Asked to picture a hospital ward, you would probably imagine a line of beds occupied by patients wearing pyjamas or nightdresses.
But now, England’s chief nurse, Professor Jane Cummings, wants to change all that — she is leading a new campaign against a threat to the health of patients, particularly older patients, which she has called ‘pyjama paralysis’.
In essence, this is the idea that wearing pyjamas reinforces the feeling of being unwell and slows down patients’ recovery.
Professor Cummings wants NHS nurses to get patients up and about and dressed in their own clothes as soon as is possible.
Last week, she issued nurses with a 70-day challenge, setting them a target of cutting bed rest by the equivalent of one million patient days between April 17 and June 26.
Her scheme exhorts nurses to identify patients who are ready to move out of bed and encourage them to change out of their pyjamas and get up and about.
To many, this might seem counterintuitive; bed rest has been a staple of nursing care since the days of Florence Nightingale. However, research increasingly suggests that it can have negative effects.
A report by the National Audit Office (NAO) in 2016, for example, found that just ten days spent in bed can effectively age your body by the equivalent of ten years.
This is due to a phenomenon called ‘deconditioning’, whereby a sustained lack of activity causes a sudden plunge in fitness levels.
Ten days of inactivity withers bed-resting patients’ leg and muscle strength by at least 10 per cent, says the NAO report. Meanwhile their heart and lung fitness — measured as aerobic capacity — drops by around 12 per cent. Furthermore, ‘wearing pyjamas reinforces feeling unwell and can prevent a speedy recovery’, argues Professor Cummings. Making the move to day clothes can shift a patient’s self-image from ‘I’m sick’ to ‘I’m getting better’.
Obviously, each patient’s condition needs to be taken into consideration and this idea cannot apply to everyone, she adds, but for many, ‘it’s a matter of nurses enabling them to get up, get dressed and get moving’.
The initiative has been pioneered by Ann-Marie Riley, a nurse at Nottingham University Hospitals NHS Trust. ‘We know that if patients stay in their pyjamas for longer than they need to, they lose mobility, fitness and strength, and stay in hospital longer,’ she says.
U npublished research by the trust has found multiple benefits, particularly among older patients. ‘We have found that getting patients up and about earlier is linked with a 37 per cent reduction in falls and 86 per cent fewer pressure sores,’ says Ann-Marie.
She adds that studies suggest as many as three in five ‘immobile’ older patients actually have no medical need for bed rest — and that doubling their walking levels can significantly cut the length of their hospital stays.
A recent pilot project to get patients up and dressed at nine trusts in the East of England reduced stays by nearly 92,000 days.
This approach may be long overdue, as the problems caused by prolonged bed rest have been known for decades.
In the British Medical Journal in 1947, Dr Richard Asher, a British endocrinologist (actress Jane Asher’s father), cited a study of 100 patients asked either to sit and walk the day after surgery, or to lie in bed for up to 15 days.
Those on bed rest took around nine weeks to return to work, while the walkers were back at work in an average of five weeks. They also suffered far fewer complications.
Some argue that the fight against ‘pyjama paralysis’ is simply the revival of a common-sense policy the NHS has somehow forgotten.
As one person told the Nursing Standard: ‘I trained as a nurse in the late Eighties and getting people dressed was a fundamental part of our education.’
But the policy is being spread further than before. A campaign called #Fit2Sit is also being rolled out by ambulance staff and emergency departments.
This urges the staff to put an end to patients lying down on trolleys and stretchers if they are well enough to sit or stand, in the hope that the patients will feel more confident about the state of their health and recover more quickly.
Cynics might say this could prove a handy way for the Government to stop headlines about patients being left on trolleys, by instead leaving them propped up against walls. But, as research shows, curtailing excess bed rest could save millions of people from suffering unnecessary complications after surgery.
It’s also a new way for patients to stand up for themselves — and the NHS.