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Fresh guidance on 'bare below the elbow'


The Department of Health has amended its guidance on uniforms and workwear to address concerns that Muslim clinicians and students were discriminated against by the adoption of a blanket “bare below the elbows” policy.

The DH has been told that some Muslim women had even felt driven to leave their posts after being told they must be wear short sleeved tops at all times – even when not carrying out direct patient care.

In revised best practice guidance and an accompanying impact assessment published last week the DH said those difficulties had partly been created by too wide a definition of “direct patient care”, which it has now narrowed and clarified.

The guidance also says that three-quarter length sleeves can be worn in place of short sleeves but they must not be loose and should be capable of being rolled back. It says disposable elasticated over-sleeves are also acceptable, but must be put on and thrown away in the same way as disposable gloves and must be accompanied by strict hand and wrist washing.

The guidance, which draws on advice from Islamic scholars, also says the synthetic alcohol used in hospital gels does not fall under the Muslim prohibition again natural alcohol from fermented fruit or grain.


Readers' comments (35)

  • I await further details on the redefinition of direct patient carebut I really hope that this is not some PC rubbish which will endanger patients. I trust too that the wearing of a cross will be evaluated against this [and I am an agnostic not a born-again!]

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  • Uniform policy should apply to all staff members.

    If it is in the interests of H&S or infection control then there should be no allowance for religion.

    It is not discrimination if certain members of staff can't remain in post because of religious beliefs. It is descrimination if certain religions are pandered for over others.

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  • The issue isn't about risk, but about overzealous implementation of dubious guidelines.

    Why must community mental health nurses be bare below the elbow? I have found no evidence that nurses in this situation pose any risk to patients (in fact they are more likely to suffer ill health themselves from the environments some of them are forced to visit) and yet PCT's around the country are insisting that because they have "patient contact" they must comply.

    You will note from the article that those Muslim women were talking about areas outside of direct patient contact. It makes sense that the "bare below the elbows" rule is applied to areas of appropriate patient contact and I'm sure if their religious beliefs are in conflict with good clinicial evidence then they would choose to change jobs (they probably would never have embarked on a direct patient-care healthcare career if they felt they could not carry out their religious duty). However, where there is no reasonable evidence that the "bare skin" rule is clinically beneficial why should they, or anyone else be forced.

    Once again it's simpler to introduce a blanket "you shalt not..." rather than think it through, introduce a sensible approach, and monitor it. The real issue is that people are unwilling to challenge individuals and tackle those acting in an unprofessional, high risk, way on a face-to-face basis.

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  • I agree to the change that we should only bare below elbow when giving direct patient care. As a muslim I have been wearing 3 quater sleeves while on my palcements and I have always roll them back and wash my hands every time I gave direct patient care with no problems. unfortunatelty due to the uniform policy I had no choice but to comply. Anyway, if there is no evidence that this can harm patients then it shouln't be compulsary to bare beleo elbow

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  • I feel that we have a universal uiniform which is policy that it is woren in the agreed manner which is noted at the beginning of the training as is the jewellery policy so when in the job why complain about something that has been policy for years

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  • England is a secular state I believe. So what all these consulting Islamic scholars and what not.

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  • I also do not understand what all the fuss is about if people want to go into a profession like nursing they have to abide by the same rules like everyone else. They are fully aware of the below elbow practice before they starting training. With all the infection we have on our wards today I strongly disagree with nurses dealing with patient's wearing long shelves.Nurse's doing sterile procedures and they have to roll up their shelves. As nurses our main function is to care for patients and not practice religion. The powers that be need to open their eyes and stop allowing different groups dictate what they want to wear.

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  • Yet again Nurses and Nursing is pandering to petty rules, this time religion. You know the rules before entering the profession, if it doesn't suit you on whatever grounds, including religion, then damn well find another job to do!

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  • When is a policy not a policy? When it involves religion. One one hand Muslims refuse to be Bare below the Elbows and then the Christian woman has to leave the job she has done for 30years wearing a crucifix around her neck.... Which of the 2 is reviewed.. you're right...

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  • Who cares , not much point in a uniform policy when staff dont decontaminate equipment between patient use = spreading of infection!

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