An individual telling friends they had spent a few nights in hospital because of a broken leg is unlikely to turn many heads, while announcing they had done the same because of a bout of depression may elicit a different response. This is because some health conditions carry a particular shame and stigma, while others do not. Studies across the world regularly identify various examples, and these range from issues such as mental health problems and HIV infections to alcohol/drug addiction and obesity.
But what is meant by the term stigma? Dictionary definitions refer to any mark or behaviour that is disapproved of by society. With another widely quoted definition coming from a book on stigma by Goffman (1963) in which he discusses the concept of ‘spoiled identity’.
More recent interpretations have divided stigma into two distinctive forms, namely enacted stigma and felt stigma. The former is a demonstratable action regarding the stigmatised issue, and this can range from a comment being made through to a specific act of discrimination. The latter is more subjective and refers to the way individuals think people will react when learning about a stigmatised issue.
The stigma around certain medical problems can also be extremely damaging in terms of public health (The Lancet, 2006). This is because it often leads to people either not seeking medical help or leaving it so late that treatments may then be ineffective.
The social and emotional impact on those living with a stigmatised health condition can also be high, with individuals often not wanting to engage with people and/or going to great lengths to hide their condition. All of which can have a significant impact on a person's wellbeing and mental health, as well as potentially effecting their wider family.
In outlining his concept of ‘The sick role’ in 1951, Talcott Parsons argued that when an individual becomes ill, society expects them to adhere to a number of social norms, which include the expectation that the individual will step back from their other societal roles (which could include family roles and work) and to submit to and accept medical interventions, with the aim of getting better. However, in relation to chronic health conditions this can become more complex.
In living with a hidden medical condition, such as mental health problems or incontinence, this can bring its own set of problems. For example, it is often hard for people to realise that an individual is ill because they are able to pass as ‘normal’. This can be difficult for individuals managing incontinence, particularly those making use of disabled toilets, because other people may not readily identify them as disabled and entitled to use such facilities. Recent campaigns to raise awareness about hidden disabilities should help with these issues.
The stigma of incontinence
A condition that is widely seen as stigmatised is incontinence. This is defined as the loss of control over one's bladder and/or bowels, which has a significant hygiene and social impact. As adults, we rarely think about the various activities of self care we carry out each day, such as eating, drinking, washing ourselves, getting dressed and going to the toilet. These are things we learn at a young age, and which are seen as important developmental milestones in childhood and the progression to adulthood. Therefore, the loss of any one of these skills particularly in later life, can have a significant impact on our self-esteem. Continence is a skill that is often learnt in early childhood through toilet training, which depending on where and what era you grew up in usually involves some form of reward and/or punishment-based approach.
Becoming incontinent in adulthood can have a major impact on a person's mental wellbeing and sense of self. Individuals worry about issues such as how people may react, returning to a childlike state, or even fearing being punished for their actions. Consequently, people living with incontinence may go to great lengths to keep their condition hidden, which often requires considerable amounts of physical and emotional effort and can be an exhausting process.
It has also been suggested that individuals who become incontinent often react with the same feelings that are associated with grief, namely: denial, anger, bargaining, depression and acceptance. Yet, as many commentators have pointed out, grieving is not a set process and individuals rarely go through specific stages, but instead cycle between these different feelings. A situation that can also be applied to those living with incontinence. Nonetheless, this is still a useful approach with which to explore the emotional impact that incontinence can have on people.
In relation to the prevalence and disease burden that bladder and bowel problems have on society, it is accepted that while urinary incontinence is more common, with roughly a 4 to 1 ratio, bowel incontinence is thought to have a greater impact on an individual's quality of life. This is because of it being much harder to hide in terms of odour, the mess created, and time needed to clean up, as well as the general disgust that is associated with faeces.
In terms of prevalence in the UK, there are thought to be around 14 million people living with some degree of urinary incontinence, and potentially around 6.5 million people living with bowel difficulties (Percival et al, 2021). However, the figures for incontinence are notoriously difficult to ascertain, as a result of the stigma surrounding the condition. There is also significant stereotyping around incontinence, with people assuming that the condition tends to only effect older individuals and particularly women, as well as those living with disabilities and cognitive difficulties. The above figures show that incontinence is a common problem and affects many more groups in society than is widely thought. If a person happens to not fit into one of these stereotypical groups, they are likely to feel even more stigmatised. For example, younger men often experience bladder problems, but this is much less talked about, which can lead to individuals feeling isolated and further stigmatised.
