Activity
Identify the ways that the nurse’s behaviour in this vignette conveys a lack of respect and dignity for Mr McKay. Why is the nurse behaving like this? How could this encounter have been improved?
Below are some of the points that you may have identified when working through the activity concerning Mr McKay’s treatment.
r Pinpointing visit times is difficult, but giving Mr McKay an indication of when the visit will take place recognizes that his time is valuable too and that the business of his everyday life is not unimportant.
r The fact that the nurse did not introduce herself and her use of Mr McKay’s first name without first asking his permission may be an attempt to be friendly and save time, but is rude.
r Barging into someone’s house uninvited and/or entering a room uninvited is rude. Just because the nurse is there in a professional capacity does not make it less rude.
r Opening a door or cupboard in someone’s house without asking permission led to Mr McKay feeling embarrassed. It shows a lack of empathy and a disregard for his feelings.
r Again the nurse may be saving time, but moving Mr McKay’s belongings around without first asking permission demonstrates a particular lack of respect for his personal space.
r The nurse is disempowering Mr McKay by her behaviour and communication in this scenario. She is taking control and ownership of the space and setting the pace of the encounter to suit her busy schedule. She is not listening to Mr McKay even though she is in his home.
background and personal relationship of the people involved and our professional relationship with them.
Nurses, by virtue of their professional status, have the privilege of being allowed into an individual’s personal space to carry out personal care or procedures. How- ever, consent to do so should be sought from the patient on every occasion. Just because an element of care has been carried out on one day does not mean that you have the patient’s permission to do so again without asking.
Personal space can also be considered in terms of the territory around us that we lay claim to as ‘ours’. Mr McKay’s vignette demonstrates that nurses working within the service user’s home can forget that they are in the patient’s territory and for nurses working in hospital settings this can be even more of a problem.
Nurses are inclined to consider the whole of a ward or department space as their own territory, while a patient, once allocated to a bed or a chair space, considers the space around them as their own.
Reflection point
Imagine you are at a meeting or at a table for group work. You have arrived early and set your papers out in front of you.
r Another person arrives a bit later, sits on the chair next to yours, even though most of the others are empty, and spreads their papers out so that they are nearly on top of yours.
r How would feel? Would you do anything and if so why?
If we go back to consider the patient claiming the bed space as their own, they may feel similar unease if nurses continue to treat the space as theirs. Nurses should signal their respect for the patient’s personal space by gaining consent before enter- ing into the curtained bed space. Mr McKay found that the nurse had claimed his home as her own space and moved around, opened doors and rearranged things, presumably oblivious to the discomfort she was causing him.
As demonstrated above, privacy is linked to personal space and modesty is a similarly related concept. Privacy and modesty are often interlinked in that we may have to provide privacy to protect someone’s modesty. Privacy of the body is an important aspect of communicating dignity and respect, and nurses need to take steps to protect a patient’s modesty. In taking such action nurses communicate to patients that they empathize with their feelings of potential embarrassment or fear of exposure and respect them enough to take steps to avoid or ameliorate situations that may engender such feelings.
Activity
What steps would you take to protect the patient’s privacy and modesty in the following situations? How would you intervene to avoid the patient being
embarrassed? Make notes of your own ideas on each scenario and then share these with colleagues in order to discuss possible options and contingencies.
1 A patient with an indwelling urinary catheter and drainage bag and wearing a nightie needs to be wheeled on a trolley to the X-ray department.
2 A patient on bed rest wears dentures but doesn’t want anyone else to know.
She has told you that she needs to clean them.
3 A patient in a clinic consulting room has to get undressed and wait for a doctor to come and examine them.
4 A young woman approaches the reception desk at a GP surgery wanting to ask for emergency contraception.
Below are just some points that you may have considered.
Situation 1
r Offering a dressing gown or covering the patient with a blanket. Making sure it is big enough to enable the patient to cover themselves from chin to toe if they choose to do so.
r Covering the catheter drainage bag to prevent the urine being on display.
r Adjusting the trolley so that the patient may sit up rather than lying flat, which is less dignified (if safe to do so).
r Ensuring that the patient’s notes are covered if the trolley is wheeled through public areas.
Situation 2
r Asking the patient discreetly whether they would prefer to clean the dentures themselves or whether they would like you to do it.
r If they want to do it themselves, providing the equipment for them to do so and if possible leaving them alone until they have finished the task and replaced the dentures.
r Ensuring that the patient feels secure and knows that no one will interrupt the procedure by coming unexpectedly through the bed curtains. For example, by using privacy pegs to hold the curtains together and to signal that people should seek permission from the patient within before opening them.
Situation 3
r Be clear in communicating to them how far they need to undress for the exam- ination.
r Ensure the patient has a private space in which to undress.
r Provide and point out to the patient adequate covering for them (gown or blan- ket) when they are undressed.
r Ensure the patient cannot be seen from the corridor when the door to the room is opened.
r Ensure the patient knows they will not be interrupted while they are changing and how to indicate when they are ready.
r Ensure the room is marked ‘engaged’ and that anyone entering the room knocks first and waits for an answer.
Situation 4
r Ensure a queuing system is in place that reduces the chance of others in the queue overhearing conversations with staff at the desk.
r Be alert to non-verbal and verbal cues from the patient that they are embarrassed or uncomfortable in stating their reason for attending. Act to provide a private place for the conversation to take place.
r Be discreet. Moderate the voice and avoid being explicit about the reason for attendance if the conversation is at risk of being overheard.
r Ensure that any medication prescribed is handed to the patient in non- transparent bags to avoid bystanders being able to see the nature of the pre- scription.
In the examples given above, it is clear that ensuring privacy often depends on communication both with colleagues and the patient. You may notice that in these scenarios, as in most nursing situations, informing the patient about what is about to happen and offering them choice is desirable. Where control over an experience or a situation is not possible for patients, then providing the opportunity for them to be able to predict what will happen is the next best option.
In a similar way, privacy is also related to confidentiality. The legal requirements on healthcare professionals to ensure appropriate confidentiality with regard to patient information is discussed in Chapter 9, but the link between privacy, confi- dentiality and communicating dignity and respect is worth reflecting on.
Reflection point
Patient privacy and confidentiality are endangered in the following situ- ations. How should you act to protect them?
r You are at the patient’s bedside and they wish to discuss something personal with you, but there is only a curtain between you and the patient in the next bed.
r You are taking a meal break with a colleague in the hospital canteen and they begin to discuss one of the patients in your care.