Acute in patient psych gowns vs street clothes

DisneyNurseGal, BSN, RN · May 14, 2018

Question for all of the psych nurses out there...
R - We took a suggestion to practice council that patients should wear stringless patient gowns and patient pants that we have. Many did not like the idea (they have been there long and don't like change). I am wondering what other psych units like ours do.
Thanks for your help! sister zyprexa (name lovingly given to me by one of my top 10 loved patients!)

All of our psych patients wear what we call psych pajamas. They are blue in color and there is a separate top and bottom. All personal belongings are locked up until the patient goes home.

I think wearing gowns poses a another set of safety issues. They are big and bulky and can be used to wrap around things.

Lastly, I think it is quite presumptuous for you to assume that just because someone does not like your idea, does not mean they are set in their ways and they do not like change. What was their reason for not liking the gowns? Play devils advocate, use the points they make against your idea and turn them into a positive. Perhaps they did not see your vision nor understood why your way was better/an improvement. In my experience it seems like nurses are against and idea if they presume that a change is going to make their job harder.

SapphireKitten, CNA · May 14, 2018

I can only speak from an ER perspective, but psych patients that come in, their room stripped of everything except the stretcher. The patients have to strip to their birthday suit, not even underwear or socks are allowed. All their items, including cell phones, etc. are collected and given to security to hold for their duration. They have a tech or a sitter that stays with them 24/7, if they have to use the bathroom, a tech, sitter, or nurse will accompany them into the bathroom.
Some people may find it "inhuman". Part of it is for their safety, but ultimately, it's for your and the staff's safety. Those patients are there for a reason and you'll be surprised how created some patients can get. In addition, you don't know what all those patients have on them. You can search them all you want, but they clever peeps and this isn't their first rodeo. They know what people are looking for, where they are going to look, and find different ways to hide things.

I also work in the ER, and we follow almost identical protocol. Our psych holds can keep on underwear (no bra though) and non-slip socks we provide. Understandably, many of these patients are hesitant and embarrassed to have to change into pretty much only a gown. In the end though, it is for their own and the staff's safety. Thankfully, they are typically transferred to a psych facility within several hours.

The vast majority of psych facilities in our area allow street clothes within certain guidelines (no sharp objects, etc.). Those facilities are better equipped environmentally and staff-wise than an ER to handle a wide range of psych patients. Therefore, I don't see an issue with patients in psych wards wearing street clothes that meet the guidelines (unless certain circumstances would benefit from wearing something like paper scrubs). After all, the patients feel way more human this way.

Racer15, BSN, RN · May 14, 2018

I can only speak from an ER perspective, but psych patients that come in, their room stripped of everything except the stretcher. The patients have to strip to their birthday suit, not even underwear or socks are allowed. All their items, including cell phones, etc. are collected and given to security to hold for their duration. They have a tech or a sitter that stays with them 24/7, if they have to use the bathroom, a tech, sitter, or nurse will accompany them into the bathroom.
Some people may find it "inhuman". Part of it is for their safety, but ultimately, it's for your and the staff's safety. Those patients are there for a reason and you'll be surprised how created some patients can get. In addition, you don't know what all those patients have on them. You can search them all you want, but they clever peeps and this isn't their first rodeo. They know what people are looking for, where they are going to look, and find different ways to hide things.

I too am an ER nurse, and just a few months ago ended up being a psych patient in my own ED, and was eventually transferred to an inpatient psychiatric unit, much to my displeasure. We have a similar policy for psych patients, and I was mostly treated the same. Although I was allowed to keep my underwear on and my phone was given back to me at one point. The ER is not equipped to handle things like a psychiatric unit is. So I wasn't quite so bothered by having my clothes taken, especially since I was only there 8 hours. When I was transferred I was put into paper scrubs until my brother could bring me some approved street clothes. I can't tell you how much better I felt being able to wear my own clothes. I already didn't want to be there, I already felt like a caged animal and felt humiliated being in those stupid paper scrubs. Like Viva said, it's hard to explain why being able to wear your own clothes is such a big deal unless you've been there. It gave me a sense of control over something since pretty much everything else was taken from me.

nursesunny, ASN, BSN, MSN, LPN, RN · May 14, 2018

I don't really see why the facility would need to launder their clothes for them if their typical length of stay is only 3-5 days unless they have nowhere to wash their own clothes on the outside. I don't do laundry every 3-5 days.

hahahaha.....Sorry...my patients come in filthy, not always because of homelessness but many are placed on psychiatric hold because they are gravely disabled. I can't imagine the other patients having to endure the smells that would be present if we didn't wash the clothes, but because of the length of stay, outdoor time, and need to attend groups, I think street clothes are the right choice.

