Empowering nurses to provide ethical leadership in care homes (ENACT)

The positive impact of dignity discussions on staff and resident experiences.

Start date

01 November 2014

End date

15 December 2014

Project website



This project focused on supporting the nursing contribution to dignifying care for older people in care homes. Registered nurses in four care homes engaged with the research team and members of the action research groups (ARGs) as co-researchers to develop a Dignity Toolkit. The project aimed to develop nurses’ knowledge and skills so they are empowered to provide ethical leadership that enacts the dignity of older people and staff.

Aims and objectives

The objectives were to develop:

  • Implement and evaluate a nurse-led Dignity Toolkit in care homes in collaboration with staff, residents, relatives and other experts
  • Registered nurses’ knowledge, skills and confidence so that they are empowered to provide ethical leadership
  • Registered nurses’ research capacity.



Advisory group

Professor Lesley Baillie

London South Bank University

Ashley Brooks

National Patient Champion

Olivia Corrie

Front Line Communication

Jane Leng

Senior Teaching Fellow, University of Surrey

Dr Julie McGarry

University of Nottingham

Alan Parker

Service User Panel Member, University of Surrey

Sheena Wyllie

Barchester Healthcare

Mantle Labs team

Professor Clement Atzberger

Company Director


The project design was action research involving researchers meeting monthly with two groups – one ARG and one Relatives and Residents (RRG) – in each of the four care homes. These meetings, along with individual interviews with registered nurses’ within the ARGs who had been supported to develop and implement the Toolkit, enabled researchers to evaluate the impact of the project with regards to the dignity of older people and staff in residential homes.

Interviews were analysed using three main themes:

  1. Dignity in Care – understanding dignity and the practice of dignity
  2. Conditions for Dignity in Care – opportunities and obstacles to providing dignified care
  3. Leading Dignified Care – the practice of dignity – promoting leadership.


There were three striking overall findings:

  1. The positive impact of making time and space in care homes for discussion about dignity-related issues for staff
  2. The project process is as important as project outputs. Being listened to and having one’s views considered important was highly valued by participants
  3. Future recommendations for further research, educational and practice related activity (see over) The project overall suggests the potential of bottom-up collaborative approaches to promote dignity in care.


  • Develop longer term partnerships between care homes and researchers/academics with expertise in ethics/professionalism to research strategies that sustain dignity in care
  • Direct home care providers to the online Dignity Toolkit and encourage engagement, utilisation and suggestions for further development
  • Highlight the value of making time and space in care homes for staff, residents and relatives to reflect on the complexity and value of everyday care practices.


There is no consensus regarding the meaning of dignity in care, nor is there an agreed framework to operationalise dignity. The ENACT research team shared insights from previous publications, studies and frameworks to initial work with the expert Advisory group. They integrated insights from materials produced by Skills for Care and by the Royal College of Nursing. This initiated the development of the first toolkit.

Discussion at the monthly meetings with the ARGs, the RRGs, with the expert Advisory Group and the research team enabled the development of the Dignity Toolkit. A generic toolkit was produced and also bespoke versions, the latter incorporating data from each of the four care homes, which were made available to participating homes. An online version was also developed. The project evaluation suggested that participants gained in confidence regarding their understanding of dignity in care homes and that they found elements of the Toolkit helpful.

Research groups and centres

Our research is supported by research groups and centres.

The International Care Ethics (ICE) Observatory  scholarship of teaching and learning

Research themes

Find out more about our research at Surrey: