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Practice comment

‘A patient’s normality should be respected, not forced to change’

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Not every hospitalised patient wants to get dressed every day, which does not necessarily mean they are deconditioned and languishing in bed, says Liz Lees-Deutsch

Recently my mum was admitted to hospital; she was acutely ill. On my first visit I found her dressed in a hospital gown, protesting that the strings were “throttling her”. I asked a nurse if they had any nightdresses and was told “you need to bring her own”. I had travelled 165 miles from my home and was exhausted; I was also tense and worried about Mum. I didn’t have keys to get into her house – which was, in itself, another 80-mile round trip from the hospital. I explained that Mum doesn’t wear nightdresses at home, only pants and a vest in bed and pyjamas around the house. No nightdress was supplied. This was the beginning of a rather fractious relationship about person-centred care.

During those first few days I visited three times. Mum was hallucinating and very frightened. She remained in bed, in a hospital gown, despite my having taken her pants, vest, pyjamas and clothes. After a full week she had improved significantly, was sat out of bed, fully dressed and complaining bitterly about being “all dressed up, with nowhere to go”.

She described the “regime” of staff getting her out of bed at 6.30am, getting her washed and dressed, then making the bed. She was incensed. She could not understand why she was being dressed, when she doesn’t get dressed at home. I suggested she tell the nurses, which she assured me she did, to no avail. I received daily telephone calls, in which my mum told me they were “torturing” her and she wanted to get out. I was both distressed and entertained by her forceful protestations and, eventually, her refusal to conform to what she called “institutionalised care for senile people”.

I realise I run the risk of upsetting die-hard, anti-pyjama campaigners but I understand Mum’s annoyance and empathise with her. You see, she wears pyjamas all day, not nightdresses or clothes, as she finds it too much of a bother to get dressed. In the hospital she was up and about, adhering to her physiotherapy and making good progress. She was not deconditioned and languishing in bed all day, as the term ‘pyjama paralysis’ implies. I shared stories of her frustrations with family, who shared their stories about neighbours seen in the local shop with a coat slipped over their pyjamas. For some, pyjamas are a creature comfort and represent normality.

Replicating normality in a hospital setting is difficult; I had taken in a clock, calendar, pen and paper, newspaper and mobile phone. I tried to help Mum stay orientated, in touch, to retain a sense of her normality. I informed her friends, who visited her daily. Getting up and out of bed reduces deconditioning, as does good physiotherapy and encouragement from friends and nurses. Mum had both but still felt she was “all dressed up with nowhere to go”. There was no dayroom, no chair by her bed (most days), nowhere even to store her clothes or laundry.

I am keen that we don’t misinterpret ‘pyjama paralysis’ in an acute ward setting. Person-centred care is getting to know a patient’s preferences and how they live; my mum’s care was approached according to normative expectations – the general rules and expectations of a group of people or society, in this case, inpatients in a hospital ward context. Patients who deviate from expected norms are sometimes identified as difficult. I suspect, sadly, that my mum was placed in this category.

On day 14, my mum was discharged. She phoned me, euphoric: “I’ve won”, she said: “They are going to discharge me in my pyjamas”.

Liz Lees-Deutsch is consultant nurse, acute medicine, Heartlands Hospital, Birmingham.

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Readers' comments (1)

  • I was in the same position as the lady mentioned above. A problem arose when during a doctors round, I was told off for taking a bit of time to get addressed to be examined ... and then expected to get dressed again.

    As there bare no longer 'day rooms' and no place to go, having to sit by your bed was the only option, so why bother to get dressed?

    When you have dressings that need changing, routine checks e.g. blood pressure that requires a bare arm, drains and drips that can be a bit uncomfortable, one has to question you need to to get dressed.

    The chairs beside beds are very uncomfortable so with modern adjustable beds, it is more comfortable to sit on the bed in a upright position, a choice i would always make.
    Hospitals need to make 'day rooms' available, even if that is off the ward, perhaps linked by intercom so if doctors need to see patient, they could be called.

    I found the lack of washing cubicles a real issue, with visitors allowed on the ward from 7 a.m. (in my local hospital at Southend University Trust). Who wants to wake up bedraggled then have to collect bowls of water to wash at the bedside with members of the public present?

    Whilst nursing may be trying make changes that suit them, I resented being called 'Sweet Pea' by staff when my name was above my bed. Why do nurses feel if someone is older, they can be given these types of derogatory labels?

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