'PJ paralysis': Why advocates are pushing to get patients out of pyjamas

https://www.ctvnews.ca/health/pj-paralysis-why-advocates-are-pushing-to-get-patients-out-of-pyjamas-1.4378824

by walterbell • 7 years ago

85 39 7 years ago

ddingus• 7 years ago

A decade ago, my wife had a very severe colon event. Three very difficult to recover from surgeries.

On each one, she rested a day, maybe two. Gotta do that, or risk tearing and such. No worries. She could feel that. Tested it constantly.

But, once the very dangerous time had passed, she always did the same thing. Get proper clothes on. Top and some shorts or simple skirt. The minimum.

Then she, in her words, "got the fuck up and moving before she gets stuck, trapped in there."

I watched her get half the wing up, some of those people resigned to dying in their beds. The nursing staff were amazed. They told me some of those people had given up too.

I would help, and just stayed out of the way otherwise. Within a few days, she knew everyone, who had kids, whatever. And it was all simple. "Tomorrow, we walk to the ice machine, deal?"

I am convinced there is real value in simple human contact and communication. I have seen what can happen when people connect, share their stories, their pain, and most importantly, their dreams, who they matter to, who needs them.

All of that brings us strength, motivation, the simple realization that it really is not over, that others are there, that we are relevant, matter, is powerful.

We heal, we cope with pain, and we laugh, love, feel, are alive and it matters.

Yeah, get them out. Get them up. Get them people who they can talk to, with.

Treats, that pet they love (I did that a couple times and had to sneak, do it outside or in a common area), whatever helps them see themselves out of there, living life, basically, not done yet, matters a whole lot more than I thought it did.

I know now what I will do, and it is that. Get the fuck up. Just get started.

skookumchuck• 7 years ago

Get the fuck up. Just get started.

Amen. And it applies to all ages (though I often get downvoted for expressing such sentiments).

sitharus• 7 years ago

though I often get downvoted for expressing such sentiments

There is a huge difference between environmental depression, where such advice is definitely positive and will help, and psychological depression where that sort of advice given without consideration to the whole situation can be unhelpful at best and damaging at worst.

silencio• 7 years ago

I honestly feel like hospitals (and other similar facilities) need to be designed to encourage this. Get dressed, and then what? You’re wandering the floor and it’s only long boring corridors and other patients resting.

My dad frequents a newer hospital that has wider sunlit corridors and a nice greenery-filled common area, as well as a lounge-y area on every floor, and it’s a big difference from other hospitals and even short term nursing facilities he’s been in.

I also wonder if the culture of any particular type of care encourages this more than others. Postpartum, many on my floor that gave birth were wearing their own clothing soon afterwards. There’s a whole market for personal gowns for labor and postpartum. And given how terrible breastfeeding is in those maternity gowns, that’s also not a surprise...

danohuiginn• 7 years ago

Supposedly†, smokers recover faster in hospital -- because they're very motivated to stand up and go outside several times a day, as soon as they possibly can.

† i.e. I've repeatedly heard it as folk wisdom, but never looked for statistics

xattt3• 7 years ago

It is difficult to change the environment of a hospital that may have been built 30-40 years, with planning likely taking place in the decade prior, when treatment-for-cure one-size-fits-all type of care was the design objective.

There’s also realities of laundry. Many families often bring in 2 or 3 days of clothes and launder them in between visits. Patients tend to go back into gowns when nursing staff try to find a balance between having family come in frequently (because of laundry soiled by incontinence), versus patients having available clothing to wear the next day for at least part of the day.

On a tangent, consider admissions where next-of-kin live in a rural community and don’t drive due to personal health problems. The determinants of health that likely contributed to the admitting condition are perpetuated in acute care in very subtle ways.

The issue is much more complex than “just don’t wear gowns”. There’s definitely solutions in changing workflows, but this needs the convincing of administrators to provide funding for additional staff.

arkades6• 7 years ago

I honestly feel like hospitals (and other similar facilities) need to be designed to encourage this.

I agree. But hospitals are also ridiculously expensive on a per-sq-foot basis. Outside of very high-end hospitals that can try to make some of that money back from cash patients and very well insured patients, most hospitals simply don't carry the funds for that, even if they wanted to.

Discussions about healthcare are always rich in "hospitals need" or "hospitals should," and people never stop and ask "why don't they?"

The answer is usually "because we don't pay for it." Most of our healthcare dollars don't end up in the hands of hospitals or doctors, though a good chunk go through the hospitals. Most dollars ultimately end up with insurers, device manufacturers, or pharmaceutical companies. What money does go to the hospitals, doesn't go towards the things people say they want.

