This article provides an overview of areas to consider when delivering person-centred intimate care. It aims to highlight the importance of the individual patient’s perspective on what constitutes intimate care.

Meeting patients’ expectations of individualised care can be difficult at times, because of the nature and busy pace of the clinical environment (The King’s Fund, 2023). However, if nurses are to meet individual patients’ expectations, there is a need to look beyond the practical aspects of privacy and dignity.

Maintaining privacy and dignity involves:

• ensuring care is delivered in a private area
• keeping patients warm and comfortable (ie with sufficient blankets)
• exposing only the part of the body to be examined or treated

The patient’s consent should be obtained before any examination, which involves communicating all the information about what the procedure involves before it begins. A chaperone should be provided if the patient requests this.

Intimate care means different things to different people

Each patient will have their own interpretation of what constitutes intimate care. Although most patients would equate this with having a personal part of their body ‘invaded’ for a procedure or treatment (eg an internal examination of the vagina, bladder or bowel), it is important to consider what intimate care could mean to others. For example, individuals who cover parts of their body for religious and cultural reasons might consider removal of that clothing a matter of intimate invasion. Individuals who have an altered body image because of illness or injury might consider treatments and discussion around these to constitute intimate care (eg having a stoma, amputation, facial acne, noticeable eczema, obesity or a stutter).

Patients can require care for injuries sustained from sexual or domestic abuse, or where alcohol or illicit drug use is apparent, which can often require healthcare professionals to be sensitive and respond appropriately to the circumstances. Whatever the clinical issue, a range of situations may require intimate, person-centred care, particularly if the situation causes the patient to feel embarrassed or uncomfortable. Since the nurse is a stranger to the patient, they must consider and react appropriately to any possible discomfort the patient feels when sharing personal details.

Hard and soft skills

Competence can be defined as the completion of training, skills, experience and knowledge, as well as the ability to apply these to perform tasks safely (Health and Safety Executive, 2024). Nursing is a profession that requires both hard and soft skills. Hard skills are job-related competencies and the accompanying manual abilities that are necessary to complete a technical task, such as:

• inserting a urinary catheter
• taking blood pressure
• assisting a patient to eat and drink

Soft skills are personal qualities and traits that affect the way you deliver your work (Walden University, 2023). Nurses use soft skills to gain awareness of the patient’s perception of the care delivery and meet their holistic needs. There can sometimes be a mismatch of expectations on care delivery, where the nurse may perceive that a skilled level of clinical competence was demonstrated, yet the patient did not feel that their intimate care needs were met.

A compassionate approach

Compassion in nursing is an essential soft skill. It equates to ‘intelligent kindness’ (Grainger, 2020) and is directly relevant to how patients’ perceive their care. Empathy and compassion are often interchangeable and complement one another. According to Halpern’s (2003) seminal text, there are two components to empathy: cognitive and affective. The cognitive component involves the ability to imagine what it is like to be in another person’s situation. The affective component is the ability to become emotionally tuned to what the other person is experiencing and the feelings that arise from having that experience.

Regular reflective practice as part of continuing professional and personal development enhances the nurse’s compassionate empathy and emotional intelligence (Grainger, 2020). Emotional intelligence is defined as having complete self-awareness, enabling a person to understand their own emotions and reactions to unfolding situations (Srivastava, 2013). As a result, an associated ability to interpret and understand the feelings of others as they experience certain situations is developed (Cornwall, 2012). Growing empathy and emotional intelligence enables the nurse to respond in an appropriate manner to the patient’s needs.

The Nursing and Midwifery Council Code

Registered nurses and nursing associates must uphold the standards outlined in the Nursing and Midwifery Council’s (2018) Code. The standards relate to the delivery of person-centred care and highlight respect towards patients and the preservation of human dignity.

The 6 Cs

The 6Cs (Cummings and Bennet, 2012) are particularly important to healthcare assistants and healthcare support workers, because this group delivers a large part of personal care to patients. The 6Cs comprise:

1. care
2. compassion
3. competence
4. communication
5. courage
6. commitment

Delegation of nursing care

When registered nurses delegate the delivery of nursing care to healthcare assistants and support workers, this not only involves the ‘what’ in terms of the required technical competence, but also the ‘how’ in terms of the way in which the care will be delivered. For registered nurses, professional accountability must be met when delegating nursing duties. This means not only checking that the member of staff has the technical competence required, but also possesses the personal attitude and behavioural competencies to ensure a safe and high-quality patient experience.

Mandatory training, continuing professional and personal development

Regular mandatory training and the development of hard and soft skills for all levels of nursing staff is important to identifying and meeting patients’ emotional needs, which falls under the provision of intimate personal care. Additionally, in accordance with the Nursing and Midwifery Council’s (2018) Code, registered nurses must be aware of how their behaviour can affect and influence the behaviour of others at all times, and the need to be a role model of professional behaviour for student nurses and new registrants. It is incumbent on registered nurses to display compassionate awareness of their patients’ holistic needs, thereby influencing others in appropriate ways to approach patients, establish a rapport and deliver personal intimate care.