I-See-U
Nurses, hospitals getting to bottom of “johnny coat” alternatives for modest patients.

By Cathryn Domrose
March 14, 2005

When actor Jack Nicholson flashed his bare behind in a hospital corridor in the movie “Something’s Gotta Give,” a lot of people winced in sympathy, even though Nicholson’s character was a bit of a jerk.

Nicholson was wearing a traditional johnny coat, the thin, drafty, and revealing hospital gown that ties in the back and represents for many patients everything they hate about being in the hospital: a loss of comfort, dignity, and control.

“It’s humiliating,” says Paige Graves, RN, an oncology nurse at Medical City Dallas Hospital in Texas. “You feel vulnerable the second you have to put on a gown.”

In recent years, some nurses have gone beyond sympathizing with patients about skimpy gowns. They’re helping design alternatives that offer more covering and protect modesty, while still allowing care givers to perform exams and hook up IVs. Some hospitals, while keeping the basic johnnies, are offering extras, such as robes and pajama bottoms. Some are tailoring their gowns for different types of patients, such as garments that open in the front for new mothers who are breastfeeding or specially heated gowns for OR patients.

Nurses routinely encourage patients to move around after major procedures, to speed healing and develop strength. But many patients find walking a hospital corridor with their backside half hanging out an embarrassing and chilling prospect.

“We used to call them ‘I-C-U’ gowns,” says Jennifer Evans, RN, BSN, director of medical-surgical supply chain management for Texas Health Resources in the Dallas area. “You really could see people from the rear.”

Evans was a part of a group commissioned to redesign the gowns through the company’s Patient and Family Journey program to improve patients’ experiences in 13 hospitals. The new gowns, introduced about two years ago and now used in all the hospitals, are about four inches longer than the old ones and have an eight- to 10-inch overlap on the side. They have a pocket in front to hold a telemetry unit, which used to hang around the patient’s neck or attach through a hole cut into the gown, Evans says.

The gowns, which tie on the overlapped side and have snaps on the sleeves to allow easy access for IV hookups, make the nurses’ jobs easier, too, she says. Often, nurses had to double-gown large patients with the old johnny coats, a cumbersome process of tying the gowns both in front and in back.

“The big guys can wear (the new) gowns, and they’re completely covered,” Evans says. “I really don’t know why everyone doesn’t have a gown that takes covering the patient’s backside into account.”

For Somali Muslim female patients at Maine Medical Center, johnny coats were more than embarrassing — they violated the patients’ cultural and religious beliefs. The center’s transcultural committee, created to reach out to the increasingly diverse community of Portland, Maine, discovered that Somali patients were canceling radiology appointments because of the gowns, says Ann McPhee, RN, MS, MSB, nursing director of outpatient clinics at Maine Medical Center.

The committee tried several new designs and settled on a sarong wrap. The two-piece gown fastens on the side and includes a long wrap-around skirt for extra coverage. The new gowns are available on request and have proven popular with other patients, including Muslim men. Some Muslim women hospital workers also wear the sarongs over their uniforms.

“We found we had overwhelming demand for them as soon as the word hit the street,” says Joy Moody RN, MSN, nursing director of the hospital’s ED.

At Los Angeles Childrens Hospital, young patients wear flannel pajamas, with drawstring bottoms and shoulder snaps, says Sherry Nolan, RN, MSN, the hospital’s clinical manager. She does not recall having a problem with children’s resisting wearing them.

“A lot of the parents take them home,” she says. “We’re always running out of them.”

Some hospitals, although not doing away with johnny coats for everyone, are offering additions and alternatives.

Patients at the University of Washington Medical Center in Seattle can request robes, pajamas in various sizes, and three kinds of nonskid slippers, as well as regular hospital gowns, says Cindy Angiulo, RN, MSN, RNC, assistant administrator for patient care services. Nurses encourage patients to walk in the corridors to speed their recovery, she says, and the extra coverings and stable footwear make them feel more comfortable doing that.

Patient satisfaction surveys at Methodist Sugarland Hospital in the Houston area gave the OR good scores, but patients often mentioned they were cold, says Becky Chalupa, RN, MS, CNOR, director of perioperative services. So the hospital decided to purchase high-tech disposable hospital gowns that can be filled with warm air pumped in through a hose. The system, called Bair Paws, lets patients control the heat with a remote control device. “The patients love them,” Chalupa says, and nurses don’t spend as much time getting extra blankets. Studies have shown that keeping body temperatures normal aids healing in surgical patients. “It’s a little expensive,” she says — the gowns cost $10 to $15 each and are used only once. But the price is worth it to make patients happy and improve outcomes, she says.

When Windber Medical Center in Pennsylvania was building a new breast care facility, Diane Pringle, RN, MSN, wanted a gown that would be as attractive to women as the rest of Joyce Murtha Breast Care Center, which offers aroma therapy, a fireplace and a comfortable sitting area.

Pringle, the center’s executive director, worked with designers to come up with a gown that opens in the front, provides coverage to the knees and has hook-and-loop (Velcro) closures that allow exposure for one breast while covering the rest of a patient’s body.

“They are private, feminine, and pretty,” Pringle says of the gowns. She is working on a more unisex design for male patients who will come to the center for magnetic resonance imaging appointments.

The center sells its patented gowns to other facilities. They are popular with nursing mothers as well as breast health patients, she says. “The gown is definitely one of the best things we’ve done.”

But the front-opening gowns are more expensive than johnny coats, and many physicians want easy access to patients from the back, she says. She does not see them replacing traditional hospital gowns.

“It’s still about functionality and the least amount of money you can put into something that actually works,” she says.

As patients become more assertive and as cultural issues about privacy and modesty emerge, nurses say they expect more health care facilities will look for alternatives to the johnny coat. But for now, in the halls of most hospitals, rear ends will continue to flash.

Though nurses and patients frequently joke about their johnny coat experiences — Ann Landers recently devoted an entire column to funny hospital gown stories — Graves, the Texas oncology nurse, has firsthand experience with the pain they can cause.

When her mother was sick and in the hospital, Graves says, she would not let anyone see her because of her appearance. Her mother isolated herself from her church friends and others. As her illness worsened, her best friends from college — whom she hadnseen in years —flew in to see her.

“She would not let her best friends in to see her unless she was dressed,” Graves says. But the process of getting her ready took hours. “She died in my arms while I was getting her dressed. She never got to see her friends again.”

As a result of their experiences, Graves and her husband, Steve, have started a company called Dignity Duds that designs and sells garments
that look like regular clothes from the front, but are completely open in the back. Caregivers place them over bed-ridden patients and adjust the fit with hook-and-loop fasteners. The clothes aren’t meant to be worn in the halls or outside, Graves says, but patients in bed can receive visitors looking fully clothed, without the fatigue of having to dress.

“Everybody that we’ve spoken to in the medical industry has been very impressed with the idea,” Graves says. “I wish I’d had something like this for my mom.”

Catherine Domrose is a senior staff writer for Nursing Spectrum.