The aims of 'Dignity in Care' were:

1. To increase and enhance staff knowledge in the understanding of dignity and person centered care, to increase skills in ethical reflection and to share and raise awareness of good practice

2. To facilitate learning into practice across partner regions

3. To explore participants' experience in the sTimul lab and ascertain the effects of the training program on ethical reflection and care in the different regions

4. To develop sustainable practice around dignity and care and encourage continued professional development

5. To identify the feasibility of care ethics training in different contexts through cross-border cooperation

6. To embed ethical care thinking in the quality management system of the participating organisations

7. To enable the further development of the sTimul concept through learning from other regions

8. To establish sustainable Dignity in Care networks



To reach the aims and objectives a project management committee and sub groups comprising of representatives from the 4 partner regions of the INTERREG 2 Seas area was established in September 2011. The project partners, KAHO Sint-Lieven (Lead), sTimul: zorg-ethisch lab, Institut Catholique de Lille, ZorgSaam Zeeuws Vlaanderen, HZ University of Applied Sciences and East Dorset District Council (Partners in Care) worked together to implement the project plans over a period of 3 years to its final conclusion in September 2014.

There were 3 main activities to implement the Dignity in Care project.
Activity 1 was focused on THE STIMUL EXPERIENCE. In this activity cross border partners sent at least 386 participants from their regional stakeholders to the sTimul care-ethics lab in Moorsele (BE) and Terneuzen (NL) to take part in the sTimul experience.
Activity 2 was LEARNING INTO PRACTICE. Participants had the opportunity to share and to put into practice what they learnt during the sTimul experience. The exchanging of experiences and good practice is made possible through 26 regional networking events, 4 cross-border study visits (CBSV) and the virtual communication platform on the Dignity in care website: http://www.dignity-in-care.eu. sTimul participants received a joint certificate as quality label of training in DIC.
Activity 3 was focused on EVALUATION through the International Expert Evaluation Group (IEEG) and regional usergroups. A report with project findings was presented in the final conference and is in the resource pack.

Tangible results are:



• sTimul experience training material in E, F and Dutch, adapted to the regional context and tailored to specific groups

• A sTimul coach and a well instructed regional facilitator and student trainer in the 4 regions

• A total of 386 participants (health and social care students, trainers, professionals and management staff from 75 stakeholder organisations, participating in the sTimul experience and in regional and crossborder events - usergroups in each region

• Questionnaires, collected data, detailed final IEEG evaluation report

• 4 Cross Border Study Visits supporting improvements in the stakeholder organisations

• CBSV for decision makers supporting the feasibility studies in France and the UK

• networking platform for virtual crossborder experience exchanges - at least 2 networking events in each region with stakeholders and sTimul participants

• Guidelines to set up a care-ethics lab in E, F and Dutch

• Joint DIC certificate and a translation into Dutch of Dignity Common Core Principles

• Practical course 'personal leadership' in E and Dutch

• installed sTimul: care-ethics lab in Terneuzen

• Dignity Champion concept and care ambassadors in UK introduced in the cross-border regions

• Training 'attentive conversation' developed by PP4 and guideline avaliable for all partners to use

- Sessions Moral deliberation in NL and clinical ethics in F

- staff mobility agreement between BU, BPC (UK) and UC Odisee (BE) - sustainable networking and collaboration between nursing education UC Odisee (BE), HZ University Applied Sciences (NL) and IFSanté in Lille (F).

- 2 DVD’s sharing the learning which can be used to support training

- snapshots and booklet with testimonies - workbook nutrition and caring for older people

- Digital resource pack on the project website containing project outcomes to support experienced based learning

Groups who are positively effected by the project were professionals in health and social care from different levels and disciplines; students (care-assistant, nursing, medical and nutrition science, physiotherapy, occupational therapy) and also their professional tutors and trainers. They were delivered by stakeholder organisations to participate in the sTimul experience and in regional and cross border events. The data in the evaluation report illustrate that critical reflection and ethical practice was enhanced through participation in the project. Stakeholders and politicians also benefited from this project as it has raised their awareness of the importance of dignity in care in providing quality services when shaping policy using the experiential learning and by sharing best practice in the events and study visits. Organisations have integrate the outcomes of the project in the quality management systems and training curricula.

It applies at organisational and governmental level. Policy makers can change existing procedures/legislation and practice according to the project outcomes.

Professionals in health and social care and education from across the project area and beyond have benefited in the longer term through our conferences, networking events, project website and the DVDs as they can share the learning with their colleagues to improve the quality of services they provide for their service users. Final service users will benefit from improved quality in the services they receive. Beside the overall benefit from the project, all project partners and participating stakeholders became more aware and had a better insight into the value of dignity in care.

The LP gained experience in leading an INTERREG project, broadening and strenghtening their network with stakeholders and in developing further opportunities for crossborder cooperation with Bournemouth university (nutrition science, nursing), Bournemouth&Poole College (nursing) and IfSanté (nursing). The curriculum nursing integrated the focus on 'leadership and value development' from September 2014 and a postgraduate training for professionals and bachelor students in health care focussing on the outcomes of Dignity in Care will be launched in 2015. The benefit for PP2 is a grown understanding about how the sTimul concept and learning can be applied in other care settings. The international network has widened as a result. The benefit for PP3 is that the importance of dignity in care is enhanced in the region, the regional and crossborder network is enlarged and experiential learning in a sTimul care-ethics lab is introduced.