Case study: male with complex health issues
Here I will be using myself as the ‘case study’. Demographic information: 52-year-old male, Caucasian decent, middle class, lives in the home counties. Occupation: scientist and medical writer, researcher, and patient advocate. Medical history: born with a rare metabolic disease (Glycogen Storage Disease), obese, has prediabetes, hypertension, low vitamin D, osteoporosis, osteoarthritis (hands and left hip), hip replacement in 2019, is neurodiverse and has mental health problems (obsessive compulsive disorder, depression and anxiety), has bile acid malabsorption (BAM) syndrome, and is doubly incontinent. Incontinence history: Late toilet trainer, bedwetting in childhood that re-emerged as a young adult, overactive bladder and bowels, weak pelvic floor, day urinary incontinence, and bowel incontinence over the past 4 years. Family status: married with one son. Further information: has care and support needs.
Living with double incontinence
As you can see from the section above, I live with quite a few health problems. But the two I find hardest to live with are definitely my double incontinence and mental health difficulties. This is because not only do they have a big impact on my day-to-day life, but they also carry the added burden of both being highly stigmatised conditions. Before reading the following, the reader should remember that this is my own particular story and, having sat on various patient panels over the years, I know that many people deal with the same issues, but how they perceive and react to these issues can be vary widely.
I also recognise that I am at the more severe end of the scale in terms of my incontinence, and how I have reacted to this issue in adulthood has certainly been influenced by my other physical and mental health issues, as well as my childhood experiences when I was in and out of hospital. The latter is important because health psychologists acknowledge that if you experience health difficulties as a child, particularly if they are traumatic, this can also have a significant impact on you as an adult. Studies have suggested that you are at greater risk of developing chronic conditions such as heart disease and depression, and that you may also be less resilient at dealing with these, particularly if you experienced medically induced trauma as a child (Blackwell et al, 2001; Rod et al, 2021; Spencer-Tansley et al, 2022). This could be anything from anxiety about having a blood test through to having a major operation and recovering from that.
There is no doubt that my life story has certainly influenced how I deal with my current difficulties, just as it does for everyone else. People with the same health conditions often share many similar experiences and we can still learn a lot about the lived experience of particular conditions through such health biographies.
Impact of the stigma of incontinence
The impact that living with a stigmatised condition like incontinence has had on me as an adult has been quite profound and wide ranging, effecting many aspects of my life. Community nurses will certainly be familiar with and recognise many of these difficulties from their own experience of working with incontinent patients. Here are some of the areas I have struggled with in particular:
Finding it difficult to tell people about incontinence
I have often found it very difficult to open up about my incontinence, even to friends and family. For example, I was still living at home in my late teens/early twenties when my bedwetting re-emerged. Although my parents have always been very understanding of my health difficulties, I was too ashamed to admit this and hid the problem, even going to the extent of using homemade solutions to manage my incontinence, such as using a bin bag as a mattress protector and sleeping on towels. I resorted to wearing swimming trunks at night, which were stuffed with flannels and toilet paper to act as basic incontinence pants.
It also took me many months to pluck up the courage to tell my girlfriend (now wife) that I sometimes wet the bed. This also made sharing a bed stressful and I was always anxious that I might have an accident. When this inevitably happened, I was embarrassed and ashamed. However, my partner was very kind and understanding, which made the situation much easier to handle. Although having to protect the bed and using body worn products myself always meant that our sleeping arrangements required careful planning.
The fear of telling people even extended to healthcare professionals. For example, I did not tell my metabolic consultant about my incontinence and mental health difficulties for many years. I only told my best friend after a rather embarrassing accident that I was not able to hide. Of particular sadness is the fact that due to my unfounded fears I kept the issue hidden, yet when I eventually told people no one reacted negatively, and I could have saved myself a lot of unnecessary anxiety.
Taking a long time to seek help
It also took me a long time before I sought medical help for my bedwetting, because of the embarrassment and shame I felt around the issue. Initially from my GP, then self-referring to the continence service. The staff at the local clinic were extremely kind and understanding, but I felt so embarrassed and ashamed after the appointment that it took me several years to re-engage with the service.