Unsurprisingly, as with every entrepreneurial discussion on HN, there's a difference between what customers say they want and what they're willing to pay for.

Ntrails• 7 years ago

Most of our healthcare dollars don't end up in the hands of hospitals [..]. Most dollars ultimately end up with insurers, device manufacturers, or pharmaceutical companies.

Do you have some evidence for that? I am pretty dubious that insurers are walking around with more than typical margin.

Also, it seems nebulous when talking about device manufacturers. That money went to the hospital in a very real way.

marcosdumay• 7 years ago

Get dressed, and then what?

Then you go talk with your neighbor.

HNthrow22• 7 years ago

"Supporters said it’s led to a 41 per cent reduction in bed sores, a 30 per cent reduction in falls and patients being discharged from hospital an average 1.8 days sooner."

Those are some wild numbers if that can be backed up with data. Always found hospital gowns dehumanizing and never put them on when given instructions to during yearly physical exams, never had an issue with it it or any doctors asking me to put it on, stringently following procedures and protocols when there's blatant evidence in your face that it's harmful seems a common trend in healthcare, at least in the US, probably for liability reasons.

gumby• 7 years ago

Always found hospital gowns dehumanizing and never put them on when given instructions to during yearly physical exams

They seem especially weird for a physical exam where the doctor is going to look at you anyway. My doctor leaves the room while I undress and put that thing on, then returns and looks at my body! I asked her about that once and she said many people don’t like to sit around naked even if thenpoint of showing up is to be looked at. Must be some weird cultural thing.

walshemj• 7 years ago

I always switched to PJ's instead of gowns - also you don't have your Arese hanging out on view.

And given that I have been in hospital (in the serious wings) a lot of the doctors and nursing staff have always been keen supportive of getting dressed and moving about.

carlmr• 7 years ago

stringently following procedures and protocols when there's blatant evidence in your face that it's harmful

This is the case in every big corporation, bureaucratic processes become entrenched, and people stop questioning them. I think it's the same kind of thinking that leads to problems like Boeing, VW, etc. (nice article here https://danluu.com/wat/).

sonnyblarney2• 7 years ago

Anecdotally, things rings very true with me. I always try my best to 'get out of the hospital as soon as possible'.

And even from working at home ... the concept of 'dressing for the task' makes sense as well. We could wear literally nothing, but dressing for the office helps to put one in the right headspace.

tonyedgecombe• 7 years ago

Yes, when I used to wear a suit for work I never felt I had finished until I changed into something casual.

choonway• 7 years ago

And I always feel my creative juices flowing when I'm in my bathrobes. Maybe it has to do with impending shower thoughts.

emerongi• 7 years ago

On my more recent visit to the hospital I was no longer allowed to bring personal items to the surgery clinic. The nurses said it was the germs, which makes sense, but on my previous visits it was never a problem.

I always switched to my regular clothes as soon as I could. The PJs are just weird. For some reason I have always been the only one wearing my own clothes, everyone else rocks the PJs. Maybe I missed the memo on not being allowed to wear my own clothes, but no one complains either.

anitil• 7 years ago

My (completely uninformed) impression was that the germs _in_ the hospital are probably worse than than the ones as home. Because you probably don't have loads of sick people walking through your house every day.

throwaway149999• 7 years ago

In everyday life (fortunately I never had to be longer in hospital) I can't stand wearing a pyjama after getting out of bed. Not even on weekends or when I have the morning off. Need to get dressed as soon as I get back from the bathroom. Keeping it on for longer than necessary feels like a dissolute lifestyle.

salex89• 7 years ago

I witnessed this many years ago when my grandad was in an eye clinic over three days for continued monitoring and tests for further therapy. He was in a room with a couple of guys, in their beds, in their PJs. If you didn't know it, you would think they were just plain sick. Luckily, they were not, non of their issues was threatening, but because of the attire and the whole "lay in bed, wait for your next test" thing, it was really gray. They surely can't read or watch the TV, but c'mon, just let them wear something they enjoy or walk around...

ChrisWilding• 7 years ago

I recently had major surgery and the hospital I stayed in in the UK absolutely encouraged both getting out of bed and sitting in a chair as well as dressing in your normal clothes as soon as possible. Even though I was in ITU the day after surgery and couldn't even sit myself up, they still got me up with support, moved the bed out from behind me and sat me in a chair for a few hours. A week later when I was on a normal ward they encouraged you to get dressed and had posters up around the ward suggesting it.

Tomte• 7 years ago

My girlfriend is a nurse, and always pyjama wearing patients are her #1 thing she complains about.

"It's not a hotel, and it's not vacation!"

