Patients' perceptions of today's nursing attire: exploring dual images

A scoping review exploring people's perceptions of healthcare uniforms

BACKGROUND

Healthcare staff uniforms are a subject of debate in the UK, and this is particularly true in the case of less understood roles such as advanced nurse practitioners. Aim: This review explores what is known about people's perceptions of health professionals' uniforms.

METHOD

A mixed methods scoping review following the Joanna Briggs Institute (JBI) methodology. Five databases (CINAHL, ASSIA, PsycINFO, and EMBASE) and several search engines were searched. Eligible reports were peer-reviewed English-language studies using any methodology to explore people's perceptions of different uniforms for health professionals.

FINDINGS

Forty-six studies (mainly from North America) were included, presenting a variety of perspectives on the uniforms worn by doctors, nurses and other health professionals.

CONCLUSION

Culture and context likely influence how uniforms are understood. Practitioners should consider how this may affect communication with both patients and colleagues. What health professionals wear matters, particularly in relation to less well understood roles.

Nursing in the 21st century: results of a pilot survey on attitudes towards nurses and nursing

Nursing is one of the most trusted professions, yet it is poorly defined. There are many definitions and characterisations of nursing. This study sought to pilot a survey exploring the views of nursing in the 21st century.

METHODS

This study piloted an electronic survey with open and closed questions. Descriptive statistics were collated for closed questions using Excel. Open-ended questions were analysed using the text analysis program Linguistic Inquiry and Word Count (LIWC) for tone, emotion and criticality.

RESULTS

This pilot study recruited 72 participants from professional and non-professional backgrounds. Respondents displayed diversity in their perceptions of nursing, the role of nurses and the role that nurses perform.

CONCLUSION

Nursing is a complex, multifaceted profession. The view of nursing was generally positive and authentic although not easy to define. Nursing was felt to be an inclusive profession; however, it is extremely diverse in nature. Further research is required to explore these concepts in greater depth.

The nurses' uniform in pediatrics, the opinion of children and nurses

Background and aim:

The nursing uniform represents a non-verbal mean of communication which in the case of children can arouse positive or negative emotions. The first study conducted on a sample of 107 children, aimed to define their preferences on different models of decorated nursing uniforms; the second one conducted on 101 nurses to understand the preferences, the meanings attributed to the uniform and their availability to adapt it according to the preferences expressed by the children.

Methods:

We conducted an observational study with a qualitative approach. For the first objective with the children, a visual stimulus was used, showing 6 models of uniform: the traditional plus 5 models of different colors and themes (cartoons characters and videogames). For the second objective with the nurses, in addition to reproducing the same visual stimulus, a semi-structured questionnaire was used.

Results:

Children and nurses seem to be in perfect accord, because in both groups, color models were the most chosen. Nurses defined their uniform with terms of particular moral, intellectual and professional value and declared themselves available to align with the preferences of the children.

Conclusions:

This study leaves little doubt about preferences; it also represents the true originality of the study because almost never in the literature have been compared the point of views of children and professionals, generally favoring the comparison between children and care givers. Our findings could represent a further landmark for guiding the choices of health organizations on currencies to be adopted in the pediatric field. (www.actabiomedica.it)

The image of the profession in the mass consciousness

The issues of nursing staff shortage and quality of their work are relevant for the health-care management today. In this regard, the established image of the profession is important, as it can lead to the unpopularity of nursing profession and affect the effectiveness of the treatment process through the self-perception of nurses. So studying the image of nursing in social media is of particular relevance today. The role of social media in dissemination of opinions is increasing every day. Unloading (31613 messages) from social media was made using keywords for 2017. А random subsample (403 messages) was formed from them, coded manually by coders (authors). According to analysis of the obtained data, nursing is perceived as a “female profession,” a nurse is a Caucasoid woman in a white uniform. She works at public hospitals, her work is discussed primarily in the context of the specialties of obstetrics, gynecology and pediatrics. Her status is rather low, nursing is not perceived as an intellectual and promising profession. Messages about nurses are mostly neutral, emotionally colored messages are devoted mainly to the personal qualities of nurses. Autoimage (self-perception) of nurses is poor. In conclusion, there is given a number of recommendations for improving the image of nurses. Implementation of organizational changes may contribute to enhancing the prestige of the profession: introducing special insignia for nurses, designating career prospects. It is also possible for these purposes to conduct an information policy aimed at demonstrating the attractive aspects of nursing and emphasizing the gender neutrality of the profession.