When I started to develop daytime urinary issues as well, I again took a long time to acknowledge the problem and to seek help. This pattern has also been repeated in the way I have tried to access help for bowel problems too.
Finding the products to manage incontinence can be stigmatising
Another problem of living with a highly stigmatised condition such as incontinence is that the products designed to help people live with dignity, can also become stigmatised themselves. This is especially true for the disposable body worn products, particularly the taped all-in-one style pads designed for heavy leakage that are sometimes, unfortunately, referred to as adult nappies. Comedians often make fun of old age through reference to products such as mobility scooters and incontinence pants and even some of the adverts for the products refer to them jokingly as ‘bulky pee pants’.
The various other products and equipment used in toileting and helping to manage incontinence, such as chair and bed pads, urinals, bedpans and commodes all carry a level of stigma and/or an embarrassment factor that mean they are usually hidden from public gaze. This means that buying or having such products on oneself or at home could cause the individual shame as it marks them as potentially incontinent.
I am no exception to that and I go to great lengths to hide my products and devices, whether that is at home where they are hidden away in cupboards or when out in public where they are tucked away in zipped compartments of my travel bag. Along with many other people dealing with incontinence, I also worry that the outline of my pads or other devices may be visible under my clothing, an issue which product manufacturers often use when selling their products by claiming they are virtually undetectable. However, I still wear baggy clothing and a vest/t-shirt under my main shirt to reduce the risk of my body worn being visible.
Going out in public
The fear of being incontinent while out in public can be extremely debilitating, because it can lead to people not wanting to go out and greater isolation. This could encompass any social situation where an individual may be around other people, whether that is commuting on public transport, going to work, socialising or attending any other events and/or meetings.
For me personally, using public transport and going to work have proved particularly stressful, which has led me to freelance and work from home as much as possible. Another situation I find difficult is being in healthcare settings, which may seem counter-intuitive since these are environments where incontinence may be more often encountered. Yet, these are situations where your body is often under greater scrutiny. For example, I still do not necessarily want a member of staff to know that I am incontinent when going for an X-ray and/or blood test, even though I am aware they are likely to see patients with this condition everyday.
As a result of my various other health conditions, I visit clinics and outpatient departments on a fairly regular basis, have had physiotherapy appointments and visited an urgent care centre, as well statying in hospital after my hip replacement. These are all situations where I have sometimes needed to be more open about my incontinence, and even ask for help on occasions.
Impact on mental health
As my incontinence difficulties have worsened over time, this has had a significant impact on my mental health. Even when wearing continence protection, it is still extremely difficult not to get anxious and afraid that you might have an accident. You are constantly on high alert, worrying that people will somehow notice you are incontinent, through an obvious wet patch on your clothing, odour or any other tell-tale sign, and subsequently embarassed. However, one cannot live with that level of anxiety and stress without it having a long-term impact, and I believe that my incontinence has been a contributory factor in my bouts of depression over the past few years. I certainly do not go out as much as I used to and when I do go out, I experience greater anxiety and more panic attacks and prefer someone to be with me in case I have an accident or other issue.
Research has shown that the relationship between incontinence and mental health is complex. This is certainly bidirectional, with incontinence being a risk factor for anxiety and depression, and the latter increasing the risk that an individual may develop incontinence. Having an incontinent episode when out and about can be very traumatic. I have broken down in floods of tears numerous times because of the embarrassment and sheer indignity of this condition.
Like many people, I was also impacted quite severely by the COVID-19 crisis, although I was fortunate to avoid catching the virus until after I was vaccinated and was only affected mildly. The various lockdowns and the fact that I was classed as extremely vulnerable (which I disputed) meant that I had various appointments and treatments cancelled, and I found the social isolation difficult to handle. My wife works with the NHS and went into work during the whole period, while my son was able to attend school as a pupil of an essential worker. This meant I spent a significant amount of time on my own, apart from occasional care visits.
This had a significant impact on my mental wellbeing, and I had to access additional services and mental health support during this period. When things began to slowly open up, like many other people I found the transition to normality quite difficult, particularly when access to many public and shop toilets remained restricted, as reported by many newspapers at the time. This affected me directly when I was out shopping with my family, soiled myself and had the indignity of having to drive home in my own mess because all the local toilets were closed. On another occasion, I had to use my car doors as a privacy shield while I changed my pad in a public car park, with my wife and son helping me by acting as lookouts. Years later, I am still dealing with the after-effects of this period in the form of ongoing problems with my mental health. For example, I lost a lot of confidence about leaving the house on my own that I have never fully recovered from.