Followed by her other hate: patients who lose all abilities as soon as they enter the hospital. Usually wifes and girlfriends cutting food for male patients who have absolutely nothing wrong with their hands or minds.

xattt3• 7 years ago

This is one (dysfunctional) way that families feel that they can contribute to care in situations that they may otherwise feel loss of control.

tim333• 7 years ago

The one time I went to hospital in the UK (wisdom teeth under general) I was forced to put on pyjamas and stay on the ward much to my annoyance as I would rather have wandered off to get a coffee. I'd had no drugs or treatment - I'd just walked in.

The reason I was given was insurance - if patients were able to wander off they might fall over and the hospital get held liable.

They also wanted to stop me driving home at the end but I got around that one by fibbing.

DanBC2• 7 years ago

The reasons given are often bollocks, used to justify knee-jerk control.

The real reason in your case was "because this is how we do things here", and there's nothing really to support it and a lot that could be used to change it, but UK NHS staff are sometimes poorly supported to make changes.

exelius• 7 years ago

So... it’s really hard to get the physical leverage to actually cut your food while laying down in bed — especially with your arms tied down by IVs, monitoring devices, etc. It’s a really awkward position.

Which brings me to my pet peeve as a patient: the fact that hospitals require even healthy patients to be monitored for vitals every 4 hours (yes, even overnight — I told the nurses to fuck right off after the first night) and hooked up to all sorts of machinery that was obviously designed to save the nurses’ time; but ended up taking probably just as much time to fix when equipment broke or didn’t work as expected.

IMO hospitals have an over-automation problem. We need to go back to focusing on patient care rather than relying on complex systems to manage it.

arkades6• 7 years ago

hooked up to all sorts of machinery that was obviously designed to save the nurses’ time;

No. We use that equipment because when shit goes sideways, I want to be able to glance at a monitor and know all your vitals, not have someone take up a critical bedside spot trying to measure things, or to start attaching measurement equipment. I want that spot devoted to someone that can be involved in intubation, giving medication, performing CPR, or attaching a defibrillator.

JetSpiegel• 7 years ago

IMO hospitals have an over-automation problem. We need to go back to focusing on patient care rather than relying on complex systems to manage it.

This is Trump's "planes are too complicated" argument. So instead of having a machine reading your vitals, what's the alternative? A nurse asking what is your current SpO2 and committing it to memory only?

Tenoke• 7 years ago

"It's not a hotel, and it's not vacation!"

So what - because it isnt a hotel patients shouldnt try to make their stay less uncomfortable?

Usually wifes and girlfriends cutting food for male patients who have absolutely nothing wrong with their hands or minds.

A hospital stay is unpleasant for most people and those close to them like doing what little they can do to make it a tiny bit better. Is that really so bad?

Honestly, it is disappointing to me when I hear about medical practitioners who can't think of the patients as humans (even if cold detachment is definitely helpful in other situations).

gdhbcc• 7 years ago

Learned helplessness is a thing, and a big part of what helps patients recover is reducing that helplessness.

It might seem rude and just pilling on someone who is already down, but from personal experience and from talking with nurses who deal with palliative care and care of elderly patients, a major indicator of whether the patient will improve or not has to do with how much they actually do for themselves.

My own grandfather for example was hospitalized for a few weeks after being blinded in 1 eye. For the first 2 weeks he continuously got worse, not because of his original injury, but because of the lack of motivation direction and drive. Eventually when my father noticed his nurses were cutting his food and feeding him, he put a stop to that with a "why are they doing that for you? You still got hands, so use them". It hadn't even occurred my grandfather that he could do it himself.

arkades6• 7 years ago

"It's not a hotel, and it's not vacation!"

A surprising number of nurses take patients' conditions personally. I can't say I've never been irritated by a patient asking me to do something trivial and "below my station" (e.g., that time I was rounding and a patient high-handedly told me to get him oreos from his closet), but... I consider that irritation something to be worked at and put away, not a valid feeling towards my patients. But yes, being sick makes people feel helpless, and being cared for - sometimes in an infantilizing ways - makes a lot of people feel significantly reassured. I don't have a drug in my armamentarium as effective at relieving hospitalization anxiety as a loved one showering you with attention. And the loved ones generally feel better for it as well, because they're otherwise helpless to help.

So, yeah, I fetch oreos. And don't have much love for the nurse that thinks it's beneath her to do the same.

arkades6• 7 years ago

So, I went ahead and straight to the website of the actual campaign (https://www.endpjparalysis.com/) because numbers like "41% reduction in bed sores, 30% reduction in falls" are pretty hard to take at face value from what reads like a press release.

"Latest Data" tracks how many people/wards they've gotten to opt into their 70-day challenge, not supporting data.

