Teaching and Learning Dignity

Yesterday there was an announcement about a new report and consultation  on the issue of ‘Dignity in Care’ (NHS Confederation – pdf).

I wrote a piece about this for the Guardian Social Care Network and don’t want to repeat myself here.

But I did engage in a brief conversation on Twitter whilst on the bus on my way to work (!) about how dignity can be assessed at interview level and how it can be possible or if it’s possible to train dignity into staff.

Apart from reverting to my possibly over-simplistic point that people are far more likely to treat others with dignity if they are treated with dignity themselves, I also reflected a lot on my role as a Practice Educator. I take social work students on placement and see them through their practice learning opportunities which (in my experience) last between 90-120 days.

It’s pretty clear to me gain insight into someone’s values over this period. Information, policies, protocols and law can be taught. Values seem to be inherent. While I think the idea of testing ‘compassion’ on interview is faintly ridiculous, there is a lot that can be learnt when you work alongside someone (not necessarily as their supervisor) over a period of months.

One thing I am very sensitive to is dismissive language. Of course, some people are unaware of the intrinsic pain that some labels can cause and that’s an issue of education. To some, an affectionate and endearing ‘old dear’ might be a term of respect but to some it might be patronising and offensive. In that sense language can be taught.

Actions speak loudly as well. I have heard of university courses that marginalise work with or about older people or mental health courses that are very dismissive of organic mental illnesses. They are somehow ‘different’ and by implication less ‘important’ to know about.

It’s easy to throw words around but words reflect values. I will be patient and explain that the first or second time if I hear patronising language or words that over generalise the needs of older adults and assume a homogenous group of over 65s – because sometimes it’s about the intent behind the language as well. I expect some learning though.

I think the needs of older adults should be reflected far more in social work training and not marginalised. Yes, it’s difficult in a generic programme to cover everything but just judging from the knowledge levels of the students who come to our team (from a number of different universities), I am surprised that there’s not more work being done on challenging ageism alongside other discrimination on the training courses.

As well as language there are many attitudes that remain worryingly present in the social work and social care field. The assumptions that older adults are dependent or vulnerable solely by virtue of their age or that age is something to fear. We need to make age more celebrated in this country, in this culture and in this area of practice so that we can better regard everyone and incorporate dignity, respect and compassion into all sectors of society – not only health and social care. That’s when the issue will truly be tackled. As for the report – I’ll give it about 2 years before we see an almost identical one giving almost identical recommendations. Cynical? Well, maybe just a little bit!

2 thoughts on “Teaching and Learning Dignity

  1. I agree that it is most unlikely that compassion and empathy can be taught. If it is not there in an adult, you are not going to be able to train it into them. Most care home managers I speak to agree with this – they would rather have someone completely inexperienced but with the right values than a highly experienced but unempathetic person.

    There is also the uncomfortable question of cultural values – many care staff now come from countries where life is very harsh. They are not esssentially uncaring, but expectations of levels of suffering in life are very different.

    Some care staff are working ridiculous hours. It is endemic in the industry. At the same time they are treated very uncaringly by their employers. That doesnt encourage thoughtfulness and patience.

    You can probably teach some social skills – knock before entering, dont call someone by their first name without asking first, and modelling behaviour for young workers is most important as imitation is still the way most people learn this job. However a lot of people find old people intrinsically annoying and their physical features disgusting , these should never be allowed anywhere near a frail older person. Training is vital for care workers, but the assumption that you can take anyone , put them through a bit of training and turn them into sensitive and empathetic staff who can maintain those principles in the face of all the pressures that militate against them, is over optimistic.

    Yesterday I heard a speaker on the Today programme, who said the problem is not staffing ratios. Well it jolly well largely is. Yes you can have situations where there are ample staff to do the job – not sure where these now exist – but there is a culture of poor care. And in some situations amazing people work their socks off and manage to provde good care despite understaffing. But the usual situation from what I hear is minimal staffing with underestimated dependency levels. No one should underestimate the corrosive effect of understaffing on empathy. If you are constantly forced to prioritise your response so that you have to choose between attending to someone in pain, having an extended conversation with a relative, and doing the massive amount of recording that is required these days, you have to harden yourself.

    A good and kind care worker put into an environment where others dont pull their weight will probably work themselves into the ground for a while trying to make up for the others, until they eventually give up and leave. Whereupon the culture of that particular unit descends ever lower.

    Finally age discrimination. To my mind FACS was a great idea, but never implemented. Age discrimination is built into the very foundations of social care, – just look at fee levels for different kinds of residential care clients. The only solution would be to massively increase the funding probably needing increase in taxation. As I approach my 60s I am aware that the cut off point for being regarded as someone with a recognised need for being able to engage with the wider community ( 65) is not far away and it quite a frightening concept. We fund placements for under 65s in homes with 1-3 staff ratios and a fleet of minibuses funded by the residents mobility allowances, paying more than twice what we do for people over 65. Over 65s do not get mobility allowance and whose needs are deemed to be met so long as they get a singalong in the lounge and a visit from the vicar now and again.

  2. An interesting debate which I am sure needs further consideration but as someone who has a great interest in teaching compassion I think it can be taught, although not like we would teach any other theoretical subject. In my view compassion comes from the heart (see Pat Deegan’s paper on mental health recovery – http://www.bu.edu/cpr/repository/articles/pdf/deegan1996.pdf)
    and we all demonstrate compassion (or not) every day. There is more research emerging on compassion fatigue – which is perhaps easier to ‘measure’ e.g. staff sickness levels, burnout and incident reporting that demonstrate that compassion is largely a social process which therefore may not be innate but develops as we grow as people.

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