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'#EndPJparalysis is not about forcing patients out of bed'

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I was sad to see the Daily Mail claiming that patients in a London hospital are being banned from wearing pyjamas in daylight hours, and that their families are required to bring in clean clothes every day, says Ann Marie Riley.

Ann-Marie Riley

Ann-Marie Riley

In fact, patients are being encouraged to get out of bed if well enough, to dress and move around as much as they are able, as part of the #EndPJParalysis campaign.

#EndPJparalysis is not about forcing patients out of bed – it aims to prevent avoidable deterioration in their long-term health.

The negative effects of immobility are well known, yet evidence continues to highlight that when people are in hospital they don’t move around as much as they could, and don’t maintain their ability to carry out their activities of daily living.

For some this can mean they are unable to return to the life they had in their own home, and have to go into residential care.

#EndPJParalysis started as a simple idea to keep people as well and as active as we can while they are in hospital. Those closest to patient care delivery in my hospital have shown ambition, drive and innovation in seeking ways to prevent patients’ deconditioning while they are in hospital. 

“Ward and department staff have initiated and led them because they wanted to improve care and outcomes”

Strategies have included ensuring stocks of clothes are available; encouraging patients to sit together to eat and socialise; revamping a garden area; and looking at new ways to care for those at high risk of falls. The initiative goes well above traditional bay nursing and ensures rich therapeutic intervention.

None of these ideas were top-down directives, none were project managed and none were performance managed. Ward and department staff have initiated and led them because they wanted to improve care and outcomes.

Those closest to care delivery know what works for their patients and their team – as leaders we need to create an environment where staff feel empowered to genuinely lead change, where teams are listened to and supported to create change quickly without red tape when needed.

Social media is full of similar stories – improvements led by staff across the NHS with multidisciplinary teams working together to improve care. Staff who are proud of their initiatives and are eager to share their resources and work in a way I haven’t seen before.

“News stories linking this initiative to any broader bed crisis are wrong”

Early signs of harm reduction and a shorter length of stay are encouraging but this initiative does not pretend to be the panacea to the organisational pressures across the NHS.

News stories linking this initiative to any broader bed crisis are wrong – the underpinning operational and resource issues are far too complex. This is just about trying to do what we can to ensure patients don’t leave hospital less able than when they entered it.

At the centre of all of this work are our patients and we must never forget that all we are doing is offering information and choice to them, not enforcing them to do anything they are uncomfortable with.

If this initiative becomes a target-driven, tick-box exercise that fails to centre actions around what a patient wants, then the whole point has been missed. Likewise we need to consider mechanisms that support staff when they are not able to deliver care to the level that patients want and need.

Ann Marie Riley is deputy chief nurse at Nottingham University Hospitals

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