In the United Kingdom (UK), despite the range of policies and targets focused specifically upon delivering dignity in care for older people [1–3], there is substantial evidence that this is still being compromised [4–13]. The Parliamentary and Health Service Ombudsman report , for example, details 10 cases of elderly patients who died after being admitted to NHS hospitals but who did not receive the most basic standards of care such that they were left without food or water, were soaked in urine or lying in faeces and left on the floor after falling. In 2011 one in five hospitals inspected by the Care Quality Commission also exhibited ‘basic failings’ on dignity and nutrition . The NHS Operating framework for 2012–2013  prioritises the care of older people stating ‘some parts of the NHS are failing to provide elderly and vulnerable patients with dignified and compassionate care or to offer good standards in areas such as nutrition, continence and communication’ (p.2).
Dignity remains, however, a complex concept subject to a range of different interpretations [15
]. Whilst the examples noted above operationalise dignity in terms of the delivery of fundamental nursing care, the Royal College of Nursing [5
] definition emphasises core nursing values of respect and autonomy rather than care delivery:
“Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals”
Similarly the more recent Social Care Institute for Excellence [16
] focuses upon the relational aspects of care delivery rather than with delivery of care per se:
“Dignity is at the heart of personalisation. Dignity means treating people who need care as individuals and enabling them to maintain the maximum possible level of independence, choice and control over their own lives. It means that professionals should support people with the respect they would want for themselves or a member of their family”
Whilst older people cite respect, communication, privacy and being treated as an individual as important aspects of dignified care they emphasise the basic and vital aspects of care such as eating, nutrition, personal hygiene and toileting [11, 17–22]. Less visible in the research literature is the professional perspective on delivering dignity in care and, more specifically, the educational, cultural and organisational factors which enable or hinder its delivery. This is a significant omission as it is the attitudes, skills and behaviour of frontline staff via the development of organisational culture, policies and practice which is critical to the tangible delivery of policy imperatives .
Hall and Høy  carried out one of the few studies exploring the professional perspective and more specifically, 29 Danish nurses’ experiences of caring for older hospital patients. Helping patients regain their dignity was considered to be of central importance to nurses. Participants reported that dignity was a value that had to do with integrity, respect and worthiness; something the older patients were in risk of losing when being hospitalised. A similar study was carried out to determine health and social care professionals’ views of various aspects of dignity and older people . A total of 85 focus groups were carried out involving 424 professionals in six European countries. Participants’ views of what constitutes dignified care were highly consistent: dignified care promotes autonomy, independence, engenders respect, maintains individual identity, encourages involvement, adopts effective communication practices and is person-centred and holistic. However, the RCN  survey of the challenges faced by nurses in delivering dignified care did not seek their understanding, conceptualisation or definitions of dignity. Overall, while the limited research that has looked at the professional perspective is important it lacks the organisational perspective which our study addresses.
If dignified care for older people is to be implemented successfully, we need to fully understand both the patients’ and health care professionals’ understanding of dignity in order to develop appropriate and relevant policies and procedures to avoid the breaches of dignity in care of older people.
This paper reports findings on two key research questions from a survey of health and social care professionals which forms part of a larger case study (survey, interviews and focus groups) investigating how dignified care for older people is understood and delivered by health and social care professionals and; how organisational structures and policies can promote and facilitate, or hinder, the delivery of dignified care. The research questions that form the specific focus of this study are as follows:-
What does dignified care mean for health and social care professionals?
What are the most important aspects of dignified care as perceived by health and social care professionals?