The Blue Gown Syndrome

[Altra, BSN, RN]

I recognize that you feel strongly about this and your article is well-written. However, I strongly disagree that the hospital gown "represents weakness and submission" or somehow precludes empathy, care or respect. It is a useful tool that facilitates physical examination and hands-on treatment, which are the reasons why people seek health care.

I can only speak for myself, but I assure you that I do not disrespect people or lack empathy for them simply because they are wearing a hospital gown. I joke with patients about the "oh so stylish gown." I make every effort to have them use the bathroom to provide a urine sample before getting undressed. I ask family members to step out when I need to expose the patient to examine them.

Simple, common-sense explanations regarding the safety and privacy of all patients are often all that is needed if patients question the need to stay in the ER treatment room. The same goes for the need to avoid p.o. intake while diagnosis of the patient's condition is underway.

Someday we may live in the world of Start Trek tricorders and nerve stimulators which diagnose and heal all without physical, hands-on examination and treatment. We're not there yet. For now, the vast majority of us (on both sides of the bed) recognize that medical treatment is necessary, temporary, and voluntary.

[vadushkas_nurse]

MLOS

I completely agree with your response and the necessary nature of gowns. I feel that some health care professionals forget that patients are human and that because they are a patient, forget to provide choice and common sense explanations as you mentioned. I hope most people think like you.

I felt that some patients need a bit of advocacy on their behalf.

[Chaya, ASN, RN]

I think you've got something there. The phrase "Blue Gown Syndrome" could well become a staple phrase and concept in the healthcare sphere.

[Angel@MyTable, RN]

Thank you for writing this!

I am starting the Fall '08 program at my school, and will graduate May 2010.

I had a pretty bad car accident in 1996, I chipped the spinous process on my C4, and had a cracked spleen. No outward injuries, but I knew something was wrong, I couldn't move with out extreme pain, and it felt like I had glass embedded in my right hand & arm. They did a CT and then found the injuries.

When I was at the first hospital while they were assessing me, I told one of the nurses the pain I was in worse than childbirth, she said she found that hard to believe, since she had just had a baby. I think she thought I was just being a big baby since they didn't see any out ward injuries, then they did the CT scan, and shipped me over to Regions, as they weren't equipped to deal with the injuries I had.

After another ambulance ride from Hastings to St. Paul, I got into ER and the nurse needed to put a new IV in, I can't remember why, but he was going to stick it into the arm that felt like there was glass in it! I begged him not to, but he was pretty cranky, and said he needed to put it into that arm!

After a battery of tests, scans and X rays, I was finally admitted into ICU (almost 10 hours after the accident). After fading in and out of sleep, I asked the nurse for something to help with the pain, and she said that they had just given me morphine through my IV. I then asked for something to sleep because the morphine wasn't helping. Not long after that, I let the nurse know that I felt like I was going to throw up, (I was flat on my back with a heavy duty neck collar on), but she said don't worry, morphine just makes you feel like your going to throw up. I must have drifted for a second, but all of a sudden I threw up, EVERYWHERE! The nurse came a running and had to call for help to turn me, so I wouldn't aspirate on my vomit.

That fiasco (plus having 3 c-sections, and raising a child with type II diabetes), I feel will help me become a more compassionate/empathetic nurse.

I think some nurses & docs forget that the majority of the folks they see in the clinic/hospital don't want to be there! My suggestion is to please give them the kindness and compassion you feel you would like yourself & your loved ones to receive!

[careerchoices]

I was helping a friend in her yard a couple years ago and fell, impaling myself on a pair of old rusty hedge clippers right into my rear.

I was not in terrible shape, not too much bleeding or anything, but the wound was a bit over 2" deep right through the base of the back pocket of my jeans. I had taken some five-year-old Hydrocodone I found in the medicine cabinet and decided to blow it off, get a tetanus shot the next morning and call it good. But three hours later I was in agony and could not move the leg at all. And it was getting worse. Of course, it was Sunday.

Ended up in the ER. I refused to go to "my" ER and went to a closer major hospital owned by a "large hospital corporation in Nashville". I could not flex my leg at all anymore, so I kind-of leaned over a chair until they got to me. Put me in a room, got an IV started, gowned, etc. They wanted to give me more drugs but I kept refusing as I have an unreasonable fear of being labeled as a drug seeker, plus I explained had already taken some narcotics at home.

It turned out to be a busy day, and a couple hours passed. Pain became quite bad. Doc wanted to flush it, but get an x-ray first to make certain that I had not chipped the ilium.

