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What we choose to wear is part of our identity

  • 9 Comments

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.

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.

  • 9 Comments

Readers' comments (9)

  • I work in a care home and have worked in elderly care for many years, it has been a long long time since the “communal clothes” cupboard was abolished! How undignified to wear someone else’s clothes! I can’t believe that this could still be happening today!

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  • How well I remember the grotty bathroom, with rails of clothes suspended from the ceiling for patients to wear. However they were used by the patients who didn’t have their own clothes, or I presume, someone to take them home and wash the clothes because I don’t remember having a washing machine or dryer or on the ward. This led to the degrading situation on a Day trip (to Rhyl!) where a chubby middle-aged lady was walking along while the ill-fitting crimpoline dress kept riding up at the back. One of us student nurses had to walk behind her reaching forward every few minutes to wriggle it down again. I had hoped these days were long past. Another degrading practice at the time was that outpatients would come to the ward for ECT. This was done in the patients’ own clothes, which would become soaked in urine when the patient convulsed, and the patients were dispatched home in that state. Please tell me that those unfortunate patients still treated with ECT are taken to a proper clinical room and changed into a gown, then assisted to wash and get dressed if still groggy after the treatment. As someone who has since received Nature’s own ECT (tonic/clonic seizures) I know how embarrassing and uncomfortable it can be having to ride home, sitting on a plastic bag.

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  • This is definitely still happening today. I know of someone, a widow in her late 60s, who was in hospital because of a broken leg. Her only family live a hundred miles away, and she has few close friends where she lives. She was not allowed to return home because she lived alone and was forced to stay in hospital for many weeks. The only clothes of her own that she had with her were those she was wearing when she broke her leg - her pyjamas and her dressing gown.

    She was given a shirt and a pair of trousers from a 'communal' cupboard to wear. The no-doubt well-intentioned care assistant told her they were clothes left behind by some patients when they were discharged. The clothes stank, and at the first opportunity, she removed them and deposited them in one of the bathrooms. She worked out that the clothes 'left behind' were most likely those left behind because the patients had died.

    She said it was the most humiliating experience of her life.

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  • Really this still goes on! Surly inspectors would have spotted this in any offending hospital. Every chief executive needs to get immediate assurances that such practices don't happen in their hospital.

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  • I had to re-read this to make sure I had got it right. This just shows how a hashtag policy becomes the very opposite of what is intended. Agree with Blair that CEOs need to get immediate assurances that this is not happening in their Trust.

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  • Excellent reflection and mirrors exactly my experience as a student nurse in mental health in the mid 70's.
    One question, did transition to Care in the Community result in an improvement in care?

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  • I completely agree that the historical practice of dressing patients in reused clothes (clean or not), where patients were not offered a choice was awful and did nothing to promote patient dignity.
    A number of organisations, including my own, do now have stores of donated clothes that patients can use if they choose to (many would rather wear these clothes than sit in Hospital nightwear or gowns).
    In my own hospital patients are not forced to wear these items, but are merely offered a choice to wear clothes when they do not have anyone to bring their own in. These clothes then become the property of that patient and can be kept by them or disposed of - we do not reuse them. The feedback from patients, and their families, has been overwhelmingly positive.
    I think it is important to stress that there is a vast difference between what many organisations are striving to achieve now which in no way reflects practice from the 70s - patients are not forced to wear these items as they would have been (or certainly shouldn't be).
    At NUH we do not have any measures or targets with regards to numbers of patients getting dressed - we just want to offer patients a choice.

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  • I remember in 1981 this was the case in the mental hospital I stated training at in January that year, by 1982 every patient had their own clothes with name tags in them, and they all got their own clothes when they were dressed. As the old system of care for the mentally ill was discarded for (no) care in the community long ago I'm not sure of the validity of this article.

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  • KC1 DECEMBER, 2017 11:54 AM

    Excellent reflection and mirrors exactly my experience as a student nurse in mental health in the mid 70's.
    One question, did transition to Care in the Community result in an improvement in care?

    No unfortunately. Another money saving exercise dressed up as "progress"

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