices and respect do we feel that’s a fair definition?
Now we will go back to the earlier slide where I said we’d be asking you to recognise when dignity is compromised.
Going to watch 5 very short films – only a minute or so each. We want you to write down for yourself which one makes you feel most uncomfortable.

6. What it means to affect the choices of others?
What choices did you make this morning?
What time to get up?
What to wear?
What to have for breakfast?
Who to call or whether to go on Facebook?
Who to interact with – apart from being here!
What to have for lunch Etc etc
Flip chart as group – words that describe dignity. We have a great list so lets look a t a couple in more detail (Choice and respect should be up there).
Explore right to Choice – we all like to make choices and don’t like to be told what we can and can’t do. Now think about being cared for – in whatever setting. Once we become dependent on someone else for our choices how much control do we have and how does that feel? How often have you gone to get something to find another family member has had the last of it – usually my Special K which no-one else likes until their coco pops are all gone. I go to have some and it’s all gone. I feel like my choice to have what I want for breakfast has been taken away from me. Only a small choice maybe but it can affect the rest of my day!

7. The Meaning of Respect
‘Respect’ is a term which is often related to ‘dignity’
‘Respect’ is a verb (action or doing word).
Let’s look at respect – we all like to feel respected and sometimes the words respect and dignity are used to replace each other. We want people to have respect for;
Our Rights
Our Habits
Our Values etc
How would we feel if we felt someone was taking our rights / choices / dignity away from us? Angry? Upset? Helpless?
So let’s go back to the beginning where you wrote down a definition of Dignity.

8. Dignity - How would you feel?
Who thought 1st one – pyjamas? Why?
2nd one – lift
3rd one – Cafe
4th one – Drink
5th one – Teddy
Different ones affected us to different degrees but none of us would want to be in those situations – but many of those cared for are in those positions daily – because they are vulnerable!! Do we know what a classes a person as vulnerable?

9. What is a Vulnerable Adult?
A vulnerable adult is (or may be) in need of community care services by reason of mental or other disability, age or illness;
and
who is or may be unable to take care of him or herself, or
unable to protect him or herself against significant harm or exploitation.
(Department of Health & the Home Office Definition) 
A very wide ranging definition
A very wide ranging definition and one that as you go through your training and career you will use very, very regularly.
So from a dignity perspective it is up to you as ‘professionals’ to make sure those people are treated with respect and dignity and as any other human being – we are starting to get into issues of human rights now. Do we have a right to dignity ……… YES it is the LAW!.

10. Learning Disabilities
Between 800,000 and 1,200,000 people in England have
learning disabilities.
80% are adults.
Expected to rise by a further 11% by 2021.
60% live with families.
40% live in residential care, hospitals or other care setting.
Only 17% have jobs or meaningful employment.
(Source: British Institute of Learning Disabilities)
Are you surprised by these figures?

11. Learning Disabilities
Compared to general population, people with learning
disabilities are:
2.5 times more likely to have health problems.
4 times more likely to die of preventable causes.
58 times more likely to die before the age of 50 years.
(Source: Equal Treatment: Closing the Gap Interim Report,
Disability Rights Commission, 2005)

12. Mental Health Issues
25% British adults experience at least one diagnosable
mental health problem in any one year, and only 25% of
these receive treatment.
Anxiety and depression most common disorder
in Britain.
Women are more likely to be treated than men.
Men are 3 times more likely to die by suicide.
A third of GPs’ time is spent dealing with mental health
issues, and mental ill-health costs the UK economy £100
billion a year.
Dementia is on the increase as we have an aging population. More and more of the people who come into care or hospital for other issues or illnesses will have underlying mental health issues. They still have a right to dignity.

13. ‘Dignity’ means .....
that we need to treat vulnerable adults as human beings.
‘all human beings, endowed with reason and conscience are born free and equal in dignity and rights and should act towards one another in a spirit of brotherhood and to be protected against the random misfortunes of life whatever their origins’.
(Human Rights Act 1998)
We will look at a few other Laws that protect our right to dignity in a minute but let’s just look at 2 service areas and think about what this means to them
Learning Disability and Mental Health

14. Treating People as Human Beings
For people with Learning Disabilities:
Most friends also have learning disabilities.
30% do not have any contact with friends. 5% have no friends and do not see anyone apart from their family.
40% would like more say in what goes on in their everyday life.
30% say they did not feel safe using public transport.
30% said someone had been rude or offensive to them in the last year. In most cases, the person who bullied them was a stranger.
People with learning disabilities are more likely to have a long-term illness or another disability than other people.
Only 25% of women have ever had a cervical smear.
Having looked at the statistics, let’s think about their needs as human beings.

