The impact of street clothes among caregivers on residents with dementia in special care units: The STRECLO study

Abstract

Aims and objectives:To examine the impact of caregivers' street clothes on people living in special care units (SCUs). We hypothesised that caregivers wearing street clothes would improve residents' relationships with other residents and caregivers and, as a consequence, would improve their quality of life.Background: Environmental factors have been recognised as important elements in the care of people with dementia. Among these factors, the importance of the caregivers' appearance and more particularly their street clothes has been raised.Design: The Street Clothes study (STRECLO) was designed as a multicentre crossover observational study. Method:This study was conducted in two volunteer nursing homes. It involved videotaping residents (N = 24) over a 6-month period: caregivers wore uniform and then street clothes for two consecutive three-month periods. Three outcome measures were observed as follows: (a) behaviours of residents, (b) contents of conversations and (c) proximal interactions between residents and caregivers. The STROBE checklist was used to ensure quality reporting during this observational study.Results: When caregivers wore street clothes, we observed the following: (a) greater solicitation and less anxiety in residents, (b) content of conversations between residents and caregivers included more personal and less health information, and (c) more proximal interaction between caregivers and residents. Conclusion:To our knowledge, this is the first study which investigated the long-term effects on residents of SCU caregivers wearing street clothes. Our study demonstrated the potential benefit of not wearing uniform on the quality of life of institutionalised people with dementia.Relevance to clinical practice: Given the budgetary constraints faced by nursing homes, wearing street clothes for caregivers could be readily applied to clinical practice and represents a promising way to increase the quality of life of dementia residents and their families.

A systematic review of specialty dementia care units in long‐term care settings

“…Interviews and observational studies were conducted in several countries, exploring family members and nursing home staffs' perceptions of care and social interactions with residents. These studies found that overall, a meaningful social community is associated with increased resident quality of life and sense of dignity as well as staff well‐being 65–80 . Focus groups conducted with nursing home staff revealed that staff were better able to provide care to residents and mitigate resident‐to‐resident aggression when they understood the trajectory of ADRD 73,75 …”

“…These studies found that overall, a meaningful social community is associated with increased resident quality of life and sense of dignity as well as staff well-being. [65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] Focus groups conducted with nursing home staff revealed that staff were better able to provide care to residents and mitigate resident-to-resident aggression when they understood the trajectory of ADRD. 73,75…”

“What if It’s not Just an Item of Clothing?” – A Narrative Review and Synthesis of the White Coat in the Context of Aged Care

“…The relational dynamic between the patient and the professional is also impacted by the presence, or absence, of the white coat. The absence of uniforms would establish a relationship of equals and force professionals to humanise their care ( Bailly et al, 2020 ; Charras & Gzil, 2013 ; Richardson, 1999 ). The resulting authenticity and relational reciprocity could promote a person-centred care model, which is currently recommended in the geriatric care sector ( Kogan et al, 2016 ).…”

“…Excessive help that we tend to provide to older adults, which stems from our paternalistic attitudes ( Vale et al, 2020 ; Sánchez-Izquierdo et al, 2019 ), can be reinforced by wearing a uniform. Moreover, healthcare professionals who stop wearing their white coat for a few months (or even more), tend to discover that patients or residents become less demanding and more independent ( Sparrow, 1991 ; Bailly et al, 2020 ). Instead of passively complying, patients or residents become more active and engaged ( Chu et al, 2020 ).…”

“…In a recent study ( Bailly et al, 2020 ), professionals in two specialised units for older people with dementia experimented with wearing their usual white coat uniform for three months and civilian clothing for another three months (the order was counterbalanced between the two units). Using cameras placed in the institutions, the researchers were able to film the residents (n = 24) and professionals interacting during teatime.…”