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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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  • I dont understand why this is an issue and why the DOH has even thought we need new guidelines when is has been felt that 'bare below the elbow' policy should be good pratice. We are told that in Britain we have excellent standards of patient care delivery and the British trained nurses are highly thought of. Why should patient care and safety be compromised because of Political Correctness in this country again taking over good practice. I thought that we as nurses should not allow our Political beliefs, Social/Economic status, Relgious belielfs etc compromise patient care delivery and should not prevent us from undertaking any nursing intervention. I agree with others and Im sorry to say that people from all relgious faiths should be made aware of this before they enter the profession and if their beliefs do compromise excellent standards of patient care delivery then surely they should not be taking jobs as nurses in the UK.

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  • Bare below the elbow has been in place for time immemorial. It is an infection control strategy.
    Anyone entering the nursing profession should adhere to this ruling.
    I am sick and tired of reading about certain religions objecting to various uniform constraints.
    If you do not wish to protect the patients,whom come within your care then you have one option....get out of nursing.
    I hope the DOH has the back bone to not go down this stupid "political correctness" road. Leave uniform protocol to the professionals who will make the right decisions for the right reasons, ie staff and patient wellbeing....

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  • i agree with many of the above comments protocols rules what ever you decide to call them are there for a reason in this case infection control
    in case any one meaning those who decided to change the rules that means the prevention of infection !!!!!!
    what will they be looking at next i wonder its aptsol;utely crazy dont like the rules dont join the profession easy as that
    i would not dream of going to a muslim countyry or any other country and not abiding by the rules but here do as you please england apparantly any thing goes
    and i for one am sick of it !!!!!!!!!!!!!!!!

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  • Once again, I read with total disdain that the Department of Health are allowing standards to be breached and policy waivered, and all of this is done in the name of religion!! It is political correctness gone stark raving mad and I for one am not happy that my profession and the high standards which I have upheld throughout my entire nursing career are being constantly eroded by the bureaucrats with nothing better to do but pander to the minority. The religion or faith of the nurse or other health care personnel delivering care should not be allowed to impact or dictate essential standards of infection control and subsequent safe care delivery. I agree with other comments which have been made relating to the nursing profession. Prior to undertaking such a profession, people must have some awareness of what will be involved in delivering direct care and the associated issues involved. If they are not happy with that, I suggest that alternative employment is sought elsewhere commensurate to their religious beliefs and tenets. However, there is one question I would like to ask in all of this - has anybody considered the needs and impact of such a decision on the service-user, the most important person who should be placed squarely in the centre of this furore? Alas, it would appear not!

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  • doesn't patient safety and best care come before anything else?
    We should all abide by NMC code and protect our patients from harm.Religious beliefs should not be a factor if it reduces patient safety and best practice.

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  • Is this an April fool?

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  • I was always led to believe the patient comes first. I work with immunosupressed patients and they would be very offended if someone looking after them refused to roll up their sleeves or use alcohol gel. So the DH have just offended another group. Totally silly. This is supposed to be a secular society .Wouldn't happen in France.

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  • I guess part of the debate of is there any evidence it causes infection transfer is what kind of contact do you have with patients or people? If the job risks being up to your elbows in amniotic fluid of malaena then you're going to spend the rest of the shift a tad soggy, and bare below the elbows seems only sensible.
    I'm intrigued what not-bare-below-the -elbows personal care would look like as my experience in muslim countries has been bare below the elbow or short sleeved uniforms.

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  • Latterlife Midwife

    http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_114751

    Read it yourself. Bear hands and forearms are still required while carrying out direct patient care, unless disposable sleeve covers are used. Provision is allowed for covering the arms at other times. This makes sense to me as there have been times I've felt cold at work when away from the bedside, and had the feeling I couldn't put on a cardie or whatever. So now I can use my judgement because the DofH says it's okay to have arms covered between direct patient care times?

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  • Latterlife Midwife

    http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_114751

    Read it yourself. Bear hands and forearms are still required while carrying out direct patient care, unless disposable sleeve covers are used. Provision is allowed for covering the arms at other times. This makes sense to me as there have been times I've felt cold at work when away from the bedside, and had the feeling I couldn't put on a cardie or whatever. So now I can use my judgement because the DofH says it's okay to have arms covered between direct patient care times?

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