Article Figures & Tables
Tables
Characteristic No. (%)* of stakeholders
n = 40Age, yr 20–39 8 (20) 40–59 17 (43) 60–79 2 (5) 80–99 2 (5) Age not specified 11 (28) Sex Female 25 (63) Male 15 (38) Geography Ontario 22 (55) Nova Scotia 7 (18) Quebec 1 (3) United States 2 (5) Location not specified 8 (20) Stakeholder group Patients or family members† 8 (20)¶ Clinicians‡ 12 (30) System stakeholders§ 20 (50) ↵* The percentages in some categories sum to more than 100 because of rounding.
↵† Domains: bariatric, burn care, diagnostic imaging, emergency care, intensive care, obstetric, other (general use or domain not declared), palliative, physical rehabilitation, psychiatry, surgery. Many participants discussed the gown in the context of multiple domains, owing to diverse and multiple experiences.
↵‡ Domains: diagnostic imaging, emergency care, infection control, inpatient and outpatient care, long-term care, obstetric and pediatrics, physical and neurologic rehabilitation, psychiatry, surgery. Professions represented medicine, nursing, occupational therapy, physiotherapy, midwifery and diagnostic imaging. Many participants discussed the gown in the context of multiple domains owing to diverse and multiple experiences.
↵§ Domains: fashion and design (health care–based); health care leadership (executives, purchasers, safety and quality control); hospital insurance; infection control (research or industry); laundering, repair or disposal; manufacturers; supply chain; textile experts; wearable technology. Many participants discussed the gown in the context of multiple domains owing to diverse and multiple experiences.
↵¶ We categorized each participant into 1 of the 3 stakeholder groupings to reflect the context in which they primarily interacted with gowns. Clinicians and system stakeholders often spoke of their experiences as a patient or family member, which is not reflected in this sample size.
- Table 2:
Quotes supporting the theme “gown utility,” reflecting the functionality of the gown and impacts on health care processes and procedures and patient outcomes
Primary stakeholder group (primary domain) Participant quote Patient or family member no. 1 (diagnostic imaging, surgery) The problem is how can you do it by yourself. You have to tie these things up at the back and have your butt hang out. It’s like why they have to tie up at the back and expect you to do it yourself? It’s impossible. Patient or family member no. 2 (emergency care, surgical) I have to look for the ties and you can’t tie it. Patient or family member no. 3 (bariatric) It’s difficult to tie. I wouldn’t be able to do it myself … and there is always the fear that it will open up, right? Clinician no. 1 (physician in emergency care) A lot of people don’t know if it should go on with the ties in the front or the ties in the back. There is not a day that goes by where I am in a clinical environment that someone hasn’t got it on backward or falling off of them or it doesn’t cover them or it’s too long or short. Clinician no. 2 (physiotherapist in multiple domains) When they are not mobilizing or moving as much as they could — it actually produces a much worse outcome. Clinician no. 3 (nurse in obstetrics) The most important for our unit would be the ability to remove the gown without impacting the IVs and to be able to selectively expose body parts on the front of a patient … For our purposes, they [current gowns] are terrible — everything about them is wrong. For a labouring mother and a new mother with a baby … if we could just unbutton 1 side of the gown or 1 area of the gown as if it was designed in an intuitive way that allowed us to expose certain areas of the body, I think that would be great. Clinician no. 4 (nurse in obstetrics) One of the obstacles is that people are busy, and they don’t want to go through the whole thing of taking the IV tubing out of a pump, pulling it through the gown and everything is twisted up, and then you’ve got all these other wires and an epidural tube is taped to the gown and all this other stuff. So, I find that patients a lot of the time, if I am covering somebody for break, I will come to the room and they are wearing a dirty gown and I wonder how long it has been like that and many people say it is a pain to change so leave it. It is annoying to have to thread everything through the arm so that could be something [to consider regarding redesign]. Clinician no. 5 (physiotherapist in multiple units) I do like the fact [that gowns] are just cotton or a cotton blend that is really thin — the cotton absorbs any liquid and shows it as a stain and typically it doesn’t hide any issues that are going on where it’s covering. So, if they are fresh from surgery and the wound is bleeding or their wound packing isn’t doing what it is supposed to, you can see that really well. If they are having an incontinence issue, you can usually see that pretty easily. So, from a material thickness perspective, I like that because you can tell right away if there is any sort of other problems going on from a fluid perspective.