Here.I.Stand, BSN, RN · May 14, 2018

I can only speak from an ER perspective, but psych patients that come in, their room stripped of everything except the stretcher. The patients have to strip to their birthday suit, not even underwear or socks are allowed. All their items, including cell phones, etc. are collected and given to security to hold for their duration. They have a tech or a sitter that stays with them 24/7, if they have to use the bathroom, a tech, sitter, or nurse will accompany them into the bathroom.
Some people may find it "inhuman". Part of it is for their safety, but ultimately, it's for your and the staff's safety. Those patients are there for a reason and you'll be surprised how created some patients can get. In addition, you don't know what all those patients have on them. You can search them all you want, but they clever peeps and this isn't their first rodeo. They know what people are looking for, where they are going to look, and find different ways to hide things.

Honest question... what exact safety risks do socks and underwear pose, that a hospital gown does not? Especially if they have a 1:1... is the 1:1 so incompetent that they can't handle a pt with underwear on? :sarcastic:

Of course it makes sense to remove anything that could be a weapon to minimize the danger to others.... but if there is a 1:1 to minimize the pt's danger to self, why can't they wear their underwear?

Racer15, BSN, RN · May 14, 2018

Honest question... what exact safety risks do socks and underwear pose, that a hospital gown does not? Especially if they have a 1:1... is the 1:1 so incompetent that they can't handle a pt with underwear on?
Of course it makes sense to remove anything that could be a weapon to minimize the danger to others.... but if there is a 1:1 to minimize the pt's danger to self, why can't they wear their underwear?

The thought process at my ER is they are less likely to run. It's not policy, just depends on the nurse. Which was good for my coworkers because I would have required a haldol blowdart if they had tried to make me strip naked.

Long Term Care Columnist / Guide · May 14, 2018

See, that's the thing. Being in a psych unit is unlike any other hospital experience. For one thing, you can't leave; they lock the doors. You have almost NO control over what happens to you, from what time you get up and go to bed, to when you eat, to when you can see your family, to what you can and can't have with you. I wasn't even allowed to have my iPod because I might strangle myself or someone else with the wires. Really?? They toss your room at least once a day to check for contraband. You have no real privacy because they're checking on you every 15 minutes, 24/7. But they also keep you safe, and that's what you need when you become an inpatient---they don't admit you just for the heck of it, you have to be totally dysfunctional. It's also something of a refuge when life on the outside becomes unbearable and you can't stand yourself any longer.

So it's really important to us psych patients to have a LITTLE control, even if it's just wearing our own clothes. When you've spent a good deal of your life holding others' lives in your hands, not being trusted at all feels really, really weird. I understand why it's necessary to be strict, because everyone needs to be kept safe. I just don't see street clothes as being a huge problem, and it helps the patient to feel human.

Eris Discordia BSN, RN · May 15, 2018

I can only speak from an ER perspective, but psych patients that come in, their room stripped of everything except the stretcher. The patients have to strip to their birthday suit, not even underwear or socks are allowed. All their items, including cell phones, etc. are collected and given to security to hold for their duration. They have a tech or a sitter that stays with them 24/7, if they have to use the bathroom, a tech, sitter, or nurse will accompany them into the bathroom.
Some people may find it "inhuman". Part of it is for their safety, but ultimately, it's for your and the staff's safety. Those patients are there for a reason and you'll be surprised how created some patients can get. In addition, you don't know what all those patients have on them. You can search them all you want, but they clever peeps and this isn't their first rodeo. They know what people are looking for, where they are going to look, and find different ways to hide things.

Here's the thing. ERs aren't psych units. They aren't designed for psych patients, of course. They are essentially a triage/holding area. The rules that the ER uses in no way apply to a psych unit. It makes absolute sense to do most of these things in the ER.

