Patients in pyjamas

Patients in pyjamas – it might sound a little flippant, but I think this is something that is very important.

I cannot comment on the behaviours of other patients outside of the UK – we, in Britain, approach hospital attire in a special way; pyjamas.

I don’t know when pyjamas began in hospital – whether back in medieval times when monks were providing hospitality to travellers; perhaps, those arriving would remove their smocks and don sleeping apparel, or whether this is something that was introduced by Florence Nightingale, Mary Seacole and others, or happened in the 1940’s and 50’s with the birth of the NHS.

From whatever perspective, I can understand people wearing pyjamas when they are asleep – that is what they are for, or even, in the morning perhaps when they have just got-up, but why at other times?

If you look at a standard 21st century hospital inpatient population, depending on the type of hospital, most of those people don’t need to spend the whole time in bed; this will vary from specialty to specialty – if you have broken your leg, lying in bed might be essential, although, these days, it is amazing how quickly people are able to walk after a fracture.

Are pyjamas comforting? I think this is part of it; they are also a sign, or a uniform that tells people, ‘We are the patients, care for us.’

Beyond any subliminal messaging, lying in bed can be bad – spending too long in a supine position puts you at risk of developing pneumonia because of your posture, or DVTs because of immobility; for old people in particular, although I suspect for everyone, spending too many hours in bed affects the quality of your sleep at night, making everything worse after dark – pain, noise, discomfort, time.

Amongst my patients, I have come to regard sleep, and sleep pattern with the same importance as nutrition and hydration – (this is helped by the nurses on my ward recording two-hourly sleep observations; something that doesn’t happen anywhere else I know of) – if you are awake all night, this impacts on your quality of life during the day, for example, the extent to which you can participate in therapy or eat. It also means that when you are awake, there is a higher chance of you coming to harm from falling, as there are fewer staff around to support you and… it’s dark.

So this, I propose for the NHS in 2016, let us look at how our patients dress, how they spend their days in our care. It is perhaps too radical for many people to extend the model to getting rid of ‘patients’ altogether (and having, just people), but why not encourage our patients to wear normal clothes during the day? Why not investigate those disused day-areas and encourage people to engage in meaningful activity – whether talking, listening to music, reading a book or watching TV; we could even offer meals away from the bed-sides – around dining-tables.

Ill people do require extra sleep, to help them recover and mend, we, those providing the care to support that recovery have, I believe an obligation to ensure that the sleep our patients experience is effective.

In an ideal world, you might walk on to a hospital ward, look around and wonder where all the patients have gone… ‘Over here,’ one of them shouts! ‘We have reclaimed our rights as people… When is dinner?’