The benefit for PP4 is the fact that sTimul Terneuzen was developed providing sustainable learning for the future. A course on personal leadership was developed as well as moral delibaration sessions and the training 'attentive conversation‘. The benefit for PP5 is that students learned from professionals' reflections and vice versa. The project was seen as very valuable through the accredition and has enhanced the scientific part of the evaluation of the learning process. PP6 has raised awareness and improved the quality of training for dignity in care learning from how care is provided in the partner areas. Students and care workers from Dorset who got a sTimul expereince benefited from this unique training which has been used in their organisations to improve the quality of care they provide and key decision makers have been influenced by the project.

One of the real values is the understanding that dignity transcends borders and that in all countries people are looking for better ways to deliver quality care. By looking at what is happening in other countries we were able to identify and spread best practice. We created a living cross-border network that continues to expand and reaching new people. Throughout the Dignity in Care project the concept of experiential learning has inspired others involved in care. The exchanging of experiences and good practice via cross border and regional networking events raised the profile of dignity in care. Participants said that they learned a lot from seeing completely different ways of working and used examples from others to change things in their own organisations. Recognising that we all face common challenges made us stronger and more convinced of the necessity of combined experiences, sessions and reflection to improve care-ethics.

PP2, PP4, PP6 are involved in the ACDC cluster in which PP4 is Lead partner. LP, PP3 and PP5 are involved in the EDECT cluster. Through this cluster the SYSIASSproject partners will collaborate with Digniyt in Care partners and some members of the Flemish usergroup to address a fundamental issue in designing technology for use by patients and their carers to consider and understand the patients dignity. In addition the LP is representing the DIC project in the North West Europe health cluster. They have completed phase 1 of this project and the second phase was recently approved which will run until June 2015. At the ACDC final conference there was a workshop on the sTimul experience which reached a new group of participants. The project uses the experiential learning from dignity in care with the project 'IC Music‘ to improve the way that musicians engage with vulnerable groups and to promote creative inclusion.

Experiental learning must be implemented carefully as people put themself in the role of a vulnerable/dependant person and it is difficult to predict how they will react emotionally. Simulation as a learning method must be treated with care. Good information and guidance and thorough preparation during the experience and proper reflection is essential. The sTimul coach must be trained and must have knowledge of care ethics. Dignity is a theme that transcends borders and people from many different organisations want to have a voice and valued the contribution they could make to our project. This theme has really sparked enthusiasm and prompted an agenda for change. We shared common principles which cut across beyond cultural differences. Open communication was vital and we all worked together to get our message across. We are pleased that we have been internationally noticed and will keep working hard to improve ways of working.

The sTimul lab in Terneuzen will continue to exist after the end of the project and was established to be long lasting initiatives, continuing to grow and develop as the sTimul concept becomes more well known. Through both the sTimul labs all the knowledge, experience and learning will be disseminated still further, continuing to influence training and daily practice in care. The DVDs, IEEG report, guidelines to set up a care-ethics lab in E, F and Dutch, guideline for the course 'personal leadership' and 'attentive conversation' can be downloaded from the resource pack on the project webiste that will remain after the end of the project so the learning can continue to be used after the project is no longer running. In the UK it is hoped that the considerable interest that the project has generated may lead to a UK sTimul being developed. Findings of the project are integrated in the nursing curriculum in Flanders and Vlissingen

A network of dignity champions using the learning from the project which will continue after the end of the project. Networks that have been set up, such as the long lasting cooperation between ZorgSaam (PP4) and HZ University for Applied Sciences (PP5), also with UC Odisee (HUB-KAHO) and Bournemouth University and Bournemouth and Poole College (through Partners in Care) which have developed strong cross border working relationships to experience the differences in education and learning around nutrition and social care. They set up staff and student mobility agreements. In the departments Food and Nutrition Sciences a first cross border staff exchange was done in November-December2014. Further cross border exchange and visits are planned by UC Odisee and IF Santé (F) who is stakeholder organisation from UCLIlle (PP3). From AY 2014-2015 the Flemish usergroup is involved in the curriculum of the bachelor students nursing in UC Odisee.

The partnership in itself will not continue, but some partners will work further in cluster projects and will look for opportunities to develop new projects. All partners will continue to work on raising the awarness of dignity in care. Universities and care ambassadors are sharing and working in new projects such as LabCap, AAL, E-Health, Assisted Living, ACDC and EDECT.

PP2, PP4, PP6 are involved in the ACDC cluster in which PP4 is Lead partner. LP, PP3 and PP5 are involved in the EDECT cluster. Through this cluster the SYSIASSproject partners will collaborate with Digniyt in Care partners and some members of the Flemish usergroup to address a fundamental issue in designing technology for use by patients and their carers to consider and understand the patients dignity. In addition the LP is representing the DIC project in the North West Europe health cluster. They have completed phase 1 of this project and the second phase was recently approved which will run until June 2015. At the ACDC final conference there was a workshop on the sTimul experience which reached a new group of participants. The project uses the experiential learning from dignity in care with the project 'IC Music‘ to improve the way that musicians engage with vulnerable groups and to promote creative inclusion.

The projcet website that was developed in UC Odisee (HUB-KAHO) will remain for at least 5 years after the project ends. The content information of the INTERREG 2 Seas project Dignity in Care, as well as the results and outcomes, contact addresses and links will be available in a digital Resource Pack and can be downloaded form every where.