
'PJ paralysis': Why advocates are pushing to get patients out of pyjamas - walterbell
https://www.ctvnews.ca/health/pj-paralysis-why-advocates-are-pushing-to-get-patients-out-of-pyjamas-1.4378824
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HNthrow22
"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
> 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.

------
silencio
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...

~~~
arkades
> 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
> 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.

------
ddingus
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
> Get the fuck up. Just get started.

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

~~~
sitharus
> 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.

~~~
xattt
Thank you for putting this into tangible concepts.

There’s a slice of a population that I work with that shows tendencies of the
way that “typical people” would react to a given situation. If a challenging
situation comes up, there’s a good balance between anxiety and resiliency.
They tend to be in acute care specifically because their needs exceeded the
ability to cope and manage their situation at home.

At the same time, mental health conditions can diminish individuals’ ability
for resilience with chronic conditions. Thus, this necessitates admission to
acute care for something that could be managed at home. In acute care, the
life style pattern known to these patients presents as ongoing “malingering”
in beds.

The “activation” that’s discussed in the article seems to reflect that
individuals who do have diminished resiliency tend to do better when their
days are structured.

------
ChrisWilding
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
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.

~~~
exelius
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.

~~~
arkades
> 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.

------
emerongi
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
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
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.

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

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

~~~
sonnyblarney
Yes! Definitely a time for that as well! And it further validates the point -
live the identity of the situation: businessy clothes for businessy work,
relaxed clothes for creative work ... and regular clothes for being/acting
recovered!

------
salex89
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...

------
arkades
So, I went ahead and straight to the website of the actual campaign
([https://www.endpjparalysis.com/](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](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.

~~~
DanBC
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.

~~~
arkades
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
I attribute this to
[https://en.m.wikipedia.org/wiki/Hawthorne_effect](https://en.m.wikipedia.org/wiki/Hawthorne_effect)

