About the Project

About the Project, the Project Team and the Advisory Group


The ENACT Project - Empowering Nurses to provide ethical leAdership in Care homes supported by a dignity Toolkit

Focused on supporting the nursing contribution to dignifying care for older people in care homes. Registered nurses in 4 care homes engaged with the research team and members of the action research groups (ARGs) 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.

A number of reports have detailed dignity deficits in the care of older people in both the NHS and care home sector. It is estimated that 4% of the UK population over 65 lives in care homes, with almost 20% of those over 85 in care homes and 78% of these residents experiencing cognitive impairment.

There has been a great deal of philosophical and research attention to dignity in care. Some members of the ENACT research team and advisory group have been involved in some of this work for over a decade, for example, an early intervention study and the Royal College of Nursing survey of nurses’ views of dignity in care. The project design was action research involving two researchers meeting monthly with two groups - one ARG and one Relatives and Residents Group (RRG) - in each of four care homes.

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 draft toolkit with the expert Advisory group. The expertise of members of the Advisory Group also led to the development of dignity-related activities that were incorporated into the 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,

Three overall findings are: the positive impact of making time and space in care homes for discussion about dignity-related issues for staff, residents and relatives; project process is as important as project outputs; and the potential of bottom-up integrative approaches to promote dignity in care requires further research.


Research Team

Professor Ann Gallagher (Principal Investigator), International Care Ethics Observatory, University of Surrey

Dr Susanne Gibson (Project Research Fellow)

Dr Michael Dunn (Co-Applicant), The Ethox Centre, University of Oxford

Dr Kathy Curtis (Co-Applicant), University of Surrey


Advisory Group

Professor Lesley Baillie, London South Bank University

Mr Ashley Brooks, National Patient Champion

Ms Olivia Corrie, Front Line Communication

Mrs Jane Leng, Senior Teaching Fellow, University of Surrey

Dr Julie McGarry, University of Nottingham

Mr Alan Parker, Service User Panel member, University of Surrey

Ms Sheena Wyllie, Barchester Healthcare


This project was funded by the Burdett Trust for Nursing


The Toolkit was transformed to an online version by Colin Loughlin and Andrew Stokoe, University of Surrey.

© University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom. +44 (0)1483 300800
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© 2015 University of Surrey     +44 (0)1483 300800     Email: nursing-ethics@surrey.ac.uk