We should all support #EndPJparalysis

The Chief Nursing Officer for England backs a new campaign to get patients out of their pyjamas and up and out of bed:

Many of you will have seen or heard about an article I wrote which was published in the Daily Telegraph in December.

The focus of the piece was to highlight how nursing, midwifery and care staff have a significant role to play in transforming the provision and delivery of care across different settings.

While Sustainability and Transformation Plans (STPs) are still at different stages and are sometimes controversial, it is important that clinicians including nursing, midwifery and care staff continue to help shape these moving forward. There are many things that we encounter on a daily basis that could improve patient outcomes by simply changing what we do and how we think.

Leading Change, Adding Value, a framework for nursing, midwifery and care staff was published in May 2016 and enables nursing, midwifery and care staff to make changes to deliver the triple aim, identified in the Five Year Forward View, resulting in better outcomes and experiences for patients, as well as making better use of resources.

One idea that is starting to go viral on social media is #EndPJparalysis, a campaign led by NHS-trained nurse, Brian Dolan, Director of Service Improvement at Canterbury District Health Board in New Zealand. And it is something that I am passionate about as a nurse – making small changes to improve patient outcomes.

The campaign focuses on encouraging patients in hospitals, where possible, to stop wearing their pyjamas or hospital gown when they don’t need to. Why? Because wearing pyjamas for many patients reinforces the ‘sick role’ and can prevent a speedier recovery.

Obviously the patient and their condition need to be taken into consideration and this idea cannot apply to every single in-patient, however for many, it’s a matter of enabling them to get up, get dressed and get moving.

We know that for every 10 days of bed-rest in hospital, the equivalent of 10 years of muscle ageing occurs in people over 80-years old, and building this muscle strength back up takes twice as long as it does to deteriorate. One week of bedrest equates to 10% loss in strength, and for an older person who is at threshold strength for climbing the stairs at home, getting out of bed or even standing up from the toilet, a 10% loss of strength may make the difference between dependence and independence.

We also know that this is the case for every patient in hospital, irrespective of their age. No matter how old a patient is, they will lose muscle strength during their stay, albeit at different levels, so it really is in the interests of our patients to help them be as mobile as possible.

Ensuring patients get into their own clothes not only helps them to recover more quickly and changes how they are viewed by staff and the patient’s family, it also has benefits for staff on the front line. It can help to build system capacity by improving patient flow, enabling more timely discharges, reducing the patient’s length of stay, and enable more timely admissions for other patients.

By getting patients into their own clothes and building their strength, as well as improving their mental outlook on the reason for their stay, it enhances the mental wellbeing of patients as they are encouraged to take greater responsibility for their own health and become active participants in their personal health journey.

In one of Brian’s latest blogs, he calls for us all to help patients get better quicker or help their final days be special and as normal as they can be. Patients should wear their own clothes unless it’s for reasons of clinical appropriateness rather than organisational culture. In Brian’s words, “Patients’ time is sacred and there needs to be no needless waiting, no needless harm, and no needless suffering.”

It’s not just patients and nursing, midwifery and care staff who should be aware of this campaign. Dr Amit Arora from Royal Stoke University Hospital says that there is sometimes a misconception by families that staff should be doing everything for their loved one simply because they are in hospital. Educating relatives and carers is just as important to ensure that they encourage their relative, friend or person they care for to get dressed and move about.

Brian’s campaign has already started to encourage behaviour change in a number of Trusts across the country, as well as other health organisations across the world.

Ann-Marie Riley, Deputy Chief Nurse at Nottingham University Hospitals, is one of our nurse leaders who has truly recognised the benefit of the campaign for patients. Nurses across the Trust have embraced the principles of the campaign to help build patient confidence and  are working hard to embed the principles into every day practice.

As CNO for England, I would encourage you all to do the same and you can find out more about what Nottingham University Hospitals are doing by following Ann-Marie on Twitter @AnnMarieRiley10.

Over the coming weeks, a number of videos will be published to demonstrate the impact of this campaign for both patients and staff. I will be supporting the #EndPJparalysis, campaign and national organisations such as NHS Improvement, the Royal College of Nursing and key charities to ensure the campaign actively supports and encourages nursing, midwifery and care staff to improve outcomes for our patients.

Watch this space and, in the meantime, follow Brian Dolan on twitter @BrianwDolan.

Jane Cummings

Professor Jane Cummings is the Chief Nursing Officer for England and Executive Director at NHS England.

Jane specialised in emergency care and has held a wide variety of roles across the NHS including Director of Commissioning, Director of Nursing and Deputy Chief Executive.

In February 2004, she became the national lead for emergency care agreeing and implementing the 98% operational standard. She has also worked as the nursing advisor for emergency care. In January 2005, she was appointed as the National Implementation Director for ‘Choice’ and ‘Choose and Book’.

