Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-26T01:51:09.686Z Has data issue: false hasContentIssue false
  • English
  • Français

‘I often worry about the older person being in that system’: exploring the key influences on the provision of dignified care for older people in acute hospitals

Published online by Cambridge University Press:  27 February 2012

M. CALNAN ,
W. TADD ,
S. CALNAN ,
A. HILLMAN ,
S. READ  and
A. BAYER
M. CALNAN*
Affiliation:
School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.
W. TADD
Affiliation:
Cesagen, School of Social Sciences, Cardiff University, UK.
S. CALNAN
Affiliation:
School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK.
A. HILLMAN
Affiliation:
Cesagen, School of Social Sciences, Cardiff University, UK.
S. READ
Affiliation:
Cesagen, School of Social Sciences, Cardiff University, UK.
A. BAYER
Affiliation:
School of Medicine, Cardiff University, UK.
*
Address for correspondence: M. Calnan, School of Social Policy, Sociology and Social Research, University of Kent, Cornwallis North East, Canterbury CT2 7NF, UK. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Older age is one stage of the lifecourse where dignity maybe threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline in combination with a lack of social and economic resources. Evidence suggests that it is in contact with health and welfare services where dignity is most threatened. This study explored the experiences of older people in acute National Health Service (NHS) Trusts in relation to dignified care and the organisational, occupational and cultural factors that affect it. These objectives were examined through an ethnography of four acute hospital Trusts in England and Wales, which involved interviews with older people (65+) recently discharged from hospital, their relatives/carers, and Trust managers, practitioners and other staff, complemented by evidence from non-participant observation. The picture which emerged was of a lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards was often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity. Informants generally recognised this but concluded that it was the older person who was in the ‘wrong place’, and assumed that there must be a better place for ‘them’. Thus, the present system in acute hospitals points to an inbuilt discrimination against the provision of high-quality care for older people. There needs to be a change in the culture of acute medicine so that it is inclusive of older people who have chronic co-morbidities and confusion as well as acute clinical needs.

