On my student placement in the 1980s, the first thing I noticed was that everyone was up and dressed in day clothes first thing in the morning. My first impression was how different the ward looked compared to an acute medical ward, and how homely it felt.
However, the illusion of personalised care was quickly shattered when I was introduced to the communal clothing cupboard filled with, among other things, secondhand bras, socks, vests and even pants.
Patients on the ward were not allowed to bring in their own clothes in case they got lost, so each morning I would take a selection of outfits and offer them to my patients. I was well-intentioned and thought I was giving my patients choice but one incident made me question the whole system.
“It is important that the philosophy and guiding principles of this campaign are not lost in the rush for implementation”
One afternoon, one of my patients, Mrs Jones, was sitting in the day room wearing a green dress with white spots.
She began to feel unwell, so we took her back to her bed where her condition rapidly deteriorated, and she died. I remember laying her out and removing the green dress, which was thrown in the skip and sent to the laundry.
A few days later I was horrified to see a lady in the next bay wearing the same dress.
Getting patients up and dressed in hospital is an important part of restoring independence. For many years, nurses specialising in rehabilitation of older people have worked hard to promote the philosophy of person-centred care.
Challenging the use of institutionalised communal clothing has been a part of this process.
The principles of rehabilitation nursing are very much part of a campaign that has recently taken hold on social media and in many organisations around the world with the aim of ending “pyjama paralysis”, as publicised in the #endpjparalysis campaign.
- London hospital adopts two patient-friendly initiatives
- Nurse’s poem highlights value of time to older patients
- Hospital staff don pyjamas to highlight patient campaign
This has motivated many nurses to challenge each other to ensure patients are able to get dressed in their own clothes as part of their steps to recovery.
But it is important that the philosophy and guiding principles of this campaign are not lost in the rush for implementation. I have been worried by news of projects to set up communal clothing systems to ensure people have day clothes to wear in hospital.
“Perhaps the aim is not a target for how many patients are dressed but how many have been given permission and support to get dressed”
In my experience, communal clothing is a marker of institutionalisation and if not managed carefully, could undermine the individuality and dignity of patients and the principles that this amazing campaign is based on.
Take, for example, a patient whom I nursed on a rehabilitation ward some years ago. When Mrs Brown arrived on the ward her notes said that she kept taking her clothes off.
We realised that the clothes she was wearing were provided by the hospital and the problem was solved when her family brought in her own familiar clothes, including her underwear and shoes. In her own clothes - with her own belongings - she regained a sense of own identity.
The #endpjparalysis campaign, which has been championed by nurses at Nottingham University Hospitals, states that there are “no targets, KPIs or project plans – we are trusting staff to use their professional judgement and do the right thing for their patients”.
Perhaps the aim is not a target for how many patients are dressed but how many have been given permission and support to get dressed. It would be interesting to hear how you help promote dignity and independence where you work.