Receiving social care support
In Autumn 2019, I had a severe bout of depression which led me to ask for social care support. I had received help earlier in the year following my hip replacement in spring 2019, when carers had helped me with personal care for 6 weeks after my operation. This time, I asked them back to primarily support me with my mental health difficulties. It is not easy to admit, but at my very lowest I get to the point where even the basic tasks of daily living can become a struggle, whether that is eating and drinking regularly, getting dressed, managing family and household tasks, or looking after my personal care. This, in relation to managing my incontinence problems, manifested itself as not changing my pads regularly, not looking after my skin care, as well as not bathing, and generally not caring about any of this. This is out of character, because I always take pride in my appearance.
Just before the COVID-19 crisis in Spring 2020, I received a care needs assessment from our local social services department, and they agreed to fund this ongoing support. I can honestly say that without my family's help and their additional support, I do not know how I would have got through that period. Particularly, when my father died in December 2019 and I sunk even further in to depression.
I expected this to only be for a short period of time, but I ended up having support over the whole period of COVID-19 and beyond. This includes up to the present day because my mental and physical health has continued to deteriorate. For example, I am now classed as totally incontinent of bowel and bladder, which has not been easy to come to terms with. I require support to manage this along with my various other needs, which include companionship support to go out on my own, assistance with household tasks and other practical help, as well as emotional support when I am struggling with anxiety and depression.
In Autumn 2021, I moved away from agency support and now employ personal assistants to help me, which has given me greater freedom and autonomy with my care needs. This support is still ongoing, for which I am extremely grateful, because it has enabled me to live the best life I can in difficult circumstances. Of course, with chronic health problems there are good and bad days, but on my good days the team always encourages me to be as independent as possible. They make sure I do as much as I can myself, so I do not become dependent and/or deskill, which is very important to me. On my best days, I only need gentle encouragement and light touch support to complete my daily tasks.
A word about the ‘other’ incontinence
I vividly remember reading academic work on bowel incontinence and thinking how much harder it must be to live with, never imagining that I would end up having to deal with this issue myself. I would certainly encourage readers to seek out the work of Christine Norton and Lesley Dibley, senior academics with a nursing background who have conducted some great research in this area. Again, you cannot overestimate the embarrassment and shame that you feel when you have a bowel accident in public. This is perfectly summed up by an old work colleague and friend, who in 2023 kindly wrote a testimony for me on the impact that my incontinence can have on me in the work environment. I still find it hard to read but it illustrates the harsh realities of living with this wretched and debilitating condition. My colleague reported the following:
‘Chris had a toilet accident while working at the office. He was without a carer and experienced a high level of anxiety because of it. This incident happened when I had left the office, upon my return Chris's face was completely drained of colour, he was struggling to tell me what was wrong and was shaking uncontrollably. At the time I thought he had had terrible family news. Eventually Chris was able to explain to me that he had had a toilet accident. Chris had no choice but to ask me if he could have help from one of the carers in the office and if they were able to assist him in the toilet. Having to do this left Chris feeling embarrassed and vulnerable. Witnessing Chris in this state really allowed me to see how vulnerable Chris can be when faced with this kind of situation in the workplace’.
The difficulties of asking for help
As highlighted earlier, there are times where I have had to ask for and accept direct help with my incontinence. Like many people I am by nature an independent and private person, who does not always find it easy to ask for help. This is particularly true when pride and personal dignity are at stake, in relation to an embarrassing or shameful health issue.
Up until 2019, I had always self-cared and never had to ask for direct help as an adult. However, during my hospital stay and in receiving care support at home afterwards, it was impossible for me to do everything, and I had to accept help. This was something I found extremely difficult, because this involved crossing a number of personal boundaries that I never thought I would have to let go as an adult. Growing up in my family we were never made to feel embarrassed about our bodies or particularly prudish. As a child between 1981 and 1982, I experienced long periods of time in hospital where I was bedbound and in traction due to a hip problem. During this time, I experienced significant bodily pain, a chronic wound infection, along with bedsores, as well as the embarrassment of needing assistance with my personal care and toileting. With the latter inevitably leading to the occasional ‘accident’ and the shame that brought. Although my experiences with the nursing staff and other healthcare professionals were largely positive, after counselling in adulthood I realise that this has left me with significant levels of medically induced trauma. This is especially true around healthcare settings and how I feel about medical interventions and support.