The things that I liked were that they were really easy to remove … I found that they were really fast to get on and off … really easy to help with people who had limited arm range of motion. … Often times the gowns get dirty and I found that the current gowns are really easy to tell if they are dirty … It’s really easy to tell if they are wet and I think that’s part of the blue colour, too.
If somebody had a bruise on their thigh, just from going in and glancing when they got out of bed, I could tell if it was better or worse rather than having somebody take down their pants to see those changes. So, in terms of physio assessment and measuring range of motion, I found the gown to be really easy that way and easy to move over to cover what needs to be covered.Clinician no. 6 (nurse in obstetrics) Doing an epidural … it is good to have that [back of gown] open, but I am not sure in general why the hospital gowns open at the back. Clinician no. 7 (nurse in obstetrics, pediatrics) I think the big thing for our department that makes the gown hard as well is the breastfeeding moms. After they deliver, their gowns are tied up at the back, they have to get someone to untie it and they have to pull it down, so they can breastfeed. It isn’t accessible, it doesn’t work. System stakeholder no. 1 (researcher in geriatric medicine) From a mobility perspective, I think the gowns, the way they are, are limiting mobility … Patients don’t feel as nice wearing the gowns. They don’t feel as nice getting outside the room and walking if they are half exposed. System stakeholder no. 2 (laundering, repair or disposal) Through the design process, I imagine the fastener was given a lot of thought — what led to holding onto this design of the fastener as opposed to a button or a clasp or anything else along those lines? System stakeholder no. 3 (fashion and design) I am not a big fan of Velcro because the pinch grasp that you need to open and close Velcro is usually not present in the group of patients I observed in rehab; that is a very difficult fastener to manipulate. There is that hook side of the Velcro — if it comes in contact with skin or other clothing in the laundry, if you don’t fasten it shut before you launder the garments, is also problematic because it sticks to other garments in the laundry and lint builds up in there, so I am not a big fan of Velcro, either. The challenge is what other fastener to use … using a magnetic fastener? But again, doing a loop over top of the fastener, so you can put your 2 fingers under the loop and lift rather than pinching and grasping to get the fastener open. System stakeholder no. 4 (hospital leadership) They’re confusing pieces of clothing and it’s not always clear if the opening is in the front or the opening is in the back and maybe that varies. Note: IV = intravenous.
- Table 3:
Quotes supporting the theme “gown economics,” reflecting the tensions between gown costs and design versus gown users’ needs
Primary stakeholder group (primary domain) Participant quote Patient or family member no. 3 (bariatric) I know it sounds terrible, but they [hospitals] want to spend their money on the machine [that] helps save lives versus a gown that is going to fit an overweight patient. Clinician no. 6 (nurse in obstetrics) You have to wear 2 [gowns] and I always give people 2 when they are walking around the halls because no one wants to have their back exposed. Clinician no. 5 (physiotherapist in multiple units) When they are walking — back, buttocks, legs, all of that can be exposed. It’s tough with the gowns because a lot of patients really don’t … what we did to get around it was to just double-gown, right? So, 1 in the front and 1 on the back in reverse, but a lot of patients really don’t like that because they feel confined. System stakeholder no. 5 (textiles expert) I know everybody hates them [current gowns] but my conclusion after supplying them for so many years and seeing that the basic design hasn’t changed … it is designed not for the convenience or for the comfort of the patient. It’s designed for the efficiency of the laundry processing … That [laundering] is the most expensive. That is the biggest cost in the life cycle of these products … Some companies here in Canada are putting a major push on converting everything to 100% polyester because it’s so much cheaper to process [dries faster]. System stakeholder no. 2 (laundering, repair or disposal) If you’re providing 2 gowns for dignity and the hospitals are billed on a per-kilogram basis or per-pound basis … come up with a solution that you have 1 gown that weighs more than an individual [but] that is a lot less than 2. You are going to give them some cost savings. System stakeholder no. 6 (hospital leadership) We have seen a surge in requests — polyester in itself has come a long way in the last few years. So, it can be brushed, it can be heavier weight, it feels nice, it’s