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Clinical Care

Hospital gowns leave patients feeling open and vulnerable – their time is up

Being escorted in this attire, often through public areas of a hospital, pretty much completes the humiliation.

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Most of us feel vulnerable when hospitalised, and being told to strip off and put on a pre-worn, revealing, backless gown does nothing to improve matters. Being escorted in this attire, often through public areas of a hospital, pretty much completes the humiliation.

What you wear affects how you feel about yourself. Studies suggest that clothing affects self-esteem, and getting dressed is a process of self-expression. What you wear informs others of your social standing, your ambitions, emotions, motivations and even your employment status.

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So what role does clothing play when you find yourself in a vulnerable situation, such as in a hospital, awaiting medical treatment? If you are what you wear, what impact does wearing a backless hospital gown have on how you perceive yourself and how others perceive you?

Do we really need to bare all?

Arguably, there are advantages to hospital gowns. They are functional, allow doctors to gain easy access to the patient to conduct a physical examination. They are also cheap and easy to clean. But researchers in Finland have argued that wearing a hospital gown is often unnecessary and can even be traumatic for some patients. A recent study found that patients are often asked to wear hospital gowns even when there is no medical reason for them to do so.

Although research on this topic is scant, the limited findings so far suggest that the hospital gown is undignified and adds to a sense of disempowerment and vulnerability. And this is made worse by the professional, authoritarian, white coat worn by doctors, which can further increase the power imbalance.

The healthcare hierarchy often plays out in the power dynamic between the patient and medical staff. Despite efforts to empower patients with so-called patient-centered care, the institutionalised acceptance of the hospital gown persists.

It is important to challenge these sorts of cultural norms as dehumanising aspects of care can increase a patient’s risk of further episodes of hospitalisation. Loss of control, loss of the power to make decisions and loss of autonomy may increase a patient’s vulnerability to psychological distress which could have a negative effect on well-being and recovery. As such, patients need to be given a say in hospital clothing, with more humanising and dignified options explored, for example, limiting the use of hospital gowns to when they are needed for medical reasons, allowing patients to wear their own clothes when possible (especially when they are in public areas) and by redesigning gowns so they are less revealing and more dignified.

To better understand these issues we are engaged in a collaborative research project that aims to explore people’s experience of wearing hospital gowns. By drawing on their experiences, we hope to better understand how hospital gowns affect their identity, well-being and recovery, with the aim of influencing change to policy and practice in hospitals.

Clothes serve more than function. Rather than having to bare all, let a little dignity, choice and humility be at the forefront of our thinking about hospital clothing.

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Learning Disabilities

Mental health and learning disability services are deteriorating, says CQC

Growing pressure on services alongside chronic staffing issues risk creating a ‘perfect storm’ for patients.

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Nearly one in ten acute mental health and learning disability services are now rated as ‘inadequate’.

The quality of care provided by mental health and learning disability services has deteriorated in past last year, a report by the Care Quality Commission (CQC) has warned.

In the CQC’s annual assessment of the state of health and social care in England, the regulator warns that growing pressures on services alongside chronic staffing issues risk creating a ‘perfect storm’ for patients using mental health and learning disability services.

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The report reveals that 10% of learning disability inpatient services and 8% of acute mental health units and psychiatric intensive care units are now rated as ‘inadequate’, compared with just 1% and 2% respectively last year.

Fourteen independent mental health hospitals were placed into special measures since last October and three were closed permanently.

The number of child and adolescent mental health inpatient services rated inadequate has also risen to 8%, up on just 3% last year.

‘A perfect storm’.

Ian Trenholm, Chief Executive of the Care Quality Commission (CQC) said: “In this year’s State of Care, we have highlighted mental health and learning disability inpatient services because that’s where we are starting to see an impact on quality – and on people.

“There has been a deterioration in ratings in these services – and our inspection reports highlight staff shortages, or care delivered by staff who aren’t trained or supported to look after people with complex needs, as a reason for this.

“Increased demand combined with challenges around workforce and access risk creating a perfect storm – meaning people who need support from mental health, learning disability or autism services may receive poor care, have to wait until they are at crisis point to get the help they need, be detained in unsuitable services far from home, or be unable to access care at all.

‘Immediate and firm action is needed’.

Commenting on the report, Patricia Marquis, Director for RCN England, said:  “With this report, the official inspectors are putting England’s nursing shortage front and centre as a key reason for poor care – no area of care appears safe from the engulfing workforce crisis. Now that their concern is on record, it leaves Ministers with nowhere to turn – they must take immediate and firm action to address the 40,000 unfilled nurse jobs.

“The CQC is painting a picture of too many nurses reaching burnout or breaking point with patients paying the price. In A&E in particular, nursing staff and their colleagues are left trying to treat patients as best they can in a system without enough capacity or boots on the ground.

“The independent inspection body backs calls made by the RCN and others for a coherent workforce plan and also puts on record its view that the removal of the bursary for nursing students led to a decline in people able to train. Now that it has been recognised here, the Government must act to put at least £1 billion extra per year into nursing education if it hopes to recover lost ground and fill these vital jobs.”

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Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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