Making the mundane remarkable: an ethnography of the ‘dignity encounter’ in community district nursing

Abstract

The concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted ‘behind closed doors’, largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the ‘dignity encounter’ through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home.

“Just because people are old, just because they're ill…” dignity matters in district nursing

“…Through demonstrating the 7Cs in their practice, individual nurses can take a proactive approach to ensure their patients receive care with dignity. Every contact with a patient has the potential to be a "dignity encounter" (Stevens, et al, 2021), and through the delivery of dignified care, nurses can ensure their patients remain protected because abuse and neglect can thrive in the space in which dignity is not present.…”

Older persons' experiences of care encounters in their home: A multiple‐case study

“…Most previous studies have focused on aspects of the encounter from the perspective of the nurse. For example, regarding the preservation of dignity (Lindwall & Lohne, 2021; Stevens et al., 2021), presence in care encounters (Etemad‐Sajadi & Dos Santos, 2021; Öhman & Söderberg, 2004), effective communication strategies (Kristensen et al., 2017; Sundling et al., 2020; Truglio‐Londrigan, 2013), and the dynamics of the nurse–patient relationship (Krityakierne et al., 2022; Pratt et al., 2021; Strandås et al., 2019). Due to the limited research available on care encounters in home care from the perspective of older persons, our study seeks to address this gap by exploring their experiences.…”