nice against the skin and it’s still breathable, but the great thing about polyester is that it holds its colour and is very durable. System stakeholder no. 7 (manufacturing) I would say cost is probably by far the number one [factor to consider] and you know you are probably the eighth or ninth person I have engaged with over the years, who has attempted to do this. Primary stakeholder group (primary domain) Participant quote Patient or family member no. 3 (bariatric) They weren’t fitting me, and they were uncomfortable because of my size … I am a large fellow … I am covered with a sheet most of the time … Majority of the time is spent in the buff … Gowns don’t do anything … One-size-fits-all is not a good mindset. Patient or family no. 2 (emergency care, surgical) The hospital gowns are not physically comfortable. They are uneasy and awkward. They take away your esteem. Do you know what I mean? Like, you go in there and you know how you feel, you are worried and anxious, and then you put this gown on and it’s dreadful and terrible … It is awful … Make sure your butt is covered, and it is all twisted and it is extremely uncomfortable. Patient or family no. 4 (surgery) A side opening. One piece, but with the side opening. I came to the conclusion that would be the best for me, personally. Clinician no. 8 (nurse in emergency care) The side [opening] might actually might be ideal because a) it’s easier to tie and b) I’d probably rather have some of my side exposed rather than my entire back … They are kind of bleak looking, to be honest — maybe if the material was nicer and they had a little more dignity in terms of coverage, it might be a bit better. Clinician no. 9 (occupational therapist in multiple units) Especially men will request pants, maybe because they don’t feel comfortable [in] something like a dress and most floors don’t have the hospital pants available. Clinician no. 6 (nurse in obstetrics) They are ill designed because they don’t look comfortable, they don’t look cozy, they are open — you have to wear 2 … People can be comfortable and more human and less like “here we are all like prisoners wearing the same orange jumpsuit.” I know that sounds extreme but [it] is a real big thing for me. I have been a patient in a gown before, so I can speak to that — you feel exposed. It is flimsy, it’s not comfortable, there is not a lot of security in it, and I think a lot of the time when people are in hospitals, they want to feel comfortable. System stakeholder no. 8 (fashion and design) I think generally the most significant concerns of people are the modesty concern, how uncomfortable the fabric is, the fact that it is not attractive, it doesn’t keep you warm and those ties are uncomfortable when you are lying on them or are trying to do them up. It’s flawed in multiple ways. System stakeholder no. 1 (researcher in geriatric medicine) There are a lot of negative things associated with the gowns — definitely from the patient’s and family’s perspective around dignity, it’s limited, it has created a stigma. System stakeholder no. 4 (hospital leadership) Feeling vulnerable and they are already in a position where they’re in pain or uncomfortable or frightened and this adds to that power imbalance with health care providers and patients. System stakeholder no. 9 (health care leadership) It says one size fits all, but it doesn’t fit obese patients. System stakeholder no. 10 (health care leadership) With all communities, modesty is coming up more often. People want more coverage. Mostly females or males speaking on behalf of Muslim females regarding coverage. May cost more, but trade-off, if right thing for patients. Primary stakeholder group (primary domain) Participant quote Patient or family member no. 5 (psychiatric) Well, they are ugly. I didn’t feel attractive at all in the gown, I didn’t feel dressed up — like when I wear my t-shirt and my flannel, I feel dressed up compared to the gown. The gown slumps and is long — like, it went down to your knees and it looked very old fashioned. I just think they’re ugly. Clinician no. 6 (nurse in obstetrics) I think the blue with the pattern on is just like a bummer. I know it sounds silly … You look like a bedsheet. Clinician no. 1 (physician in emergency care) I just feel like as soon as you put one of those things on people, suddenly, it is like this illness behaviour that goes with it, this stereotype that goes with the Johnny shirt hospital gown and all of a sudden it looks like you are sick. Clinician no. 10 (nurse in emergency care) A lot of people say it’s ugly and there’s a lot of negative comments usually. System stakeholder no. 11 (health care leadership) I think that we can do quite a bit in terms of improving the looks of them … the ones we have here … blue and white pattern or they’re completely blue and they’re ugly. They just look institutional.
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