Implications of wearing the hospital gown on mental health, practice and policy

The importance of personalised and dignified care is increasingly being recognised in healthcare policy and practice. While the impact of clothing on social identity is well established few studies have considered the impact of hospital clothing on patient wellbeing. Despite recent drives to empower patients with person centred health care provisions, the institutionalised acceptance of the hospital gown persists. Research has yet to explore the impact of wearing the hospital gown on patients’ health, wellbeing and recovery. A mixed-methods approach, comprising two studies, was carried out to consider the impact of the hospital gown on wellbeing 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 congenital heart disease, a lifelong medical condition, which were audio-recorded, transcribed and thematic analysis was used to identify themes from the qualitative data. The second study was a cross-sectional, online survey exploring adults’ views (n = 928) and experiences of wearing the hospital gown. Qualitative analysis identified the following master themes: (1) loss of ‘healthy’ identity, (2) symbolic embodiment of the ‘sick’ role, (3) relinquishing control to medical professionals, and (4) vulnerability, disempowerment and embarrassment. Quantitative analysis of the online survey data indicated that 60% of adults reported wearing the hospital gown despite uncertainty that it was a medical necessity. Its design was considered to be not fit for purpose, with 65% of adults reporting that they struggled to put it on and/or required assistance and 70% reported that they did not think that the gown fitted them. Adults reported feeling exposed (72%), self-conscious (60%), vulnerable (58%), uncomfortable (57%) and cold (43%) while wearing the hospital gown; essentially lacking in dignity. The implications of these findings for public health policy and practice are discussed, emphasising the importance of challenging cultural norms in healthcare since de-humanising aspects of care, as symbolically represented by the hospital gown, may adversely impact on wellbeing and recovery and increase patient distress and sense of exposure. Alternatives to the hospital gown are discussed. This work is considered as part of a wider effort to promote psychologically informed medicine.