Improving the quality of healthcare has been a key policy goal of the last 20 years in the UK. The debate has focused on the technical aspects of care delivery – optimal therapeutic regimens, the delivery of guideline and evidence-based care – with an emphasis on targets as a mechanism for improving standards. Running in parallel with these initiatives has been the revela-tion of the lack of good-quality care and caring for vulnerable children and adults in a variety of settings, including acute hos-pital wards and long-term care homes.
Such features are not unique to the modern healthcare context but the “failure” of health and social care staff to deliver care that is of good quality in terms of standard, evidence base and effectiveness, and digni-fied in how it respects the individual, has received considerable attention in the press. This has also been at the heart of several recent public inquiries in the UK – such as Winterbourne View and the Francis inquiry – and generated a stream of national and local policy initiatives, interventions and service developments to promote the delivery of dignified care.
Patients expect to receive individual-ised, patient-centred care delivered through a caring relationship between staff and patients that considers and incorpo-rates the views of patients and their fami-lies.
Research exploring professionals’ per-spectives on dignity in care suggests main-taining dignity plays an important role in care provision. “Caring” has been described as being part of good care as has the delivery of dignified care.
Caring and dignified care are elusive con-cepts, yet they are both central to good-quality healthcare, particularly in nursing where much of the care undertaken is hands on. Findings clarify how health professionals can implement such care and highlights the importance of seem-ingly little things when delivering digni-fied care – these things not only allow staff to care for patients, but indicate that they care about patients. This also suggests that by providing the little things to patients, caring for and caring about become intrinsically interlinked rather than being two separate aspects of care. In that sense, the little things are the big things and should receive increased focus in nurse education, practice settings and organisa-tional management.
We need to draw on theoretical and philosophical conceptualisations of caring and dignity to understand its theoretical basis and provide transferable definitions of these complex concepts, but it is also crucial that we give health professionals concrete examples of how they can improve their care and deliver dignified care in practice. This research shows that a focus on the little things can help profes-sionals deliver such care and that, by making poor care visible, they can chal-lenge ingrained and task-focused, rather than people-focused, care in a non-threat-ening way – this can be the catalyst for pro-viding care that is caring and dignified.