15. Treating People as Human Beings
For people with Mental Health issues:
22% of people would not want to live next door to someone who has had a mental health problem.
60% of people describe a person with a mental health problem as “someone who has to be kept in a psychiatric or mental hospital”
33% think people with mental health problems should not have the same rights to a job as everyone else
Only 31% of people think mental hospitals are an outdated means of treating people
Stigma & discrimination stops engagement in day to day activities such as shopping, going to the pub, taking a holiday, obtaining insurance, making new friends, joining a club, talking openly to other family members and preventing effective engagement with health professionals.

16. Laws that promote and support Dignity Sex Discrimination Act (1975)
Race Relations Act (1976)
Mental Health Act (1993)*
Data Protection Act (1998)
Sexual Offences Act (2003)
Discrimination Acts (1995) & (2005)
Race Relations Act (2000)
Freedom of Information Act (2000)
Mental Health Act (2007 – amended *)
Health and Social Care Act 2008
and many others
Just a few of the laws that will affect your practice.
Going to move on a little to look at some of the theories, then we’ll look at a short dvd and ask you to try to relate where you can see the theory relate to the practice you see in the dvd. Not complex – if you keep dignity in mind it’s very obvious.

17. Maslow’s Hierarchy of Needs
Father of Social Care = Abraham Maslow (1943). 5 levels of needs and we have to have each one met before we can ascend to the next level.
We all aim to move as far up the hierarchy as we can however we can easily slip back.
Example – aspiring to having a relationship, getting married, having children, getting a good job …. Then losing the job, getting divorced, not seeing children ….. Struggling to maintain first level needs being met. As we are unable to maintain different levels then we feel increasingly anxious and possibly depressed.

18. Elizabeth Kubler Ross (1969)
Five Stages of Loss;
Denial – ‘I feel fine’, ‘This can’t be happening to me’
Anger – ‘Why me?’, ‘It’s not fair’, ‘Who can I blame?’
Bargaining – ‘Just let me live to see my daughter get married’, ‘I’d give anything to ’
Depression – ‘I’m so fed up, why bother with anything?’, ‘What’s the point without my husband’
Acceptance – ‘I can’t fight it’, ‘It will be ok’
Often used to address grief following bereavement but can also apply to unexpected unemployment, serious injury or becoming disable (ex-servicemen), bankruptcy, ending a long term relationship (life changing events). It’s human nature to go into denial when faced with something we don’t want to face.
Anger is perfectly normal and is sometimes repressed and It is often associated with guilt.
Bargaining is our way of compromising, not wanting to accept what has happened but trying to make themselves feel better about it.
Depression sets in with the realisation that ‘life goes on’ but the person is struggling to come to terms with it and that leads to the
acceptance stage, when the person has move through the emotional struggles they face and find some inner strength to come to terms with their situation.

19. Albert Mehrabian(1971) Two Conclusions of Communication
There are 3 elements to communication;
- Words
Tone of voice
Body language
Communication is made up of all three aspects.

20. How do we communicate? 7%
55%
38%

21. What Do You See?
Watch the following short film, think about what we have discussed this morning and how you think about the importance of dignity to those you will care for in the future. I hope you will be able to recognise aspects of the theory we have just talked about in practice within the film. Think about the approaches that the staff in the film take and listen to how the person at the centre of the film perceives them.
Where can we see the theories? Communication (Merhrabian) – the staff bathing the woman and feeding her. Loss and change (Kubler Ross). Growing old and losing control of situation (Maslow).
What stage of Kubler Ross’s loss and change theory was she at? Acceptance stage?
Do you feel her dignity was respected? How could that have been improved?

22. Dignity in practice is ..... Ensuring people are not left in pain
Treating people with respect
Listening to people
Giving people privacy
Encouraging people to help themselves as much as possible
Maintaining confidentiality at all times

23. The Dignity Challenge – look at your pen
Finally just want to ask you to look at the pen. These are the 10 points to the Dignity Challenge. We hope that you have a few more ideas about how important dignity is and how small things can make such a difference. As you go through your professional training try to keep this in your mind and dignity in your heart. Think about what matters to you.

24. Often it’s about bringing yourself to work and treat others as you would want yourself or someone close to you to be treated! Meet Clair’s Family