When I began to experience hip problems again and needed hospital treatment, I never expected the memories from the above period to come flooding back so intensely. A situation that has also been mirrored in the way I have reacted to the emergence of my incontinence as an adult, with again intense feelings but this time of embarrassment and shame.
It is also interesting how discussions on dignity and end-of-life care often end up focusing on issues around toileting and incontinence. Debates on the right to die also reference the indignity of incontinence, with advocates often referring to comments made by patients along the lines of ‘If I ever get to the point where I am incontinent and someone has to wipe my bum for me, then I just would not want to go on’. But as campaigners such as Baroness Tanni Grey-Thompson have pointed out, people living with disabilities lead highly rewarding lives with conditions that non-disabled people may judge as unmanageable. Other commentators have noted that this type of skewed thinking often originates from ableism, the assumption that typical individuals are superior and disabled people need ‘fixing’.
Returning to the topic of asking for help, before 2019 I had always managed incontinence care myself. During my hospital stay and while recovering at home, I knew I would probably need help to manage this. This is a situation that I had always dreaded, but I am a realist and knew that this was the only way I could maintain some degree of dignity.
In particular, two situations spring to mind. The first one occurred in the hospital, where I unfortunately wet the bed in the middle of the night because the pad that I had been given was not my usual one. The nurse was on her own, but still managed to change the sheets and help me put a fresh pad on, during which I was treated with great kindness and never felt my dignity was compromised. We even talked about the different types of pads that were available, and she even thanked me for the chat which she said had been most informative.
The second one occurred when I was recovering at home. I went for an appointment not long after my hip operation and had a care visit booked for the afternoon. The appointment over ran and I ended up soiling my pad on the way back, and I was so exhausted after being on crutches for most of the morning that I could barely stand when I got home. But I insisted that I was still capable of doing everything, which was untrue. Fortunately, the carer had many years of experience and persuaded me to accept help. I ended up holding on to a Zimmer frame for support, while she removed my pad and helped clean me up. Although I felt totally embarrassed, I was grateful that she had stepped in to help me, particularly when I realised that ‘the sky had not caved in on me’ after the situation that I had most feared had actually happened. This was a real turning point for me, because I realised that there were far more scary things in the world, and I was able to gain much better perspective on the issue.
Unfortunately, since then my incontinence has worsened, and I have had many more occasions where I have needed to ask for assistance. This is to the extent that for my care team this has become somewhat routinised, and although I will always do as much as I can and do not think I will ever completely accept the situation, it is much easier for me to rationalise and understand now. As a result, I do not blame myself as often now, although this remains an ongoing battle.
Learning to live with incontinence and its stigma
Living with a stigmatised condition such as incontinence is not all ‘doom and gloom’, because you do learn to live with it, to an extent. While there is no doubt that the stigma surrounding the condition does make things more difficult, as individuals we encounter stigma every day and we learn to look beyond that.
There is also far more awareness around incontinence now, and the condition is more widely discussed than even a few years ago. Although the field does not yet have the type of widespread campaigns that other stigmatised conditions such as mental health enjoy, I definitely think things are beginning to change for the better.
As individuals, it is difficult not to internalise the stigma that surrounds the condition, and for me personally this remains very much a work in progress. More awareness and better information, as well as people talking more openly about incontinence is the key to breaking down the stigma that surrounds the condition.
How can community nurses help?
In terms of what good quality continence care looks like, various NHS documents and policy reports have highlighted a number of good practices and guidelines. Healthcare academics such as Percival et al (2021) noted that:
‘Good continence care was said to be advanced through person centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence.’
In relation to specific nursing skills, I do not want to give a generic answer either, particularly when the skills identified as making a good community nurse, such as knowledge and understanding, empathy, good listening skills, a good communicator, ability to work under pressure, and as part of a team or independently, are equally applicable to nursing a patient with incontinence as they are to dealing with any other health condition.
Nonetheless, here are my main thoughts. First, I think recognising that patients are all individuals and although we may react similarly in regard to conditions such as incontinence, everyone's response will be unique to them. Empathy is also extremely important, because the patient is likely to already feel wretched and by acknowledging their situation, the nurse can begin to build up trust and understanding.