(Serious soapbox: Sorry, not sorry...no socks and no underwear is just degrading and in no way improves safety. You can strip them nude, do your skin search, check out the underwear, give it back, and give them hospital, no skid socks. If they are wild enough to run, not having socks or panties ain't gonna stop them. Trust me on that. I've tackled a fully nude delusional psych patient I had to CO trying to elope from a pre-op suite...aiming for a sterile OR suite door. They don't care at that point. And no socks on an ER floor?? That's just nasty. Seriously nasty. You absolutely know what gets trekked in those rooms on the bottoms of your shoes. God forbid they have to walk barefoot down a public, nasty hallway to the bathroom. I can't even. Would you want your mom walking around in that filth barefoot if she came in suicidal because life had knocked her down? No. So don't put others thru that either. Someone needs to make that a policy change yesterday. Be the change.).

Now, back on track...

The ER isn't locked down, the ER has all sorts of hazards to psych patients, even in a stripped down room. Things like call bells and paper towel holders with serrated edges, and curtains to strangle yourself with, and tall stretchers with nice side rails to hang yourself from, or a misplaced scalpel in a drawer a patient could turn on themselves or someone else. Suction and oxygen tubing, a fire extinguisher to club someone with. The list is endless why an ER, or a med surg room, would need seemingly extreme rules. We all get this. Of course you need the absolute bare minimum in there and a sitter to boot. Maybe even security.

None of this applies in the psych ward. Even the plates are styrofoam, so you don't have to worry about being clocked over the head with a heavy plastic dish. Our patient bathroom doors are open at the top and the bottom, so there's no where to hang a bedsheet to try to hang yourself on. Staff can't wear lanyards or pull down badges...because a patient could cut my throat or choke us out with them. Not a call bell in sight. No plastic trash bags. No plastic water cups to hit me with. There is no plain hot water. It's all cold or warm. That's it.

We live, breathe, and die preventive environmental safety...not reactive. Our furniture is plastic and feels like it's full of lead, so not even a linebacker can pick it up and chuck it at me. And the units are double locked, so they can wander to their hearts desire in street clothes, but they aren't gonna be able to bust out of the bullet proof glass and elope. So yes, they can wear underwear and sports bras and reasonable street clothing. They are not in prison.

They aren't all TDO'd or committed. Most are voluntary where I work, at least. And regardless, they all still have pages and pages of patient rights that we are mandated to respect. They are human. Just because their disease is of the mind in no way diminishes their right to dignity. Medical patients aren't better than them...they don't have more human rights, that's for sure. That gets forgotten too often.

I mean, is the risk of a patient wearing hospital socks *really* a more important safety issue than the risk that they may contract or spread around an infectious disease from walking around a hospital barefoot? That's not rational or evidence-based practice. That is fear-based practice. And that's wrong.

I actually PREFER patients in street clothing in the psych ward. I had an instance where an elderly, spritely lady had a baby doll that she said was her infant. It had a plastic head, plastic hands and feet, and a soft body. Powers that be deemed it okay to keep around. She usually just held it and talked to it, and left everyone alone.

When she was in her huge, one size fits all gown, because she had no clothing, I couldn't tell that one day she had the baby stashed in her bra in order to "breast feed" it (apparently)..until she took it out and clocked her roommate over the head for whatever reason. I mean, it's a plastic and cloth doll, so no damage was done. But her roommate sure was traumatized regardless. If she had been in street clothes, we all would have seen the nefarious toy stuffed in her bra and suggested she only "breastfeed" alone, in private. Or maybe wrestle the doll away. Or keep an eye out. I don't know. But it would have been on our radar.

So, yeah, there is no good reason that patients shouldn't be in street clothing in a locked psych ward that does good searches and has a solid dress code.

Medic_Murse, BSN, RN, EMT-P · May 15, 2018

(Serious soapbox: Sorry, not sorry...no socks and no underwear is just degrading and in no way improves safety. You can strip them nude, do your skin search, check out the underwear, give it back, and give them hospital, no skid socks. If they are wild enough to run, not having socks or panties ain't gonna stop them. Trust me on that. I've tackled a fully nude delusional psych patient I had to CO trying to elope from a pre-op suite...aiming for a sterile OR suite door. They don't care at that point. And no socks on an ER floor?? That's just nasty. Seriously nasty. You absolutely know what gets trekked in those rooms on the bottoms of your shoes. God forbid they have to walk barefoot down a public, nasty hallway to the bathroom. I can't even. Would you want your mom walking around in that filth barefoot if she came in suicidal because life had knocked her down? No. So don't put others thru that either. Someone needs to make that a policy change yesterday. Be the change.).

