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The Impact of the Evolving Nursing Uniform on Hospital Acqui

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Laura Vorona

on 24 April 2015

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Transcript of The Impact of the Evolving Nursing Uniform on Hospital Acqui

We are interested in the effects of a standardized nursing uniform on nursing professionalism.
Focus group: Nurses in the adult clinical setting
Patient Population: Adults admitted in hospital
Patient Outcomes: Patient will be able to correctly identify RNs from other hospital personal and view them as professional members of the healthcare team.
A Professional Approach to Nursing Attire

Patient Perception of Contemporary Nursing Attire: A Pilot Study

Examine patient perception of the nurse uniform
Different uniforms
Patient perception using Likert scale
Sample size:
43 adult patients
Prospective comparative design
Patients associated the solid white pantsuit not only more professional in appearance than print or solid-colored uniforms, but also as displaying more confidence and competence
Potential biases from media, need for qualitative interviews, MORE research

Image is More Than a Uniform
The Professional Appearance of RNs:
An Integrative Review
: To evaluate published, peer-referred studies on the effect of standardized uniform style and color for RNs.
: Seven studies that fit author criteria were analyzed using the Oxford Centre for Evidence-Based Medicine evidence hierarchy.
Standardized uniforms reflect a more professional appearance and allow patients to easily identify their care providers.
Inability of patients to identify RN poses safety concern and undermines our promise of quality nursing care.
Inconsistent data on the preferred style and color of uniforms.
What Nurses Want in a Uniform
Mrs.Kelly (Massachusetts General, Boston; B.S., Teachers College Columbia University)

The American Journal of Nursing Oct. 1957
Criticisms of uniform:
-"too many frills"
-Look like party dresses
What they desire:
"Should be different, more dignified"
We will be looking at research comparing the perceptions of standardized versus diversified uniforms
A Picture of Competence
American Journal of Nursing, 1988
People find nurses in traditional uniform to be "neat, organized, reliable competent, and pleasant than did those who saw her dressed in scrubs" (p.1110).
: This was a qualitative study to explore the phrase "image of the nurse" when creating/ upholding the brand of a large healthcare system (Indiana University Health/9000 nurses). IU Health felt that uniforms conveyed both a literal figurative image for the patients.

: A total of 39 nurse focus groups (363 nurses) and 63 direct care nurses took part in the study. Focus groups were conducted throughout IU Health statewide (IV) using the same group facilitator and the same focus group questions.

Nursing uniforms, along with nursing badges, and overall cleanliness of the nurse were identified as the most important factors in upholding ASSURANCE message. This lead to the implementation of a standardized nurses dress code across the healthcare system.
1940- Nursing School
1 Franzoi, S.L. (1988). Uniform supplement: A picture of competence.
The American Journal of Nursing, 88(8), 1109-1110+1112. http://www.jstor.org/stable/3470961

2 Hatfield, L.A., Pearce, M., Del Guidice, M., Cassidy, c., Samoyan, J. & Polomano, R.C. (2013).
The professional appearance of registered nurses: An integrative review of peer-referred studies. Journal of Nursing Administration 43(2). Doi: 10.1097/NNA.0b013e31827f2260

3 Kelly, C.W. (1957). What nurses want in a uniform. The American
Journal of Nursing, 57(10), 1282-1284. www.jstor.org/stable/3461501

4 Lippincott Williams &Wilkins (1940). The student nurse's uniform. The American Journal of
Nursing, 40(11), 1204-1211. http://www.jstor.org/stable/3414657

5 Porr, C., Dawe, D., Lewis, N., Meadus, R. J., Snow, N., & Didham, P.
(2014). Patient perception of contemporary nurse attire: A pilot study. International Journal Of Nursing Practice, 20(2), 149-155. doi:10.1111/ijn.12160

6 Spragley, F. and Francis, K. (2006). Nursing uniforms: Professional
symbol or outdated relic? Nursing Management, 37 (10), 55-58. nursingmanagement.com

