Safeguarding the dignity of those dying in hospital
Valerie Yule
Adapted extracts from the conclusions of a descriptive account sent to The Natural Death Centre.
The dying of my father in hospital recently, aged 94, made me realise the simple cost-free measures that could have prevented or at least mitigated the humiliation and despair of his last weeks.
What would help in such situations?
To train all the staff on how to put the most important things for the patient ahead of the rituals and the tests and even the meetings - important as the meetings are for the staff's needs.
To take seriously the records the patient brings, and what the relatives say, rather than take the very common tinge-of-pride attitude of 'starting diagnosis from scratch' and ignoring the past. Put both old records and new findings together.
To have at each bed a photograph of the old person when they were in their youth, so that young staff can always see in that old person, that shell, what they really were, and respond to that image, of another human being like themselves, inside the shell they see.
To improve ways of caring for the very old and weary, so that they can rest in bed if they want to, even if it does 'shorten their days'. There's nothing I like myself more sometimes than a 'good lie down' - and I am petrified that in my old age I could be kept sitting up bored and weary and uncomfortable and chilly all day.
To put a high priority on the dignity of the old person - and that means more attention to bowels than to clever tests to help train medical students.
Let the patient set the relationship. First-name calling between people of roughly the same age can establish friendliness, but when young staff first-name the elderly before being given permission, it can increase the effect of declaring 'second childhood' and the lower status of the patient.
Always assume awareness somewhere. Underestimating patients is so easy and can push them into the state they are supposed to be in. I have learnt from experience and observation always to behave as if a person even in a coma can hear, and to give physical contact to the dying even if they are supposed to be unconscious. Weariness, despair and drug effects are not the same as dementia. Few old people know or care what day it is anyway. With their friends and relatives old people can often still show a life that staff may not see when they have put a patient at a physical disadvantage. Even the demented have a person suffering within.
To ensure that all staff, including social workers, put the organising paperwork before the meetings among themselves. Our nice girl was incommunicado in too many meetings, while paperwork and phone calls that would have taken five minutes should have had priority, to really help patients and families. A good deal of her busy time (and ours) was therefore wasted in her answering calls that were just repeating the same unfulfilled requests.
I was surprised by how often nursing staff in nursing homes as well as in hospitals objected to old people having personal reminders of their lives with them, because 'they're a nuisance to the cleaners'. If they do have photographs and cards, often they are put on the wall behind the bed where the patient cannot see them. Yet the happiest people I saw in the nursing homes were those who did have mementos of their lives around them, to remind them who they still were. When Everyman dies, he can take nothing with him, he is stripped of all (except, some say, Good Deeds) - but why should he be stripped while he is still alive?
To ensure that grieving relatives receive all the personal belongings of the patient, and that they are not the perks of some cleaner.
Valerie Yule, 57 Waimarie Drive, Mount Waverley, Victoria, Australia (tel 9807 4315).
Previous / Next / Table of Contents