So they called X-ray, who showed up with a wheelchair. I was now in significant pain.

X-ray tech insisted I must ride in a wheelchair. I explained that I was in a lot of pain, that I had a deep hole right though my gluteus, and I was laying on my side on the gurney facing the wall because it was too painful to lie flat. There was no way I could ride in a wheelchair.

Now we had an argument. Tech insisted I could walk or ride in a wheelchair, and she had the paperwork to prove it. She had only brought the wheelchair to be nice, by all rights I should walk the 1/2 block to radiology myself (dripping blood all down the hallway I suppose).

This argument went on for a while. Tech finally agreed to take me on the gurney because I had refused to do otherwise, but all they way down and back complained about what a baby I was. When she left me in the exam room back in the ER, I could hear her complaining about what a pain I was to the nurses. I'm one of the more compliant patients you ever meet.

The new-shift Doc came in to flush the would herself (by that time the nurses were busy with another more-acute patients), but when she looked, she refused to touch me until I took some more pain meds.

This time, I gave in. And 15mg of Lortab finally took the edge off. Even then, I spent the whole day in the ER and had to come back for several days of IV antibiotics. I ended up actually needing 15Mg of Lortab Q6 for a few days, as I could not even sleep without them. But even with all those drugs, I could not even make it from my bed at home to the bathroom without crutches.

I just kept wondering, where this woman got off chewing me out like that. She did not know that I was also experienced in medicine--did not know my education or background--and yet she acted like I was a fool because I thought I was in more pain than indicated on my form. When I had to make it to the bathroom (I refused to make nurses empty a bedpan if I can make it myself), it took two nurses and me leaning hard on the bed rail mounted on the wall...and I'm a pretty strong guy. There is no way I could have walked even 1/20th of the way to Radiology, and I could not sit in the car seat for the drive home even on heavy narcotics.

Yet this "professional" with >20 years of experience (she told me all about her career, and how she was used to male patients being "big babies") decided that there was no way I could be in that much pain, in particular since the X-ray showed my bone was not damaged.

And how would I know...I was a mere patient.

Now imagine how it is for patients who are too timid to stand up for themselves in the hospital. I could have tried to walk and then collapsed in the hallway.

You hear about this happening with patients, and now I can understand how.

In this case, it had nothing to do with the nurses (indeed, I did not see them that much), but with the other hospital staff as a whole. Just a little bit of time to consider the feelings of the patient, and that when a 35 y/o puts on a gown he is not transformed into a child. And, in my opinion, even a child deserves to have his concerns taken seriously.

[dpbrown523]

My brother in law is a quadriplegic after a MVA 12 years ago. He was in the hospital about a year ago. He asked for someone to help him eat since he cannot feed himself. He was told by the nurse, no and that they were not set up for individual care there at that hospital! Then my sister overheard two nurses talking ugly about him at the nurse's station while she was standing there, not knowing who she was! I think that is just horrible and hope that I have never treated anyone like that.

[macspuds]

Thank you for this. What a wonderful thing it is to read articles from nurses who reall have got it in respect to patients. This article and one other re candid talk with families represents what Real Nurses do and feel.

My heartfelt gratitude to you all, for I also have had a bad experience as a patient. It is too bad that sometimes it helps if they do know if you're a Nurse as their patient.

It should be as you say to All patients. What a wonderful Nurse you must be.---------macspuds

[krolik]

I am almost four years into my career as an ER nurse and now concurrently working through the obstacles known as graduate school. I am constantly being torn between two very different worlds, that of reality nursing and that of academia. This professional battle often leads me to reflect on how my learning will impact patients. :loveya:More so, this reflection time allows me to acknowledge gaps and become a stronger bedside nurse as well as a fellow leader.

There are many areas of nursing that I am passionate about. Patient advocacy is one. With the craziness that is becoming the health care system. I have some issues with how the nurse patient relationship is progressing. This article is one based on a phenomenon I have witnessed over and over again. I highly value the relationship between a nurse and patient. There is an unspoken almost immediate human bond between two strangers. It is a privilege for me to work with people from all walks of life, and to be a confidant in the midst of a health crisis.

