Editorial: The importance of dignity

Across the world there is a message that older people are being overlooked. A recent alert has identified that in Canada, businesses are not aware of the issues involved in a workforce growing older, and are failing to support older people or even recognize their skills and experiences. In Bolivia, ‘Helpage International’ is mounting a campaign to get older people included in political processes, as their poverty and hardship increases, their voices are heard less. In the UK recent plans for increasing housing have been criticized for ignoring the needs and preferences of older people – it is assumed that the people wanting new homes will be younger. We can all find examples of neglect and exclusion of older people in different parts of the world and in different areas of life, work, politics and housing, but also transport, shopping, leisure and health care. For us as nurses, it is probably this last area that affects us most strongly, as we see services being withdrawn or reduced, or not started, and the policy-makers coming up with plans which do not address the circumstances of older people, but assume that healthcare users will all be affluent, mobile and young. This neglect is important in the way that it affects the quality of the nursing care that we can deliver, both in the amount and type of care that we can give. The funding for health care for older people can be reduced, leaving us with few staff and resources, and services for older people can be regarded as of lower status and requiring less skills and knowledge than other services. This suggests that social influences and perspectives can shape what we do, and this point has also been made by Jacobson (2007) in her discussion of dignity – the way in which personhood and agency are maintained. She presents an historical account of the concept and distinguishes between two prevalent ideas. The first is that dignity is accorded to people because of their humanity – the fact that they are human beings accords them dignity, and it follows from this that they should be given access to services, including health care. The second idea that Jacobson identifies is the idea of ‘social dignity’ that is that dignity is an aspect of the way that we relate to each other socially, and it comes from our interactions. From this idea of social dignity comes a concern with the way that health care is delivered – we do not just have access to health care but to health care delivered in a way which maintains dignity. In health care generally dignity has become an increasing concern. The World Health Organization held a conference on Health, Dignity and Human Rights in 2003, where the keynote address emphasized how important this was (Bruntdtland, 2003), and in the UK the editor of the Lancet has talked about the ‘rediscovery’ of dignity in health care (Horton, 2004). More recently, the UK National Institute for Health Research has put out a call for research grants to be submitted exploring the contribution of the health and social care workforce in maintaining patient dignity (http://www.sdo.lshtm.ac.uk/ecashome.html). For older people the move to maintain dignity is a prominent feature of health care as we reflect on the ways in which this has been eroded over time (Department of Health 2001). For nurses the idea of dignity, then, presents imperatives for care. How do we maintain personhood and agency in older people? We have a history of developing individualized care, and this has been a theme of nursing for some time. We do need, however, to think about whether this is enough to address these issues, or whether we also need to think about social interactions and ‘social dignity’ that is the way in which the social processes of care can contribute to promoting dignity and personhood. This might mean that we think carefully about this dimension and the way we interact to promote dignity – people might be entitled to this because of their humanity, but we need to make sure that dignity is also strongly supported by the processes of care. Dignity is a multifaceted concept and one that we cannot understand through a simple lens of technical caring practices. The papers in this edition of IJOPN all address aspects of dignified care from a variety of perspectives. Issues of tactile stimulation, the concept of dependence and activities of daily living and caring experiences in care homes all underpin these papers. As Carr and Kemmis (2005) suggest ‘…the transformation of practice understands that changing practices is not just a matter of changing the ideas of individual practitioners alone, but also discovering, analysing and transforming the social, cultural, discursive and material conditions under which their practice occurs…’ If we are to ensure dignified care for older people and dignified workplaces for staff, then we need to think carefully about how we understand the concept of dignity and its multiple-dimensionality in health and social care. We hope the papers in IJOPN contribute to this understanding.

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