"Dignity is a birth right. There are no questions about children’s value and worth. Dignity is our sense of worth, our feelings and values. We are born with this. We are priceless. We are unique." (Hicks, 2011)
What do you think dignity is - and what do you think it feels like?
If you type 'definition of dignity' into a Google search, you will be rewarded with 169,000,000 results. After reading over a hundred of those definitions, I still feel very strongly that Dr Dona Hicks’ definition encapsulates more coherently what dignity means to me.
What I am very sure of however, is that although many people may struggle to define what dignity actually is, we are all immediately aware if we have NOT been treated with dignity.
What are the differences between dignity and respect?
Most of us talk about dignity and respect as if they are both the same, but dignity is very different from respect. Please watch this video of Susanne Boyle:
Then ask yourself, did the audience and the judges treated her as a valued and worthy person? Did you notice the expressions on the faces of the people in the audience and judges, their gesticulations, how they talked to her? You can see that they were openly laughing at her. Can you think of a compatible situation when you felt that your dignity was violated?
Respect is an attitude and determines how this manifests in our behaviour towards others and ourselves. We cannot demand respect. Respect has to be earned. Susanne earned the respect of the audience and judges just a few seconds after she started singing.
As health professionals, we must ensure dignity in our interventions, by promoting a client-centred approach, engaging in effective communication and supporting the safety (physical and emotional) of each individual, regardless of any differences (e.g. physical, cognitive, language, culture, sexuality or religion). This will promote better engagement leading to corresponding improvements in recovery and wellbeing.
Client centre approach
This is an approach which recognises the person as a partner in their own health care. It acknowledges that each individual has a unique perception and experience of his or her own world which shapes the person that they are. Client-centred practice is about ensuring that the service user remains the primary focus at the centre of any decisions related to their life and treatment.
We must involve our service users by listening to them, thinking together, training them and sharing ideas. We should aspire to treat each person as an individual, offering a personalised service and working together in partnership. We aim to involve and inform our patients, their caregivers and family so that they acquire an active role in the treatment of their illness and adopt adequate means of recovery. This empowerment will give strength and confidence to our service users, especially with regard to controlling their lives and claiming their rights whilst attaining the optimal level of autonomy, choice and control.
Safety (physical and emotional)
Physical: The person needs to feel safe from bodily harm, e.g. when we use a hoist to transfer the person, or to assist them to mobilise.
Emotional: The person needs to feel safe from humiliation, e.g. some people feel very embarrassed to be naked. We should be sensitive to this, allowing them to remain covered as much as possible when assisting with self-care and eliminating the risk of other people being present.
To achieve all of the above, we need to communicate with the person. However, despite the fact that we are constantly communicating, we need to develop an awareness of the role our emotions, body language, tone and choice of words play. Some of our service users may not be able to communicate verbally with words. We can use verbal prompts, but it is often the case that service users react differently with different people. As Javier Cebreiros stated in his book “We are the emotions that we communicate" (Cebreiros, 2015).
Therefore, it is imperative to ensure that the service user feels empowered and respected when adopting a person-centred approach and that they feel that their inherent value and worth is recognised. Good communication is vital to the promotion of dignity. Giving people the information they need to make their own plans and decisions is central to the UK's Care Act 2014, Mental Capacity Act 2005 and to the person-centred care agenda. It is a basic requirement for promoting dignity in care.
Each individual that we work with is potentially vulnerable, as they are likely to have some form of physical and/or mentally disability. Therefore, their dignity may also be vulnerable. Some of the negative consequences of exercising a lack of dignity and respect in our interventions are that the person may not engage in treatment, leading to poor rehabilitation outcomes, depression, stress and anxiety.
The fact is that all of us want to be treated with dignity and respect, but in reality, we do not always treat everyone with the dignity and respect we expect.
On the other hand, as health professionals, we are likely to have suffered the violation of our dignity in the past, whilst trying to support and help a service user. It is important that we are able to perceive the related emotions, so that we are able to maintain a professional approach and continue supporting the person. Conversely, if we fail to acknowledge our dignity or exercise adequate self-care, we risk becoming numb to our feelings, leading to apathy in the workplace and increasing the risk of depression. According to the Health and Safety Executive, in 2018/19 stress, depression or anxiety accounted for 44% of all work-related ill health and 54% of all working days lost due to ill health.
English is my second language. Having a strong European accent, I frequently experience situations where service users or family members assert that 'my accent' undermines me. In my experience, these situations appear to coincide with a challenge where, for example, my recommendations have failed to reflect the service user or family’s preferences. I recall a service user’s daughter who corrected my OT report and made 15 amendments of my grammar and punctuation which my colleagues failed to recognise as incorrect. I feel that her behaviour was due, in no small part, to the fact that the recommendations contained in the report were not to her liking.
Practising mindfulness, I am able to carry on treating every person with dignity, even if they violate my dignity. I have learned how to respond and to not react (well, in almost every situation!)
Tips that help me on daily basis:
Start by having 30 seconds' mindful meditation before my intervention, where I just observe my breathing (breathing in and breathing out). “Mindfulness means paying attention in a particular way: on purpose, in the present moment and non-judgementally” (Kabatt Zinn, 2013).
At the end of the day, I observe how many times I have done my 30 seconds meditation. More importantly, I consider the benefits of my meditation each evening, before sleeping.
I list 3 things every day that I have to be grateful for
I try to perform regular random acts of kindness
We do have the power to make people feel good, by recognising their value and worth, by honouring their dignity. Please watch this documentary about validation:
I invite you to do your part, in making dignity the priority of any intervention and relationship in your life.
Health and safety legislation laws in the workplace. Retrieved from: http://www.hse.gov.uk
Hicks, D. (2011) Dignity. Yale University Press; reprint Edition (5 Mar 2013).
Kabat-Zinn, J. (2013). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (rev. ed), New York, NY: Bantam Dell.
Care Act (2014)
Mental Capacity Act (2005)
María N Gómez Lacalle has been a committed Occupational Therapist for 15 years, with a particular focus upon the dignity, empowerment and safety of people among the ageing population and anyone in need of support.
'I stand for the dignity, empowerment and safety (physical and emotional) of all people who rely upon the support of others. I am the founder and CEO of Healthy and Independent, providing life-changing projects for organisations and individuals, through training, practical advice and recommendations. I am the author of A Dignified Approach to Moving and Handling People: as a Pathway to Empowerment and Tecnicas para movilizar y transferir con dignidad a las personas el camino hacia el empoderamiento. The aim of my book is to awaken the potential to increase the dignity, empowerment, and safety of people who are reliant on the support of others for manual handling, whilst reducing the risk of injury to either party. We can start to achieve this objective by recognising the dignity of others, regardless of our differences.'