Several studies have found that hospital gowns or nightclothes put privacy of the body at risk as they are ill-fitting and expose the back (Baillie 2007; Baillie et al. 2008; Bauer, 1994; Matiti, 2002; Matiti and Sharman, 1999;; Walsh and Kowanko, 2002; Woogara, 2005). In addition, Matiti (2002) identified that as gowns are done up at the back they render patients helpless
In Baillie’s (2007) study, several male patients commented that operation gowns allowed bodily exposure. These were worn by patients during surgery and immediately post-operatively and then a nightshirt was offered which still had an opening at the back. The rationale for not wearing pyjama trousers was that male patients inevitably had urethral catheters, which must drain freely and needed to be easily checked by staff. Some patients perceived that these garments caused a loss of dignity because of the associated bodily exposure. For example one patient said that he did not like wearing an operation gown as it was 'indecent'.
Some extracts from interviews with patients:
'How dignity's compromised is these gowns you wear are wide open at the back aren't they? I mean I noticed a man who was a good friend of mine in the next bed - every time he stood up and looked out of the window you could see all his back wide open - which is not the prettiest scene in the world …I'm only thinking about when I do it - that's my dignity'.
‘if you were going anywhere you had to chuck your dressing gown over the top a bit quick because otherwise your bum was hanging out the back. And everybody said the same. The guy in the next bed - he was quite a big bloke - and they had a job to find one to fit him. And they couldn't even get the tapes done up on that... I mean that was one of the worst bits, to be absolutely honest - that was one bit where you hadn't got any dignity cos you just couldn't do anything about it'.
It was noticed in Baillie’s (2007) study) that patients wearing hospital gowns and nightshirts seemed ingrained as a ward 'norm' and only two staff members identified them as a threat to dignity. There was no obvious insight into the levels of discomfort experienced by some patients. One male patient referred to the gown as embarrassing and like a ‘frock’ and it seemed that as well as leading to a risk of exposure, he also considered them a problem as they were not what men usually wear: 'I'm not used to a frock! Women are'. This patient was particularly concerned about exposure when visitors were present:
‘I had visitors there when this poor old chap opposite was walking around moving up his gown - so there he's all exposed - there's my son and his wife. You feel a bit embarrassed for that'.
Baillie (2007) recommended that design of operation gowns should be reconsidered, arguing that it must be possible to reduce the accompanying bodily exposure. To reduce threats to dignity in hospital, bodily exposure should be avoided which will require challenging practices such as traditional hospital gowns and searching for other creative solutions. In a large survey of the UK nursing workforce in 2008, nurses identified gowns as a dignity issue, particularly as they were invariably ill-fitting or in bad repair (Baillie et al. 2008).
Reed (2011) reports on research that investigated dignity of children in hospital. She includes an example of a 14 year old boy with cystic fibrosis who was regularly admitted with acute infections and who felt ‘ridiculous’ in a hospital gown. Reed (2011) expands that hospital gowns are particularly disliked by boys who view them as dresses and therefore embarrassing, a situation compounded when they have to leave the ward in their gown to visit other areas of the hospital.
Baillie, L. (2007) Patient dignity in an acute hospital setting. Unpublished thesis. London South Bank University, Baillie, L., Gallagher, A., Wainwright, P. (2008) Defending dignity: challenges and opportunities. London: Royal College of Nursing. Bauer, I. (1994) Patients' privacy: an exploratory study of patients' perception of their privacy in a German acute care hospital. Aldershot: Avebury. Matiti, M. R. (2002) Patient dignity in nursing: a phenomenological study. Unpublished thesis. University of Huddersfield School of Education and Professional Development. Matiti, M.R. and Sharman, J. (1999) Dignity: a study of preoperative patients. Nursing Standard. 14(13), pp.32-35. Reed, P. (2011) Dignity for children. In: Matiti, MR and Baillie, L (Eds) Dignity in Healthcare: a practical approach for nurses and midwives. London: Radcliffe Publishing, pp 81-94. Walsh, K. and Kowanko, I. (2002) Nurses’ and patients’ perceptions of dignity. International Journal of Nursing Practice. 8(3), pp.143-151. Woogara, J. (2005) Patients' Privacy of the Person and Human Rights. Nursing Ethics. 12(3), pp.273-287.
Dignity Giving Gowns & Suits would like to thank Professor Lesley Baillie for the inclusion of her research paper
Professor Lesley Baillie is the Florence Nightingale Foundation Chair of Clinical Nursing Practice, School of Health and Social Care, London South Bank University, and University College London Hospitals NHS Foundation Trust, also Director of the Centre for Nurse and Midwife-led Research and Honorary Professor, University College London
A solution to hospital gowns Posted on October 8, 2014
In many discussions about patient experiences in healthcare there are allusions to the loss of dignity that many patients experience when they enter the hospital. Often patients who value their privacy are subjected to extraordinary intrusions which would be intolerable in any other circumstance. Often, because it is such an ordinary part of the hospital experience, we do not see the indignities that occur as a matter of course. The most glaring of these is the hospital gown. Patients’ bodies are only partly covered by a gown that seems to be a mandatory requirement in hospitals almost everywhere. We have forgotten the reasons for it, but assume that gowns are designed to allow doctors and nurses easy access to the patient’s body.
It first occurred to me that this was a privacy issue which is not covered by the current privacy regulations, as it’s currently fixed on keeping medical records away from prying eyes. Many patients believe that at least the same amount of attention that’s paid to safeguarding medical records should be paid to keeping their bodies private. I believe that this is yet another hangover from the early days of scientific medicine when patients gave their bodies over to science once they entered the hospital. This is clearly privacy issue of significance to patients.
Last week journalist Tom Blackwell of the National Post wrote a long and varied feature on the issue and interviewed not only physicians, but also patients and representatives from Patients Canada. The article pointed out that the vast majority of patients had no medical need to be so accessible to doctors or nurses, and it was even suggested that the gowns contributed to health deterioration that led to increased returns to hospital.
Dignity Giving Gowns & Suits would like to thank Sholom Glouberman for the inclusion of his blog
Formed in 2011, Patients Canada (formerly the Patients’ Association of Canada) is a charitable organization that fosters collaboration among patients, family caregivers and the healthcare community. As a network of patients and family caregivers, we believe that working in collaboration with the healthcare system can lead to real, effective change – change that will improve everyone’s experience with healthcare.
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