Why do hospitals make you wear gowns

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.

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.

Objectives The importance of personalized and dignified care is increasingly being recognized in health care policy and practice. Despite the known impact of clothing on social identity and self-expression, the impact of hospital clothing on patient well-being has been widely overlooked. Patients are often required to wear hospital clothing, commonly a backless gown, during medical procedures and surgeries. The impact of wearing patient clothing on well-being, during this time of vulnerability, was explored. Design A sequential multi-method approach consisting of two studies. Methods Two studies were carried out to consider the impact of the hospital gown on well-being among adults with and without chronic health conditions. The first study consisted of conducting in-depth, semi-structured interviews (n = 10) with adults living with a lifelong chronic health condition (congenital heart disease). The second study was a cross-sectional online survey exploring adults' views (n = 928) and experiences of wearing the hospital gown. Results Qualitative analysis identified the following master themes: (1) symbolic embodiment of the 'sick' role, (2) relinquishing control to medical professionals, and (3) emotional and physical vulnerability. Quantitative analysis of the online survey data indicated that adults often reported wearing the hospital gown despite a lack of medical necessity. Its design was considered to be not fit for purpose and lacking in dignity. Conclusions The implications of these findings for health policy and practice are discussed, emphasizing the importance of challenging cultural norms in health care since dehumanizing aspects of care, as symbolically represented by the hospital gown, may adversely impact on patient well-being. Statement of contribution What is already known Getting dressed is a form of self-expression, which contributes to the construction of social identity, yet few studies have explored the impact of wearing hospital clothing on patient well-being. The few studies on hospital clothing that exist suggest it is predominantly associated with feeling depersonalized, stigmatized, and devitalized, being in the 'patient role', low status, and a lack of control and privacy. However, previous studies include a variety of hospital clothing including pyjamas (Edvardsson, 2009) and dressing gowns (Topo & Iltanen-Tähkävuori, 2010), whereas in the United Kingdom, a 'one-size-fits-all' backless gown, held together with ties at the back, is most commonly used. What this study adds This study furthers understanding about the lived experience of wearing hospital clothing for people living with a chronic health condition (congenital heart disease) and without. Wearing hospital clothing (most commonly the hospital gown) was associated with symbolic embodiment of the 'sick' role, relinquishing control to medical professionals, and emotional and physical vulnerability for people living with a chronic health condition. Findings from a wider sample, drawn from the general population, suggest that the hospital gown is often being used despite a lack of medical necessity often leaving patients feeling exposed, self-conscious, vulnerable, uncomfortable, cold, embarrassed, and disempowered. These findings are exacerbated for people living with a long-term health condition and women. Together, these studies suggest that the current design of the hospital gown is not fit for purpose and impacts negatively on patient well-being.

Keywords: congenital heart disease; hospital clothing; hospital gown; patient experience; person-centred approach; psychologically informed medicine; surgery.

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