Jane moved to NHS North West in November 2007 where she held executive responsibility for the professional leadership of nursing, quality, performance as well as QIPP, commissioning and for a time Deputy Chief Executive Officer. In October 2011, she was appointed to the role of Chief Nurse for the North of England SHA Cluster.

She was appointed as Chief Nursing Officer for England in March 2012 and started full time in June 2012. Jane is the professional lead for all nurses and midwives in England (with the exception of public health) and published the ‘6Cs’ and ‘Compassion in Practice’ in December 2012, followed by publishing the ‘Leading Change, Adding Value’ framework in May 2016.

Jane has executive oversight of maternity, patient experience, learning disability and, in January 2016, became executive lead for Patient and Public Participation.

She was awarded Doctorates by Edge Hill University and by Bucks New University, and she is a visiting professor at Kingston University and St George’s University, London.

She is also Director and trustee for Macmillan Cancer Support and a clinical Ambassador for the Over the Wall Children’s Charity where she volunteers as a nurse providing care for children affected by serious illnesses.

Follow Jane on Twitter: @JaneMCummings.

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  1. Debbie Clark says:

    There are loads of great posters on the internet for this topic – how do I access them to use in my Trust? I have tried downloading some but I can’t do it! Is there a resource bank somewhere, and if so, where?

  2. Aly says:

    Is there any solid evidence for this with statistics etc..?

    I’m doing a presentation linked to this for preceptorship staff and hunting for some statistics on improved patient wellbeing and getting dressed etc…


  3. Joyce Midlane says:

    My 89 year old husband is recovering from 11hospital admissions since February 27th for various reasons including pulmonary embolisms, pneumonia following a fall, Arrhythmia, pacemaker fitted and other reasons. Doctor checked him over yesterday, everything was working ok so why can’t I get him to dress? He is always cold in spite of efficient heating on highest setting. Should I nag him to get dressed? When he dressed once it made me feel so happy, he looked better too. He had an oesophagectomy 10 years ago so is remarkable anyway. I would really appreciate some professional advice regarding whether it is better to dress. He says that he is more comfortable in pyjamas.

    • NHS England says:

      Dear Joyce,
      Thank you for contacting NHS England.
      Unfortunately we are unable to provide professional advice via the comments function on our website. We would advise you to speak to the healthcare professionals who are looking after your husband to discuss your issues with them.
      Kind regards,
      NHS England

  4. Majella Cahill says:

    Does? #EndPJparalysis give Nurses the right to not put on pyjama bottoms on male bed bound ill patients?
    My father is currently in hospital with pneumonia and is too ill to sit out of bed.He also pulls off the bed clothes,so not very dignifying at all.
    There are no medical contraindications for this.I deduce that it facilitates easier pad changes and there are is no Nursing evidence to suggest otherwise.

  5. Steve Fay says:

    I am very surprised you use the term “pyjama paralysis” without thought of the huge offence this can convey. Would you say to a patient “you have pyjama paralysis”, I assume not. Therefore why do you think it is reasonable to support this whilst well intentioned campaign without a thought for the terms being used. Perhaps the simpler dressed and out of bed to get home…

  6. Jayne says:

    Wow, the NHS hospital I work at has been getting patients out of pyjamas for years, every day we encourage and support patients actively getting up washed and dressed, it’s all part of the recovery and promotion of independence we promote, it’s superb to hear that this great new initiative is being launched at a time when our hospital is closing…….

  7. Nicola Richardson says:

    Can I use the pj paraylasis posters in my trust or do I need to ask permission/ make my own

  8. Graham says:

    I’m a band 4 for and I have been placed in an ortho ward with a mix of elective and trauma as part of an enablement pilot. I’ve been left to ‘get on with it’ so to speak. I love your article, such a fantastic online article! Hit’s the key points in such a targeted way.

    I’m trying to source some material to help me change the culture in the ward I’m in and was wondering if you would be able to direct me in any small way at all? Anything would help.

    Thanks Jane.

    • NHS England says:

      Dear Jane,

      Thanks for your comment, it’s great that you are starting to implement the campaign across your organisation. The following blog on FabNHSstuff may be a helpful start and it would also be very useful to read the latest conversations on Twitter, using the hashtag #endPJparalysis.

      Kind regards,

      NHS England.

  9. Anonymous says:

    What a brilliant idea. If you are a resident in a care home you don’t sit in PJ’s all day. Lets get patients back in charge of their care (up and dressed) rather than passively in PJ’s

  10. ann says:

    I was in hospital for a hip replacement, and we were all ‘persuaded’ out of bed every morning, partly for the risk of dvt, and i felt so much better for this…’s obvious to any caring nurse, and both the sister, and deputy sister on my ward , cared so much about the patients well being.

  11. Ghosay says:

    Good evening.Nice usefull informations.I appreciate your suprt for such measures in faviur of patients.I am a Syrian phesician spent more than 3 years in the UK Nhs..more than 1 year in Royal Free in London.liver transplantation unit..I saw teams working together.I admire you plans continuous improvements.All the best..Dr.Ghosay M.Shaban.