The Impact of Nurses' Uniforms on Nurse-Patient Interactions: Patients' Perspectives

OBJECTIVES

The aim of this study was to explore patients' perceptions toward the nursing uniforms used in a hospital in Singapore and how different uniforms impact nurse-patient interactions.

BACKGROUND

Nursing uniforms act as a form of nonverbal communication. However, implications of the increasing variety of nursing uniforms on patients' perceptions of nurses and nurse-patient interactions are unexplored.

METHODS

An exploratory qualitative study design using semistructured interviews was adopted for the study. Twenty-one patients agreed to be interviewed. An audio recorder was used during data collection. The thematic analysis method was used for data analysis.

RESULTS

Four major themes were identified: identity, subjectivity, suitability, and inconsequential. Nurses' uniform was regarded as a representation of identity. Suitability of the uniform for nurses was a main concern for patients. However, nurses' uniforms were inconsequential to nurse-patient interactions.

CONCLUSION

Patients' perceptions of nurses' uniforms were highly subjective and have no substantial impact on nurse-patient interactions.

Pilot evaluation of isolation patients' perceptions on ability to identify types of health care workers when wearing isolation gowns

In a survey research study, perceptions of 50 hospitalized patients on contact isolation were evaluated regarding their ability to identify health care worker (HCW) type in isolation gowns with no hospital badge under or on the gown, in isolation gowns with the hospital badge partially visible through the gown, and in isolation gowns with a preprinted large font Registered Nurse and Nursing Technician sticker badge on the outside of the gown. Patients ranked their ability to identify HCWs when entering their hospital room as important (average ranking, 8.0, where 0 was not at all important and 10 was very important); 28 patients (56%) specified all HCWs entering their hospital room should wear a preprinted large font sticker badge on the outside of their isolation gowns. Patients found little difficulty identifying HCW type with the large font preprinted sticker badge (average difficulty ranking, 1.0, where 0 is not at all difficult and 10 is very difficult), a simplistic method to improve HCW type identification.

Psychiatric patients' perspective: nursing uniforms

This paper studied and determined the importance of the design and color of selected uniforms of psychiatric nurses and evaluate their effects and implications for patients. In this descriptive study, a questionnaire developed by the researchers and a nursing uniforms catalog were used during the data collection stage of the research. There were 40.9% of the participants who told that the design and color of a nursing uniform is important and 31.5% of the participants selected white uniform color from the catalog for psychiatric nurses and 33.9% of the patients expressed that they find white nursing uniforms comforting.

What to wear? The influence of attire on the perceived professionalism of dentists and lawyers

Using a sample of 201 participants and a between-subjects design, the perceived professionalism-suitability, capability, ease to talk to and friendliness-of male and female dentists and lawyers in various attires was examined. Results showed an absolute preference for male dentists and lawyers in professional and formal attire, respectively. Male dentists and lawyers in professional and formal attire were further rated as more suitable, capable, easier to talk to, and friendlier than female professionals, and than those dressed in smart or casual attire. Results are discussed in terms of positive dental outcomes and legal representation. Limitations are considered.

Image is more than a uniform: the promise of assurance

OBJECTIVE

The purpose of this qualitative study was to explore the meaning of the phrase "image of the nurse" in the context of the desired brand experience of assurance.

BACKGROUND

A brand is a promise that lives in the minds of consumers. Nurses play a key role in delivering on the brand promise of a hospital.

METHODS

Using focus groups, the authors applied a deductive approach to generate data. Discussion transcripts were analyzed by establishing codes and identifying themes.