Keywords

ageingacute hospital caredignified care
Type
Articles
Information
Ageing & Society , Volume 33 , Issue 3 , April 2013 , pp. 465 - 485
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baillie, L. 2007. The impact of staff behaviour on patient dignity in acute hospitals. Nursing Times, 103, 34, 30–1.Google Scholar
Baillie, L. 2009. Patient dignity in an acute hospital setting: a case study. International Journal of Nursing Studies, 46, 1, 23–6.CrossRefGoogle Scholar
Baldock, J. and Haddow, J. 2002. Self-talk versus needs-talk. Quality in Ageing – Policy, Practice and Research, 3, 1, 42–8.Google Scholar
Brown, P. 2008. Trusting in the new NHS: instrumental versus communicative action. Sociology of Health and Illness, 30, 3, 349–63.Google Scholar
Brown, P., Alaszewski, A., Pilgrim, D. and Calnan, M. 2011. The quality of interaction between health service managers and frontline clinicians: a question of trust. Public Money and Management, 31, 1, 43–50.CrossRefGoogle Scholar
Bryman, A. 2008. Social Research Methods. Oxford, University Press Oxford.Google Scholar
Bryman, A. and Burgess, B. (eds) 1993. Analyzing Qualitative Data. Routledge, London.Google Scholar
Calnan, M., Almond, S. and Smith, S. 2003. Ageing and public satisfaction with the health service: an analysis of recent trends. Social Science and Medicine, 57, 4, 757–62.Google Scholar
Calnan, M., Badcott, D. and Woolhead, G. 2006. Dignity under threat? A study of the experiences of older people in the United Kingdom. International Journal of Health Services, 36, 2, 355–75.Google Scholar
Calnan, M. and Rowe, R. 2008. Trust Matters in Health Care. Open University Press, Maidenhead, UK.Google Scholar
Calnan, M., Woolhead, G., Dieppe, P. and Tadd, W. 2005. Views on dignity in providing health care for older people. Nursing Times, 101, 33, 38–41.Google Scholar
Commission for Healthcare Audit and Inspection 2007. Caring for Dignity: A National Report on Dignity in Care for Older People While in Hospital. Commission for Healthcare Audit and Inspection, London.Google Scholar
Daykin, N. and Clarke, B. 2000. ‘They'll still get the bodily care’: discourses of care and relationship between nurses and health care assistants in the NHS. Sociology of Health and Illness, 22, 3, 349–63.Google Scholar
Delamothe, T. 2011. We need to talk about nursing. British Medical Journal, 342, 7809, d3416.Google Scholar
Department of Health 2000. The NHS Plan. The Stationery Office, London.Google Scholar
Department of Health 2001 a. The National Service Framework for Older People. The Stationery Office, London.Google Scholar
Department of Health 2001 b. The Essence of Care: Patient-focussed Benchmarking for Clinical Governance. The Stationery Office, London.Google Scholar
Department of Health 2004. National Standards, Local Action: Health and Social Care Standards and Planning Framework. The Stationery Office, London.Google Scholar
Department of Health 2006. A New Ambition for Old Age: Next Steps in Implementing the National Service Framework for Older People. The Stationery Office, London.Google Scholar
Department of Health 2010. Essence of Care 2010: Benchmarks for Respect and Dignity. The Stationery Office, London.Google Scholar
Dixon-Woods, M. 2003. What can ethnography do for quality and safety in health care? Quality and Safety in Health Care, 12, 5, 326–7.Google Scholar
Entwistle, V., Renfrew, M., Yearley, S., Forrester, J. and Lamont, T. 1998. Lay perspectives: advantages for health research. British Medical Journal, 316, 7129, 463–6.Google Scholar
Flicker, L., Denaro, C. and Mudge, A. 2008. Should geriatric medicine remain a speciality ? British Medical Journal, 337, 7660, 8–9.Google Scholar
Gilleard, C. and Higgs, P. 2000. Cultures of Ageing: Self, Citizen and the Body. Prentice Hall, Harlow, UK.Google Scholar
Gilleard, C. and Higgs, P. 2010. Aging without agency: theorizing the fourth age. Aging and Mental Health, 14, 2, 121–8.CrossRefGoogle ScholarPubMed
Glen, S. 1998. Role transition from staff nurse to clinical nurse specialist: a case study. Journal of Clinical Nursing, 7, 3, 283–90.Google Scholar
Hammersley, M. and Atkinson, P. 1995. Ethnography: Principles and Practice. Second edition, Routledge, London.Google Scholar
Health Service Ombudsman 2011. Care and Compassion: Report of the Health Service Ombudsman on Ten Investigations into NHS Care of Older People. The Stationery Office, London.Google Scholar
Higgs, P. and Rees Jones, I. 2009. Medical Sociology and Old Age. Routledge, London.Google Scholar
Jacelon, C. 2002. Attitudes and behaviours of hospital staff towards elders in an acute care setting. Applied Nursing Research, 15, 4, 227–34.Google Scholar
Jacelon, C. 2003. The dignity of elders in acute care hospital. Qualitative Health Research, 13, 4, 543–56.Google Scholar
Jacelon, C. and Henneman, E. 2004. Profiles in dignity: perspectives on nursing and critically ill older adults. Critical Care Nurse, 24, 4, 30–5.Google Scholar
Kemshall, H. 2002. Risk, Social Policy and Welfare. Open University Press, Buckingham, UK.Google Scholar
Macklin, R. 2003. Dignity is a useless concept. British Medical Journal, 327, 7429, 1419–20.Google Scholar
Matiti, M. and Trorey, G. 2008. Patients’ expectations of the maintenance of their dignity. Journal of Clinical Nursing, 17, 20, 2709–17.Google Scholar
Mays, N. and Pope, C. 1995. Qualitative research: observational methods in health care settings. British Medical Journal, 311, 6997, 182–4.Google Scholar
Nordenfelt, L. 2009. The concept of dignity. In Nordenfelt, L. (ed.), Dignity in Care for Older People. Wiley-Blackwell, Oxford, 119–42.Google Scholar
Oliver, D. 2008. ‘Acopia’ and ‘social admission’ are not diagnoses: why older people deserve better. Journal Royal Society of Medicine, 101, 4, 168–74.Google Scholar
Oliver, S. 1999. Users of health services: following their agenda. In Hood, S., Mayall, B. and Oliver, S. (eds), Critical Issues in Social Research. Oxford University Press, Buckingham, UK, 139–53.Google Scholar
Ormrod, S. 2003. Organisational culture in health services policy and research. Policy and Politics, 31, 2, 45–56.Google Scholar
Philipson, C. 1998. Reconstructing Old Age: New Agendas in Social Theory and Practice. Sage, London.Google Scholar
Pleschberger, S. 2007. Dignity and the challenge of dying in nursing homes: the residents’ view. Age and Ageing, 36, 2, 197–202.Google Scholar
Polivka, L. 2011. Neoliberalism and postmodern cultures of ageing. Journal of Applied Gerontology, 30, 2, 173–84.Google Scholar
Power, M. 1997. The Audit Society: Rituals of Verification. Oxford University Press, Oxford.Google Scholar
Rockwood, K. and Hubbard, R. 2004. Frailty and the geriatrician. Age and Ageing, 33, 5, 429–30.Google Scholar
Rothstein, H. 2006. The institutional origins of risk: a new agenda for risk research. Health, Risk and Society, 8, 3, 215–21.Google Scholar
Shewan, J. and Read, S. 1999. Changing roles in nursing: a literature review of influences and innovations. Clinical Effectiveness in Nursing, 3, 1, 75–82.Google Scholar
Tadd, W. 2006. Dignity and Older Europeans. In Gunning, J. and Holm, S. (eds), In Ethics, Law and Society. Volume III, Ashgate, London, 73–92.Google Scholar
Tadd, W. and Calnan, M. 2009. Caring for older people: why dignity matters – the European experience. In Nordenfelt, L. (ed.), Dignity in Care for Older People. Wiley-Blackwell, Oxford, 26–53.Google Scholar
Tadd, W., Hillman, A., Calnan, S., Calnan, M., Bayer, A. and Read, S. 2011. Dignity in practice: an exploration of the care of older patients in acute NHS Trusts. Available online at www.sdo.nihr.ac.uk/projdetails.php?ref=08-1819-21.Google Scholar
Taylor, I. and Kelly, J. 2006. Professionals, discretion and public sector reform in the UK: re-visiting Lipsky. The International Journal of Public Sector Management, 19, 7, 629–42.Google Scholar
Theodosius, C. 2008. Emotional Labour in Health Care: The Unmanaged Heart of Nursing. Routledge, London.Google Scholar
Twigg, J. 1999. The spatial ordering of care: public and private in bathing support at home. Sociology of Health and Illness, 21, 4, 381–400.Google Scholar
Twigg, J. 2000. Bathing: The Body and Community Care. Routledge, London.Google Scholar
Wainwright, P. and Gallagher, A. 2008. On different types of dignity in nursing care: a critique of Nordenfelt. Nursing Philosophy, 9, 1, 46–5.Google Scholar
Woolhead, G., Calnan, M., Dieppe, P. and Tadd, W. 2004. Dignity in old age: what do older people in the UK think? Age and Ageing, 33, 2, 165–70.Google Scholar