Register      Login
Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

New Zealand hospice staff perspectives on ‘Xcellent Gowns’ for big bodied palliative care patients: a qualitative study

Jazmin Phillips 1 , Emily Wood 2 , Tanya Loveard 3 , Eileen McKinlay https://orcid.org/0000-0003-3333-5723 4 , Carol MacDonald 5 , George Parker https://orcid.org/0000-0002-5749-3294 6 , Lesley Gray https://orcid.org/0000-0001-6414-3236 2 *
+ Author Affiliations
- Author Affiliations

1 University of Otago, Christchurch, New Zealand.

2 Department of Primary Health Care & General Practice, University of Otago, Wellington/Te Whare Wānanga o Otāgo ki Te Whanga-Nui-a-Tara, Wellington 6242, New Zealand.

3 Mary Potter Hospice, Wellington, New Zealand.

4 University of Otago, New Zealand.

5 Masterton, New Zealand.

6 Victoria University of Wellington, New Zealand.

* Correspondence to: lesley.gray@otago.ac.nz

Handling Editor: Tim Stokes

Journal of Primary Health Care 15(3) 238-245 https://doi.org/10.1071/HC23009
Published: 29 May 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

A handful of reports detail efforts to redesign traditional hospital gowns to address common concerns related to patient comfort and privacy for big bodied patients. Results suggest that improving gown design has the potential to improve both the patient and carer experience and satisfaction of care.

Aim

This study aimed to ascertain the utility of gowns purposely designed for big bodied patients (named Xcellent Gowns) from a staff perspective.

Methods

Qualitative semi-structured interviews were conducted in 2022 with 14 hospice staff members. Interview transcripts were uploaded to DedooseTM. Data were analysed utilising reflexive thematic analysis according to a six-phase process including data familiarisation, iterative data coding, and theme development and refinement.

Results

The qualitative analysis of the interview data identified four main themes: (1) the gown experience, (2) fit-for-purpose, (3) love and dignity, (4) design principles. Each theme is presented and discussed with illustrative quotes from participants’ interview transcripts.

Discussion

The perspectives of the staff participants in this study confirm research findings from other healthcare settings, that the patient and carer experience may be improved through focused redesign of this vital item of patient clothing.

Keywords: body size, equity, palliative care, qualitative study.

References

Jankovska D, Park J. A mixed-methods approach to evaluate fit and comfort of the hospital patient gown. Int J Fash Des Technol Educ 2019; 12(2): 189-198.
| Crossref | Google Scholar |

Lucas CM, Dellasega C. Finding common threads: how patients, physicians and nurses perceive the patient gown. Patient Exp J 2020; 7(1): 51-64.
| Crossref | Google Scholar |

Oliver D. David Oliver: there’s no dignity in hospital gowns. BMJ 2020; 368: m413.
| Crossref | Google Scholar |

Cogan N, Morton L, Georgiadis E. Exploring the effect of the hospital gown on wellbeing: a mixed methods study. Lancet 2019; 394: S32.
| Crossref | Google Scholar |

Morton L. Using psychologically informed care to improve mental health and wellbeing for people living with a heart condition from birth: a statement paper. J Health Psychol 2020; 25(2): 197-206.
| Crossref | Google Scholar |

Dakessian Sailian S, Salifu Y, Saad R, et al. Dignity of patients with palliative needs in the Middle East: an integrative review. BMC Palliat Care 2021; 20(1): 112.
| Crossref | Google Scholar |

Arunachalam P, D’Souza B. Patient-Centered Hospital Gowns: A Novel Redesign of Inpatient Attire to Improve Both the Patient and Provider Experience. In: Proceedings of the 2022 Design of Medical Devices Conference; 11–14 April 2022; Minneapolis, MN, USA. V001T04A008. ASME; 2022. 10.1115/DMD2022-1058

Gordon L, Dunne L. The Re-design and Evaluation of the Patient Gown for an Integrated Healthcare Organization. In: International Textile and Apparel Association Annual Conference Proceedings. Vol. 70, Issue 1. Iowa State University Digital Press; 2013.

