After my last blog, I kept thinking about dignity and long term care, and I decided to write a little more about it. Dignity and respect when dealing with the elderly can be a delicate subject. The very mechanics of long term care can almost negate dignity in a way, as our residents need to trust us to perform personal care and more. My last blog discussed what dignity and respect mean in respect to human rights. In this second chapter, I would like to spell out common situations that may occur in care that fail to provide respect and dignity. I thought that it might help us all to translate what it all means into our daily practice.

As health care professionals we are obligated to protect our clients/patients from abuse and neglect, as well as to provide care with respect and dignity. Through communication and involvement, we can help to provide care with dignity to all we see. We can also foster independence whenever possible to enhance self worth. Here are some examples of how we may unwittingly infringe upon human rights in our day to day work. I am not saying that this occurs every day, nor I am saying that this is an issue for all facilities. However, these situations do happen at times, and I think that if we place it into a context of abuse of human rights, rather than poor practice, it might hit home with our staff.

• Leaving a patient without a means to alert or communicate with staff. Forgetting to place the bell within reach, or switching it off. This does happen by accident, but often it is a response to a difficult patient that likes to ring the bell frequently.
• Not answering or ignoring call bells. Even if you are too busy to get there right now, answer the bell and let them know that you will come as soon as you can.
• Not giving unpaid caregivers the respect they deserve. These people are a valuable resource and should be appreciated, and treated as such. I have seen these people shooed out of the room to allow staff to work. They should be included whenever possible and at the very least be kept aware of what you are doing with their loved one.
• Making incorrect assumptions regarding a person’s ability to understand what you are saying and allowing this assumption to result in the patient not being involved in their care. How many times have you heard staff chatting about their weekend while caring for a “complete” patient, rather than talking to the patient and explaining what they are doing? Not involving the patient in their care by not talking to them or even by failing to explain what you are doing as you work is not acceptable.
• Not ensuring that the fundamental daily care is given, for example, having eye glasses clean and within reach, cleaning dentures every day and dressing people in their own clothes. We should not have to tell staff to clean dentures daily, but I have still had to have that talk with staff.
• Leaving people lying in urine or feces or putting them to bed at 7 p.m. because it is better for staff. I know that it is impossible to keep everyone dry at all times. However, I have seen staff on night shift skip a room on rounds because a difficult resident is sleeping and they do not want to wake them up. I have also seen facilities that do a generic round of putting people to bed whether they want to go to bed or not.
• Failing to chart and/or document in a timely and accurate manner. Working where I do, I do both long term care and acute care in the same shift. I am fully aware that charting is not always at the top of the priority list, especially so in long term care. However, we have to keep accurate records not only for the legal implications, but also because it is a right of the resident.

It is up to all of us to try and prevent these types of violations from becoming standard practice in nursing home care. Need I say more?

By Aurora Cyganik-Barker RN, BN.  Aurora has worked in all aspects of long term and seniors care for over eight years. Currently, she works in a rural facility that has both acute beds and a long term care wing that houses 20 residents.

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