I'll borrow from you, "Sorry, not sorry." 1) Department policy. 2) Ever have a patient that taped a straight blade to the underside of their ass (yes, this has happened)? Now, the socks part (My bad! We do give them hospital, non stick (in case that may upset you as well) socks, I didn't take the time to edit, have someone review through the post for accuracy, but gosh if I didn't think most people could take the time and think for themselves.

Meriwhen, ASN, BSN, MSN, RN · May 15, 2018

Our patients come to us in gowns because a. they come via the ER, and b. we need to do a safety search before they can enter the milieu, and it's a lot easier if they're in the gown.

After that, they can wear street clothing as long as it's appropriate (i.e., no strings, underwires, short shorts, profanity, etc). Allowing them their clothing helps the patient maintain their dignity and provide a sense of normalcy, since being is a psych unit is usually a far from normal experience for the patient. We keep a clothing locker for those who didn't come in with clothing or they can't wear what they brought in, but as it's all donations, we can't always guarantee it'll be to the patient's taste. But it's there if they need it And if they prefer to wear gowns, they can.

Patients on the med-psych unit will usually wear gowns because they're often medically more fragile, have lines/tubes, are incontinent, etc., and it's easier for us to provide care if they're in gowns. But if they don't want to wear gowns, they don't have to.

The only time we'll restrict someone's access to clothing and require them to wear a gown (cloth or paper) is for safety reasons. But if it comes to that, things are pretty bad with this patient and they're already on other safety precautions as it is (item restrictions, door always open, line of sight, 1:1, etc.). We don't just take away a patient's right to wear clothing "just because."

As far as laundry goes: if they want us to wash it, we will. If they don't, we won't. It's up to them to put it in the laundry area if they want it washed. It's also at their own risk, though AFAIK we haven't had any major clothing-related disasters due to the laundry.

If a patient came in with lice, scabies and/or bedbugs (and yes, it's does happen that a patient comes in with two or even all three), their belongings are double-bagged, placed in storage, and returned upon discharge. They have to wear gowns until any treatments are completed, after which they can wear street clothing. But since they won't get their original clothing back after discharge due to the vermin, they'll have to have someone bring in clothing or get something from our clothing locker.

LilaDavis · May 25, 2018

I completely agree with those who answered before me about it being degrading, humiliating and unnecessary for patients. There needs to be a balance between safety and dignity which I understand is difficult to strike, but I don't see how forcing patients to wear hospital gowns is needed.

I guess it depends on the purpose of your unit - if it's literally to just keep them alive, then it makes sense to strip people of anything that could be used as a weapon or a ligature (although a hospital gown could also be used). But if you want to be more person centred and recovery focused, I think hospital gowns are the wrong idea completely. Of course you're wanting to get someone through a crisis and stay alive, but you're also not wanting them to come back - allowing them their street clothes and some personal affects I think is both comforting and keeps people connected to the fact that they're a human with a life outside hospital.

Pac0 · Jun 28, 2018

Good afternoon.

In the psychiatric unit of my hospital, all patients must wear pajamas,. One during the day and other at night. Cloth trousers with ribbon tied at the waist and fly with two buttons. A long sleeve fabric jacket without pockets and the whole blue set.

It also obliges the health personnel to comply with the dress code.

You will not see staff with green surgical pants and jackets, they are always more comfortable than white pants.

In my patients' rooms, no one comes in uniform surgical or jeans .... Although they left the operating theater 10 minutes ago.

Of course, I don't let anyone sit in the patient's bed and I don't care if is an assistant or the minister of health.

It is our office but for a sick person, it is your home.

In other services patients go as they want, and the staff3 with green pants black turtleneck over the shirt and to finish a pink fleece and its hanging scissors with tweezers well tied to a string of colors.

I've heard some of them complain about a patient for not wearing the pajama jacket: The rock group shirts are not part of the dress code for patients, and you have to put under your pajamas, underwear. The answer was very clear that when she complied with her dress and the nurse who had a breast augmentation wores a bra. He would think about it.

The theme that so many female nurses bother, that men do not wear underwear, surprises me. Old chaps, we are nurses we have seen more memberes and lady partss than the rest of the world population. But that will be another issue.

A great hug.