RESULTS

The most frequent comment from participants was that for nurses to communicate assurance, they must 1st be clean, well groomed, and understated in overall appearance. Nurse behaviors that reassure patients include being present with patients, helping patients know what to expect, and demonstrating a consistent team approach.

CONCLUSIONS

Overall appearance and behaviors define the image of nurses and contribute significantly to the brand of assurance.

Patient perception of contemporary nurse attire: a pilot study

Patients have expressed difficulty accurately distinguishing registered nurses (RNs) from other hospital personnel because standardized uniforms are no longer worn by RNs. According to American studies, such complaints are widespread; moreover, patients' perceptions of nurse caring and competence and of other traits associated with nurses' professional image have been negatively affected by casual, non-conventional attire. As there are no published Canadian studies, we conducted a pilot study to examine patient perception of the nurse uniform. Adult patients viewed photographs of the same RN dressed in eight different uniforms and rated each uniform according to 10 traits associated with nurses' professional image. The white pantsuit scored higher for professionalism than uniforms with small print, bold print, or solid colour, and most patients preferred that the RN dress in white. Our preliminary findings suggest that RN attire warrants further investigation, and we are planning a large-scale, fully powered study to inform patient-driven change to existing uniform policies.

Nursing professional attire: probing patient preferences to inform implementation

OBJECTIVE

The aim of this study was to increase understanding of patient perceptions of nursing professional image, appearance, and identification to inform implementation of professional clinical attire.

BACKGROUND

There is growing evidence of patient preference for and organizational implementation of professional clinical attire.

METHODS

A total of 350 randomly selected inpatients were surveyed using the professional image and patient preferences survey prior to a revision of the dress code for nursing.

RESULTS

Patients gave high scores for nursing image, appearance, and identification, with no support for color-coded uniforms.

CONCLUSIONS

Organizations should assess patient perceptions before implementation of a dress code for nursing.

The professional appearance of registered nurses: an integrative review of peer-refereed studies

BACKGROUND

There is a paucity of research examining the impact of standardized uniform style and color for registered nurses (RNs).

OBJECTIVE

The aim of this study was to appraise published peer-refereed studies on the effect of a standardized uniform style and color for RNs.

METHODS

Seven peer-refereed studies exploring standardized uniforms for RNs were identified. Using the Oxford Centre for Evidence-Based Medicine evidence hierarchy, each study was assigned a level of evidence and overall rating.

RESULTS

Data suggest that patients felt that RNs appeared professional and were easily identified by a standardized uniform style and color. No strong evidence supports a patient's preference for a specific style and color of uniform.

CONCLUSIONS

Findings are inconsistent but demonstrate that a standardized uniform style and color increased the perception of professionalism and recognition of RNs among patients.

Reflections on the practice of facilitating group-based antenatal education: should a midwife wear a uniform in the hospital setting?

The first author of this paper, a Thai midwife, conducted a feminist action research project aimed at collaboratively developing a model for group-based antenatal education in Thailand. Should a midwife wear a uniform when facilitating midwife-led group-based antenatal education sessions in the hospital setting? This paper reports on a single example of reflection in and on midwifery practice that aimed to answer the guiding question. The practice and reflection occurred over a number of months at the beginning of the feminist action research project. The midwife should wear normal clothes when facilitating group-based antenatal education as a symbol of equality in power relationships within the group. When power relationships between women and the midwife are equalized, women are more able to take responsibility for their health as they are less likely to defer to the 'expert'. Reflection in and on practice is a powerful tool to allow the midwife to understand and change her own practice as required to meet those goals. Self-change is a critical first step because there can be no change in the way maternity care is provided without each midwife being willing to be self-aware and open to appropriate self-change.

Perception of nurse caring, skills, and knowledge based on appearance

OBJECTIVE

The objective of the study was to assess differences among perceptions of patients, nurses, nursing faculty, and nursing students regarding nurse caring, skill, and knowledge based on attire and level of visible body art.

