Care pathway offers dignity for patients

A pioneering study in Tayside working with community nurses and terminally ill patients has produced a standardised care package which researchers say could be a valuable aid for the NHS and other health systems.

The Dignity Care Pathway allows community nurses to better understand the needs of , and for the patients themselves to express their own concerns. It has been developed through a research project carried out at the University of Dundee, working closely with NHS Tayside and patients and nurses across the area.

"This is a time of life where patients can have very different concerns and needs and where a trusting, constructive relationship with the community nurse can be both a comfort and a help," said Dr Bridget Johnston, from the School of Nursing and Midwifery at Dundee, who led the research.

"The system we have developed gives a considerable degree of support both to the community nurse and to the patient. We have developed this in distinct stages and tested it fully with patients and nurses and the response has been overwhelmingly positive.

"This is a practical guide and one which could be adopted across health services, bringing significant benefits in terms of dignity-based care."

The pathway starts with a questionnaire which the community nurse shares with the patient and which helps identify the issues which are important to each patient. That is followed by a set of reflective questions to explore the issues further and then a set of actions designed to cater to the patient's needs.

"The system helps build a pathway of very personalised care, catering to the concerns and needs of each particular patient," said Dr Johnston. "It can also help build a strong relationship between nurse and patient, which our research has shown to be very important in this area of ."

The study worked with 25 and 5 carers in Tayside and with community nurses and Macmillan nurses across the region.

NHS Tayside Nurse Director Dr Margaret McGuire said, "NHS Tayside is working collaboratively with the University of Dundee on this project, which is an innovative approach to better understanding the needs of patients and helping patients themselves to express their concerns."

Dr Deans Buchanan, Consultant in Palliative Medicine with NHS Tayside, said, "The Dignity Care Pathway allows a safe, structured approach for people to discuss issues relating to advanced illness with their care professionals. This tool also gives a framework to aid the confidence of the professional to know how to respond in a compassionate, evidenced and effective way to such issues. Our experience in this study has re-enforced the usefulness of the tool as a gateway to such conversations occurring and was welcomed and acceptable to patients."

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