Privacy and dignity

One of the key findings of the Francis (2013) report investigating the failing in care at the Mid Staffordshire NHS Trust was how care had become routinised and there was a lack of respect for people and their dignity. This not only led to people feeling undervalued, but also impacted on both the quality and experience of care for patients.

Privacy requires the nurse to consider how they provide and manage the care of an individual when accessing important information about them, while only sharing that information, with consent, with other staff (Griffith, 2019). Privacy also applies to ensuring that care delivery is undertaken in such a way that it is only witnessed by the necessary people (Tehrani et al, 2018). Therefore, this involves not only the physical surroundings of the patient, ie closing the curtain during examinations, but also protecting their personal information, ie ensuring no one else is

Nurses must work to maintain the patient's right to privacy in all aspects of their care (Nursing and Midwifery Council, 2018). This involves understanding what information about an individual is confidential and assessing who this can be shared with. Nurses must also assess their environment to ensure that care is delivered with consideration to the privacy needs of the individual. Nurses need to understand what patients regard as dignified care and treat people as individuals and uphold their dignity (Nursing and Midwifery Council, 2018).

Some items, such as curtains, can help to protect the privacy and dignity of an individual. It is also important to consider the environment, eg taking someone to a private area to have a difficult or private conversation.

Nurses and other staff providing care should also consider that the provision of dignified care also includes ensuring that the patient is both fully informed about their options for care, and that they are central to any decision making. In this regard, protecting and promoting dignity is as much about treating people with respect as it is about protecting their private information.

The provision of dignified care requires the nurse to pay constant attention to the protection and promotion of:

• the patient’s choices about their care
• the patient’s autonomy
• the patient’s rights
• person-centred care
• empowerment and enablement

A central principle of dignified care is that the nurse pays attention to the personal preferences of the patient (Martin et al, 2021) and promotes their right to choose how their care is delivered.

The 6Cs of care capture the essence of what is means to provide dignified care (Cummings and Bennett, 2012). These are:

• Care – provided in a consistently high quality, person-centred manner
• Compassion – care based on compassionate, empathetic and respectful relationships
• Courage – always doing the right thing
• Competence – having the knowledge and skills to provide evidence-based care
• Commitment – to providing high quality dignified care
• Communication – ensuring all decisions are made with patients and not for them.

There

When nurses fail to provide care in a way which respects both the privacy and dignity of patients, they risk undermining the therapeutic relationship and providing care which does not live up to the expectations of patients and their families or of the professional regulator (Nursing and Midwifery Council, 2018).

When care is not dignified, this not only impacts the patients who feel devalued and violated, but also nurses who may experience conflicts as a result (Lindwall and Lohne, 2020).

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 2: Procedures for the planning, provision and management of person-centred nursing care

3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions

3.4 take appropriate action to ensure privacy and dignity at all times

Clancy A, Simonsen N, Lind J et al. The meaning of dignity for older adults: a meta-synthesis. Nurs Ethics. 2021;28(6):878-894. https://doi.org/10.1177/0969733020928134 

Cummings J, Bennett V. Developing the culture of compassionate care: Creating a new vision for nurses, midwives and care-givers. 2012. https://www.england.nhs.uk/wp-content/uploads/2012/12/compassion-in-practice.pdf (accessed 5 February 2024)

Delves-Yates C. Value-based, person-or family-centred care. In: Delves-Yates C (ed). Essentials of nursing practice. 3rd edn. London: Sage; 2022

Dignity in Care. The 10 dignity do's. 2023. https://www.dignityincare.org.uk/About/The_10_Point_Dignity_Challenge/ (accessed 5 February 2024)

Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry. 2013. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/279124/0947.pdf (accessed 5 February 2024)

Griffith R. Electronic records, confidentiality and data security: the nurse's responsibility. Br J Nurs. 2019;28(5):313-314. https://doi.org/10.12968/bjon.2019.28.5.313 

Lindwall L and Lohne V. Human dignity research in clinical practice – a systematic literature review. Scand J Caring Sci. 2020;35(4):1038-1049. https://doi.org/10.1111/scs.12922 

Martin R, Allen G, Hardy K et al. Elimination. In: Lister S, Hofland J, Grafton H,