Second, trying to put the patient at ease, which in an embarrassing situation is not always easy. Again, the ability to read a patient is key here, with some people responding best to quiet efficiency, while others may benefit from distraction through chat, or even humour that can diffuse a situation. The latter may be easier to use when you have got to know the individual. I now realise that when I wet the bed in hospital, the nurse used talk to distract me from an embarrassing situation, and it worked. At other times, my care team have used humour to make me feel less anxious.
Communication is unsurprisingly also key here, by explaining how you can help the patient, as well as giving them the opportunity to talk about their concerns. Talking quietly and discretely is also important, particularly if the conversation could be overheard.
Maintaining the patient's autonomy and giving them options is also helpful, because it promotes them still feeling in control of the situation. When I soiled myself during a treatment session, the urology nurse simply asked how best she could help me. She followed this up by stating that she was happy to help me as much or as little as I wanted. This really helped, because by giving me complete autonomy I felt empowered rather than ashamed. I also appreciated that the nurse was proactive, because in situations like that I often become so overwhelmed with anxiety that I can't ask for help.
When helping a patient change their pad or other device, as well as clean them up, being confident and professional can really help. As someone at the receiving end of such support I always feel anxious, and if I sense that the carer or nurse is also struggling that can quickly transfer to me and can quickly make me feel even worse. In addition, rushing or taking too long to complete the personal care can be equally difficult for the patient. Again, this is not easy to gauge due its subjective nature.
Visiting a patient at home can sometimes be easier or harder for the patient, depending on the individual. For example, being at home can put the patient more at ease especially if incontinence is an issue and they have their own bathroom close at hand. But equally, letting healthcare professionals into your home and safe space can be difficult too, as the patient may worry about the tidiness of their house and in the case of incontinence may also be concerned about any lingering odours. As they would with any person visiting their home for the first time.
Acknowledging the stigma around incontinence is also important; otherwise, patients may feel a nurse does not understand their situation. This might be harder for nurses who may have worked in continence care for many years, because it is easy to become desensitised to the shame and embarrassment around the issue when you deal with it every day.
Another potential problem is when carers or nurses go into ‘professional carer mode’, which patients who spend any significant time in healthcare settings will likely be familiar with. It is not that this type of care is poor or uncaring, it just sometimes comes across as a bit automatic. It is not always easy to define either, but as a patient you feel less acknowledged.
Equally, patients do not want nursing staff to go the other way either and become too focused on the stigma surrounding the condition. Therefore, community nurses have a difficult balancing act to perform with the tightrope that is incontinence, needing to come across as empathetic but not overemphasising the horrors of the situation so that the patient becomes upset.
In terms of my own experience of care, I have been lucky in never being made to feel bad or that it was my fault, as an adult. My experiences in hospital as a child were less positive, and while I would rate the vast majority of the care that I received as excellent, I sadly do still remember the times when I was made to feel bad about my incontinence. As highlighted earlier, this has had a negative impact on how I sometimes deal with my incontinence in adulthood.
I also do not want to be patronised either, and I have only ever experienced this a couple of times and fortunately never from nurses. For example, during a scan I wet myself and the technician did not quite know what to say, and although I appreciate that they were trying to be kind, they ended up saying ‘Oh you poor thing, do not worry these things happen’. This made me feel like a child and was made worse by the fact that a few minutes earlier we had been happily chatting away about the biology of the bladder, very much on an equal footing as one professional talking to another.
But again, as a patient living with incontinence, I do still really appreciate the kindness and compassion that I have been shown by so many nurses and healthcare workers over the years, particularly when things have gone wrong, and I have needed help. Therefore, as someone living with a stigmatised condition, I always appreciate it when the person caring for me is friendly and sees me as an individual and acknowledges my difficulties. A situation that is infinitely better than being treated as a medical condition, with cold indifferent professionalism, with the person responsible for your care clearly having left their humanity at the door of the clinic.
Conclusion
Looking after people with stigmatised health conditions such as incontinence is not easy for either patients or nursing staff. But as someone who lives with this condition, when patient care is done well, the benefits to the individual are immeasurable. It can make or break an individual and how they feel about themselves and their condition. Therefore, seeing patients regain their dignity and transform their life can be hugely rewarding for carers and nursing staff.