7 Thomas, C., Ehret, A., Ellis, B., Colon-Shoop, S., Linton, J., & Metz, S. (2010). Perception of nurse
caring, skills, and knowledge based on appearance. Journal Of Nursing Administration, 40(11), 489-497. doi:10.1097/NNA.0b013e3181f88b48

8 Wocial, L.D., Sego, K., Rager, C., Laubersheimer, S., & Everett, L. Q. (2014). Image Is More Than
a Uniform.
Journal Of Nursing Administration
, 44(5), 298-302. doi: 10.1097/ NNA.0000000000000070
A Brief History of the Nursing Uniform
People look for a unique uniform
only worn by nurses that also exhibits the qualities stated above.
-Traced back to religious orders

-1836: Earliest mention of nursing uniforms in literature at Kaiserwerth Deaconess Institute's Nurse Training School.
-Required a standardized uniform
-"...believed the nurse had to have a respectable and competent outward appearance as
both an individual and as a member of a respected occupational group"(Spragley & Francis, 2006,p.58)

-Florence Nightingale brought a military influence to the uniform
-"wanted nurses to be represented as clean and neat, and wanted them to be distinguished more as a “lady” nurse" (Spragley & Francis, 2006,p.58)

Uniforms change to short sleeves and one piece to save costs of laundering and to ensure sterile technique.
Students wear chevrons or other small insignia on collar.
The American Journal of Nursing, Vol. 40, No. 11
-"White has traditionally been the color of nursing uniforms and dates back to the wearing
of white by servants. In the 1900s, nursing magazines were emphasizing all-white uniforms
for nurses, but it wasn’t until the 1940s that all hospital nurses wore white"(Spragley & Francis, 2006,p.58).
The White Uniform

Nursing Recommendations
Image References
Uniforms have constantly changed throughout the decades

More research needs to be conducted in the United States concerning this topic

Regardless of color, there is evidence, the nurse's image does affect the patient's perception of the nurse

Image retrieved: http://www.thegreathospital.co.uk/history/medieval/background.shtml
Image retrieved: http://ww2.odu.edu/oduhome/news/spotlight104.shtml
Image retrieved: http://magazine.nursing.jhu.edu/2005/04/uniform-measures/
Image retrieved : http://aisforayeaye.blogspot.com/2011/07/
Image retrieved: http://whitescrubs.org/wp-content/uploads/2012/10/nursing-uniform.jpg
Image retrieved: http://www.bbc.co.uk/schools/primaryhistory/famouspeople/florence_nightingale/
Image retrieved: http://thenerdynurse.com/2012/05/historic-military-nursing-propaganda-images.html
Image retrieved: http://www.jstor.org/stable/3470961

Evidence suggests that a solid-color uniform be worn by RNs in adult inpatient units, however, a specific color is not preferred over another
Level of evidence according to JBI is level three
Sentara has adopted standardized uniform policy to promote professional image in healthcare
Nursing Traits

Perception of Nurse Caring, Skills and Knowledge Based on Appearance

Image retrieved: http://www.jstor.org/stable/3414657
ODU Class of 1967
Image: doi:10.1097/01.NURSE.0000444535.96822.3b
White is the preferred color of most nursing schools because it cannot fade. However, some schools used other solid colors. Which caught on with the public by 1940.
Assess patient’s perception of nurses, nursing staff, and nursing students based on their attire and visibility of body art
Dependent Variable
: Patient, nurse faculty, nurse, student nurse perceptions regarding the uniform
Independent Variable
: RN uniforms
Sample Size:
A convenience sample of 240 patients, nurses, students, and faculty
Descriptive comparative design
Nurses wearing solid scrubs were perceived as being significantly more skilled and knowledgeable than a nurse wearing print or T-shirt. All subjects rated the nurse with the most visible body art as being the least caring, skilled, and knowledgeable
Anna English, Nick Grose, Abigail Hren, Megan Manning, Laura Vorona, Latonya Warren
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