Gordon L, Guttmann S. A user-centered approach to the redesign of the patient hospital gown. Fash Pract 2013; 5: 137-151.
| Crossref | Google Scholar |

10  Salahuddin Y, Abou-Zaid C, Jabber Z, et al. Enhancing patient dignity by considering new innovations in hospital gowns: a qualitative study using one-to-one interviews. World Wide J Multidiscip Res Dev 2021; 7(2): 18-22.
| Google Scholar |

11  Black S, Torlei K. Designing a new type of hospital gown: a user-centered design approach case study. Fash Pract 2013; 5(1): 153-160.
| Crossref | Google Scholar |

12  Byers LEE. “Warmth, Sympathy and Understanding May Outweigh the Surgeon’s Knife or the Chemist’s Drug”… Unless They’re Fat. An Analysis of Fat Patients’ Experiences with Health Care Providers. Doctoral dissertation; 2018. (George Mason University, Fairfax, VIrginia, USA) Available at https://hdl.handle.net/1920/11090

13  Auckburally S, Davies E, Logue J. The use of effective language and communication in the management of obesity: the challenge for healthcare professionals. Curr Obes Rep 2021; 10(3): 274-281.
| Crossref | Google Scholar |

14  Accident Compensation Corporation. Moving and handling people 2012. pp. 387–406. Available at http://www.acc.co.nz/assets/provider/acc6075-moving-guide-bariatric.pdf

15  Hales C, Gray L, MacDonald C, et al. Dissonance in naming adiposity: a quantitative survey of naming preferences from a convenience sample of health professional and lay population in Aotearoa New Zealand. N Z Med J 2019; 132(1496): 20-30.
| Google Scholar |

16  Volger S, Vetter ML, Dougherty M, et al. Patients’ preferred terms for describing their excess weight: discussing obesity in clinical practice. Obesity 2012; 20(1): 147-150.
| Crossref | Google Scholar |

17  Baqraf F, Mohamed MA, Mahgoub AA. Obstacles face nursing staff toward care of critically ill obese patient in intensive care units. Assiut Sci Nurs J 2020; 8(23): 100-112.
| Crossref | Google Scholar |

18  Parker G, Pause C. The Elephant in the Room: Naming Fatphobia in Maternity Care. In: Verseghy J, Abel S, editors. Heavy Burdens: Stories of Motherhood and fatness. Demeter Press; 2018. pp. 19–32.

19  Nwosu AC, Raj J, Hugel H. Palliative care and obesity: are we prepared? J Palliat Med 2012; 15(1): 7-8.
| Crossref | Google Scholar |

20  O’Donnell D, Ní Shé É, McCarthy M, et al. Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting. BMC Health Serv Res 2019; 19: 797.
| Crossref | Google Scholar |

21  Maxcy SJ. The new pragmatism and social science and educational research. In: Ethical foundations for educational administration. (E. Samier editor) Routledge; 2003. pp. 155–177.

22  Rothblum ED, Solovay S, editors. The Fat Studies Reader. New York University Press; 2009.

23  Braun V, Clarke V. Successful qualitative research: a practical guide for beginners. London: Sage; 2013.

24  Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol 2021; 18(3): 328-352.
| Crossref | Google Scholar |

25  Desselle MR, Ibanez-Arricivita IN, Blackler AL, et al. Transform the uniform: designing fashion for the hospital of the future. Int J Fash Des Technol Educ 2021; 14(2): 232-242.
| Crossref | Google Scholar |

26  Frankel R, Peyser A, Farner K, et al. Healing by leaps and gowns: a novel patient gowning system to the rescue. J Patient Exp 2021; 8: 23743735211033152.
| Crossref | Google Scholar |

27  Edvardsson D. Balancing between being a person and being a patient—A qualitative study of wearing patient clothing. Int J Nurs Stud 2009; 46(1): 4-11.
| Crossref | Google Scholar |

28  Cook KM, LaMarre A, Rice C, et al. “This isn’t a high-risk body”: Reframing Risk and Reducing Weight Stigma in Midwifery Practice. 2019. Available at https://atrium.lib.uoguelph.ca/xmlui/bitstream/handle/10214/17830/Cook_ThisIsnt_ra04_vor.pdf?sequence=1&isAllowed=y

29  Freeman L. A matter of justice: “fat” is not necessarily a bad word. Hastings Cent Rep 2020; 50(5): 11-16.
| Crossref | Google Scholar |

30  Friedman M, Rice C, Lind ERM. A high-risk body for whom? On fat, risk, recognition and reclamation in restorying reproductive care through digital storytelling. Feminist Encounters: J Crit Stud Cult Polit 2020; 4(2): 36.
| Crossref | Google Scholar |

31  Harper K. “That could have killed me.” How anti-fat bias can be dangerous, even deadly, for heavier patients. Masters dissertation. Massachusetts Institute of Technology; 2021. (Massachusetts, USA) Available at https://dspace.mit.edu/bitstream/handle/1721.1/139976/harper-kharper1-sm-cmsw-2021_thesis.pdf?sequence=1&isAllowed=y