BACKGROUND

People often make judgments (positive and negative) based on how a person appears. Given somewhat more flexible dress codes for nurses, we wondered what type of perceptions a variety of stakeholders would have of nurses in different levels of attire.

METHOD

A descriptive comparative design was used. A convenience sample of 240 patients, nurses, students, and faculty were surveyed regarding their perceptions of a nurse based on appearance. Multivariate analyses of variance were calculated to determine if participants' perception of nurse caring, skill, and knowledge differed by scrub type or level of body art.

RESULTS

For the entire sample, the nurse wearing the solid scrub was rated significantly more skilled and knowledgeable than a nurse wearing print or T-shirt attire. Students rated the nurse wearing the solid scrub and print scrub significantly more skilled and knowledgeable. They rated the print scrub higher, with faculty rating it lower. Nurses rated the T-shirt attire more caring than faculty. Patients rated the T-shirt attire more skilled than faculty and students. All subjects rated the nurse with the most body art (piercings and visible tattoo) the least caring, skilled, and knowledgeable. Nurses rated the most amount of body art more caring than patients and faculty. Students rated the most amount of body art more caring than patients and faculty.

CONCLUSION

The conflict between the right to self-expression and professional role expectations during nurse and patient interactions is a difficult one. However, because a nurse's appearance can impact perceptions during an encounter, dress codes in the acute care setting should take this into account. To be perceived as skilled and knowledgeable, nurses should wear a solid colored uniform with limited visible body art.

Clothes encounter: patient perception of nursing attire in a behavioral health unit

BACKGROUND

In an acute behavioral health unit, patients' perceptions of nurses can be influenced by the type of clothing they wear.

OBJECTIVES

The purposes of this study were to determine if mental health patients had preferences related to nursing attire, to determine if patient preference varied with age, and to determine if nursing attire affected patients' thoughts on approachability, competence, and professionalism.

STUDY DESIGN

A six-question survey was distributed to patients who met specific criteria between August and December 2008.

RESULTS

Overall, patients did not have a preference for the type of attire worn by staff. Identification of nurses was a concern for many. More than half of the respondents indicated approachability was not affected by attire; however, 29% said that street clothes made the nurse less approachable. Attire did not affect patient perception of competence or professionalism.

CONCLUSION

As behavioral health care changes, staff attire may need to be reconsidered.

Perceptions of outpatients regarding the attire of physiotherapists

PURPOSE

This study investigated perceptions of patients regarding physiotherapists' attire.

METHODS

Three hundred patients in three publicly funded outpatient physiotherapy clinics were asked to complete a questionnaire, ranking four photographed modes of attire (lab coat, tailored dress, "scrubs," and jeans) in terms of professionalism, preference, and appropriateness and rating their level of agreement with four statements about physiotherapists' attire.

RESULTS

Response rate was 63.7 %. The lab coat was ranked most professional, tailored dress most preferred, and jeans least professional and least preferred. Although jeans were deemed inappropriate (p < 0.001), strong support was shown for wearing jeans on "casual day" (p = 0.001). Age of respondents influenced the perception of the appropriateness of wearing jeans (p = 0.007 for male therapist; p = 0.017 for female therapist); only the cohort <36 years considered jeans appropriate apparel. Overall exposure to physiotherapists (number of lifetime visits) affected patients' perceptions of the importance of attire (p = 0.039) and the appropriateness of wearing jeans (p = 0.018): as number of visits increased, perceived importance decreased and perceived propriety of jeans increased.

CONCLUSION

The findings of this study, the first to examine patients' opinions of physiotherapists' attire, suggest that outpatients made clear distinctions between what they perceived as professional and what they preferred, as well as between the appropriateness of physiotherapists' wearing jeans in general and the appropriateness of their doing so on "casual day." Age and exposure to physiotherapists influenced patients' perceptions of attire.

Clinical nurses find a voice: how nursing practice councils succeeded at one hospital

A not-for-profit community hospital created nursing practice councils, both hospital-wide and on individual units, giving clinical nurses the power to implement evidence-based practices.