Mrs Jones has had alopecia for several years. She is completely bald, apart from a small patch of hair; she wears a synthetic wig. She has several of these for different occasions. Mrs Jones is now living with dementia and often forgets to wear her wig. She resides in a care home and relies on staff to ensure she is wearing it. Mrs Jones’ daughter completed ‘This is me’ documentation for her mother. She informed staff verbally and in writing of what has always been important to her mother; Mrs Jones is a devoted Christian woman who attends church every Sunday. She is always well-dressed and likes to wear nice dresses, her favourite pearls, and earrings. She always wears make-up and a synthetic wig, even when alone indoors. She has always taken pride in her appearance.

One morning Sarah, a care assistant is helping Mrs Jones to get dressed for church. Today is a special day; it is her grandson’s christening. All the family are meeting her there.

Mrs Jones selects a dress from the wardrobe from the choices Sarah shows her. She is assisted to put it on. Sarah then applies her make-up. Mrs Jones chooses her favourite shade of lipstick. She

checks her appearance in the mirror, smiles and thanks Sarah. Sarah then attempts to assist with the pearls and synthetic wig.

Mrs Jones stops her, saying, “Oh no, not today”.

Sarah reminds Mrs Jones that she has always worn these.

She still declines.

Sarah insists that she at least wear her wig and attempts to put in on Mrs Jones’s head.

Mrs Jones promptly removes it and snaps “No, I don’t want it!”

“But you can’t go to church bald- your daughter will be very upset”. Sarah argues. It’s the Christening today- there will be photos….”.

Mrs Jones looks at her appearance in the mirror and responds, “I look fine- just take me to church”.

Sarah shakes her head “I’m sorry, I won’t let you go out without your wig, it is undignified”

If they do not leave in 5 minutes, they will be late for the christening. What are your thoughts on this? Consider the situation in relation to Mrs Jones’ dignity.

Congratulations to the three winners:

Sarah Beechey – winner of first place

Katy Mills – winner of second place

Sarah Chowdhury – winner of third place

We hope this competition raised awareness of the importance of dignity in care. Please see the winning submissions below, along with other entries who have given their permission for this to be published online.

Katy Mills (second place) entry

Dignity is a complex feeling which is formed by opinions and expectations. Different values and morals influence how we perceive ourselves and from the eyes of others. Absence of dignity can evoke feelings of worthlessness, embarrassment and ‘please just let the floor swallow me up’.

Dementia is variable and never the same on any two days; but in a way, isn’t that human nature? We have a right to change our minds – what we want to eat, wear, say, do – at any time. Yet our worries about how this will be received by others often influences our choices. For Mrs Jones, the ‘This is Me’ booklet may reinforce values and preferences when she can no longer do it herself. It may also give her daughter reassurance that her Mum’s aesthetic wishes are being maintained – a common indication of how well someone is doing by their ability to maintain their expected appearance. The booklet should enhance Mrs Jones’ life, not dictate it and cause distress.

Perhaps Mrs Jones’ daughter doesn’t like seeing her Mum without her wig as it signifies deterioration and detachment from her treasured personality. Finding the balance between rationalising decisions and taking the leading choice makes the head and heart clash painfully. As nurses, we must anticipate these feelings and help families understand the change in their loved ones on both good and bad days.

Our society is becoming more aware and accepting of different appearances, whether that be hair loss from cancer, alopecia, or just a styling choice. We are conditioned to look, make verbal or silent comments and gain justification of our opinions. Is it the consciousness of how others perceive us that influences our dignity? Or is it how we see ourselves?

As nurses, we have a professional duty to uphold the values of others regardless of our own opinions. As human beings, we have the same obligation.

The photos from the christening may not be how the family want to remember Mrs Jones, but having her present, wearing her choice of outfit, makeup and a smile on her face shows that she felt dignified and comfortable within herself. A photo is a snapshot of one moment in time and just like choices, these can change within moments. Lives with dementia are not black and white; they take emotional strength to do what’s best for the person at the time, but we can all ensure they feel dignified by removing our own opinions and expectations.

Sarah Chowdury (Third place) entry

When caring for a person like Mrs Jones, I personally feel that it’s important to consider her feelings. Mrs Jones has stated that she doesn’t want to wear the wig on this occasion, I feel that it would be unethical to force Mrs Jones or say anything that will make her feel agitated. I respect the fact that

her daughter has filled in the information booklet designed for dementia patients and has stated how Mrs Jones would have felt previously in regards to her appearance. However, I feel that as a nurse its important to consider the patients feelings now.

It is unimaginable for someone like me who doesn’t suffer with this debilitating condition to understand how an individual is feeling whilst going through it every day. I think its important to make her feel at ease and to make her feel comfortable in her own life.

I think its important for the nurse to be kind and to listen to the patients wishes. It’s also important to try and understand that this disease can often leave the patient feeling scared and anxious and recalling situations that may not have happened. So, it is important that the nurse speaks to the patient in a calm empathetic manner. This is where the carer went wrong, I feel.

Nobody likes being told what to do but its especially difficult for someone who’s already confused and anxious and maybe even a little bit unsure of herself. Its important to recognise Mrs Jones’ thoughts and opinions on the situation and she has made a clear statement in regards to her wishes.

Perhaps the carer could have contacted Mrs Jones daughter to giver her the heads up on the situation and let her know what’s gone on an reassure the daughter that a wig can be put in a bag and taken to the church if Mrs Jones changes her mind later on in the day. That way it will not be a shock for the family of Mrs Jones if they know what to expect beforehand.

I feel that when handling a situation such as this one a nurse or carer should value the opinion of their patient and respect their views and wishes. The meaning of dignity to me is exactly that. Its also about giving the patient a choice and on this instance, she has chosen to not wear her wig.

Lastly, I would like to say that, I think when caring for a person with Dementia life isn’t always black and white for them, it’s not about waiting for the storm to pass, its about learning to dance in the rain with them!

Thank you for reading

Other notable entrants who have given their permission to share their submission: see below