This paper reports on an ethnographic study to explore the experience of dignity in the acute care of older people in four acute NHS trusts. It explores the prevalent view that acute care is not the right place for older people and the failure to acknowledge that the largest group of users are the very old, the frail and the dependent, which results in environments that are not friendly to older people generally, and are especially hostile to those with cognitive impairments. Added to this, a culture that is risk averse and defensive, where care is undervalued and where professional accountability and discretion are replaced by standardised checklists, pathways and audits, cultivates the attitude that if an aspect of care can't be measured it doesn't matter. Overall, getting the job done appears to matter more than how the job is done, so that the focus is primarily on the task rather than seeing the person. It describes how the failure of acute trusts to respond to the needs of the majority of their users ‐ older people ‐ results in the failure to provide dignified care and the impact of this on both the quality of care and patient outcomes.

This work identifies the different ways dignity is conceptualised by older people. The evidence showed that person centred care for older people needs to be specifically related to communication, privacy, personal identity and feelings of vulnerability. It provides evidence for policy makers and professionals to tailor policies and practices to the needs of the older person.

Nurses are responsible for the well-being and quality of life of many people, and therefore must meet high standards of technical and ethical competence. The most common form of ethical guidance is a code of ethics/professional practice; however, little research on how codes are viewed or used in practice has been undertaken. This study, carried out in six European countries, explored nurses' opinions of the content and function of codes and their use in nursing practice. A total of 49 focus groups involving 311 nurses were held. Purposive sampling ensured a mix of participants from a range of specialisms. Qualitative analysis enabled emerging themes to be identified on both national and comparative bases. Most participants had a poor understanding of their codes. They were unfamiliar with the content and believed they have little practical value because of extensive barriers to their effective use. In many countries nursing codes appear to be 'paper tigers' with little or no impact; changes are needed in the way they are developed and written, introduced in nurse education, and reinforced/implemented in clinical practice.

This paper reports the findings of 89 focus groups and 18 individual interviews (involving 391 older people in 6 European countries) that were held to explore how older people view human dignity in their lives. Participants were all aged over 60 years and 25% were aged 80+ years. They were from a range of educational, social and economic backgrounds. 72% were women and 17% were living in residential or nursing homes.There was substantial agreement about the meaning and experience of dignity in older people's everyday lives. It was seen as a highly relevant and important concept, enhancing self‐esteem, self‐worth and well‐being. Three major themes were identified: respect and recognition; participation and involvement; and dignity in care.The theoretical model of human dignity developed in the project was reflected in many of the findings from the empirical data. Of particular importance and relevance was the notion of ‘dignity of personal identity’, not least because it is perhaps most vulnerable to the actions of others. Menschenwurde (expressed as the innate dignity of human beings) was also important.For dignity of older people to be enhanced, communication issues, privacy, personal identity and feelings of vulnerability need to be addressed. Education of all professionals should pay attention to practices that enhance or detract from the experience of dignity. Policies and standards need to go beyond the merely mechanistic and easily quantifiable, to identify meaningful qualitative indicators of dignity in care.