Recently, I have noticed something unusual and invisible occurring to people when they enter the hospital setting. It is a phenomenon I'd like to call The Blue Gown Syndrome. It seems that once a person is triaged and directed to a room, they are stripped of their personal self and ability to speak up and have choices. The hospital gown now identifies people as 'patients'. The blue gown seems to be a symbol that represents weakness and submission. It is an image of permission to be cared for under extreme restriction. For instance a person suffering from the blue gown syndrome may hear the following: yes you have to change, no you can't eat, it ties in the back and make sure you stay in your room until the doctor sees you. It baffles me to know where this presumed authority comes from. When did nurses remove respect from their vocabulary? Behind the overshadowing blue gown is a person, a family member, someone in need of empathy and care, and above all, a human. :redpinkhe

I am fully aware of staff shortages, lack of time, changed consumeristic value of health care and less than altruistic reasons some end up in the health care field. What I want to emphasis is the patients' rights and the ultimate need for human respect and relationships in today's world. Patients enter the health care system for various reasons, often medical assistance. It is our professional responsibility to ensure that each patient be shown respect, dignity and care despite their background or rationale for being in the hospital setting.

Behind each tightly tied hospital gown is a person, a human, all of which are deserving to have their integrity and self kept whole. Next time you catch yourself instigating a blue gown syndrome, take a step back and instill confidence towards the patient that they will be cared for unbiasedly and that humanity is valued.

P.S: The blue gown syndrome can be easily prevented with nursing acknowledgement and skill. It can be treated by frequently remembering why nursing is personally rewarding... and to care for those lives you touch. Every person is someones family. :redbeathe:heartbeat:redbeathe

"Every person is someones family" Very simple words, but so nice:) You know I'm changing my career from Engineering into nursing. After I read your text I'm now more sure than ever that I'm doing the right thing. Thanks.

[gal220RN, BSN, RN]

I appreciate your thoughts on this issue. I think it is our responsibility to empower our patients not to be bystanders in their own care, but to own their own care. Elderly patients have not been taught they have a say in what happens to them- they have been taught not to question their care. I have seen this with my grandparents. When I ask them why they are on a certain medication, they have no idea. When I ask what their lab tests revealed, they have no idea. They are totally passive.

Let's face it- patients who are owners of their health care are terribly inconveinent. They are labeled the 'trouble makers'. They have the nerve to actually ask what medication you are spiking into their IV. They will ask your name if you have not taken the time to introduce yourself and they even request for health care workers to wash their hands before they are touched. The nerve! The audacity! How dare they question the health care gods!

Wait! Could it be that the well informed, empowered patient might actually prevent errors in their own care? Might they be the ones to question which limb is being amputated or which breast is being removed?

When we allow patients to be active participants in what happens to their bodies, everyone benefits- blue gowns and all.

[HazeKomp, BSN, RN]

Good article. We often strip patients of their autonomy and rights without even thinking.

My way of approaching patients is that they are either my father or mother, my brother or sister, or my son or daughter. This helps me look past any difficult behaviors they may have, and care for them as individuals.

I use humor alot in my job. I tell my patients they are free to use their call lights to ask questions, to let me know what they need, or to see a friendly face. I tell them that if I didn't want to hear from them, I'd put the call light on the floor out of their reach--and then I hand them the call light!! I work in Labor & Delivery, so when they say they are feeling really nervous for their C-section or their induction, I tell them that laying under a sheet with no underpants in front of stranger makes me nervous, too. When, in their fear and nervousness, they curse a blue streak and then apologize for it, I tell them that I do NOT judge them in the labor room, but that if they talk to me like that in the middle of the grocery store next week I'm gonna get upset. Stuff like that.

In labor and delivery it is interesting watching folks transition from being a couple to being parents of their firstborn child. The biker dudes in leathers, the tattood & pierced, the druggies, the yuppies, the rich and the poor all experience the change, holding that baby.

Everyone is someone's child. Treat them like family!

[missjennmb]

hazecomp, its so great to see someone in L&D who sees their patients as people and not just patients. I don't know your stance on the many birth debates but I do know that I have met with SO much resistance in that specific community regarding patient autonomy that its the only area of patient care that I will NEVER work in. There is just such a blatant disregard in the birth community for patients' right to own their own care and be a part of their care.

I was screamed at by a doctor in an office full of people (an OB in his practice...in the "hub" where they take vitals for all patients before moving them to their rooms and where the nurses' station is). All because I asked why they wanted to give me a specific medication (that I knew led to other interventions that I was hoping to avoid if possible) I didnt even refuse or anything... just wanted to know why and if there were any less invasive options. The doctor barely took the time to introduce himself before screaming at me until I ran out of the office crying and shut myself in the bathroom for a good 10 minutes to get myself pulled together.

This is only 1 of many horror stories I have with medical people in the birthing community, and is why I can say that I understand why people avoid going to the doctor/hospital until they have no choice, and why unassisted birth/out of hospital birth in technologically advanced countries is on the rise.