Their "Stories" page is just that - stories. If you're interested in a poem by a nurse, dive in. The top of the page, however, has a link to a Medscape interview with the CNO (https://www.medscape.com/viewarticle/898975#vp_2). Does the CNO have any supporting data? No.

Medscape UK: It appears a very simple thing but it seems to be having a health effect.
Prof White: Absolutely right. I've got lots of stats to share with you. The one that struck me when I came to look at this, it says that research has shown that 60% of immobile patients have no clinical reason that requires bed rest, and that for people over 80, spending 10 days in bed ages their muscles by 10 years, and that older adults living at home will take 900 steps a day compared to only 250 steps in hospital.
Healthy patients in a bed begin to weaken immediately. After one day of admission and after just 24 hours of bed rest you can lose between 2% and 5% of your muscle power. This is something that happens almost immediately. It's not surprising then when you have patients that often end up in care homes instead of going home. And if you stay in bed any length of time you are more prone to things like thrombosis, delirium, infectious diseases like pneumonias, depression, loss of confidence, constipation, and incontinence. It's undignified as well, all of that, so it's really compelling when you start looking at what the statistics and the evidence tell you.

That is, they don't have any support that this intervention gets people moving more, just that moving more is good for patients.

The "Resources" page "Everything you need to know" packet. It's nothing but information on how to enro - no! There's a references section! But wait, it's nothing but a list of articles on the dangers of deconditioning. Nothing to support that putting people in street clothes has the benefits being touted in the parent article.

There's literally nothing on the entire site to support their claims. At all.

If I sound like I'm starting from the base position of "I want my patients in a gown," and it'll take actual data of patient benefit to change my position on that, it's because I am. I'll never forget running codes, rapid responses, and time in the trauma bay during my training. Getting fast access to the body of a patient in distress is critical; taking trauma shears to a patient and stripping them down takes a fair amount of time. If all my rapids and codes were in full dress and had to be cut out every time we ran a code, I guarantee we'd be measuring the impact of this policy in deaths. It doesn't surprise me that this campaign is for self-selected wards; I'm pretty much taking for granted that any ward with any level of actual acute patients isn't doing this.

Never mind that for your everyday physical exam - not your outpatient exam, for someone healthy and mobile enough to get to the office, but an inpatient exam - quite a few patients are unable to, you know, mobilize well. That's one thing for a physical therapist or a nurse, as the campaigners in the article are, who largely don't need anyone to move well enough to give them unfettered access to the body. But me? I actually need to get in there. For many patients, having to be mobile enough to disrobe from full dress every morning would be a problem. And a lot of docs don't have the time to wait for that - many get an hour to an hour and a half or so to finish our rounds in the morning. If you add a 5 minute delay on each patient just to get them disrobed, you've nearly doubled the time it takes to complete rounds. Frankly, if you want to change the healthcare system economics to pay hospitals to allow us an extra 5 minutes with each patient, I'd be grateful, but I'd also rather not spend it on them struggling with their clothing. I'd rather be speaking to them and/or examining them.

tqi• 7 years ago

It’s troubling how quickly people accept these claims as true, simply because it fits their pre-existing views/ anecdotal experience. This is exactly how pseudoscience gets traction.

DanBC2• 7 years ago

If you wait for an RCT for everything we'd never get anywhere.

#EndPJParalysis and #FitToSit are using QI methods to gather data which could then be used to justify running RCTs.

Nurses are not fucking idiots, and would assess the patient using all the skills and experience that nurses have and wouldn't just put everyone in their regular clothing.

arkades6• 7 years ago

If you were speaking to someone that didn't used to work in QI, that would almost sound convincing. Except that QI is, from a study-design perspective, equivalent to "shittily-built pragmatic observational trial," aka, the thing we know from every other field of clinical medicine that is ultimately followed by an RCT to be wildly unreliable.

That said, hey haven’t even provided that shoddy data. They’re providing anecdotes.

Some nurses are great, some nurses are "fucking idiots," and neither is relevant to the discussion of "if a patient is in a hospital, I want to be able to handle an emergency." I don't ask a nurse if they think a gown is needed, any more than I wouldn't ask a nurse if we should keep a BVM by the bed, any more than I wouldn't ask a nurse if we should have an oxygen supply by the bed, any more than I wouldn't ask a nurse if a crash cart should be kept reasonably close. Because it's not a question - as long as the patient is under my care in an acute care environment, I will have reasonable access to emergency supplies should they need it.

jasonhansel• 7 years ago

I attribute this to https://en.m.wikipedia.org/wiki/Hawthorne_effect

'PJ paralysis': Why advocates are pushing to get patients out of pyjamas

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