Uniforms in dementia care: A barrier or a necessity?

Case presentation

This case represents an area of contention between two groups of care-staff who work within a 30-bedded dementia care home within Northern Ireland. The care home provides specialist dementia care across two 15-bedded units, and all residents are living with moderate to advanced dementia. Following transmission of a television programme called ‘Dementiaville’, in the United Kingdom, a group of care-staff (comprising nurses and care assistants) asked their care home manager whether they should consider trialling not wearing uniforms in their dementia care unit. The theory behind this, as asserted by David Sheard ¹ in the ‘Dementiaville’ programme, is that uniforms can create a barrier between the care-staff and the residents who live with dementia. It was proposed that instead of wearing clinical uniforms (i.e. blue tunics for nurses and green tunics for care assistants) that staff should dress in either their own clothes like their residents or in attire that is from another era, so as to facilitate reminiscence.

Following an initial staff meeting, it was apparent that the absence of staff uniforms was divisive among staff. One group of care-staff felt that they should wear attire that is less clinical so as to break down potential barriers and so enhance the lives of people living with dementia at the care home. The other group of care-staff felt that adopting a different uniform policy has the potential to be more disruptive to the care that is afforded in the care home.

Background

While the concept of person-centred care in dementia has been established for some time, ² there is still a plethora of diverse ways in which person-centred care is operationalised in clinical practice. Succinctly, person-centred care is an approach that puts the person living with dementia at the centre of their own care. In other words, that person is supported to contribute to their life and care through shared decision-making, equality of communication and mutual respect. These aspects are of course morally and ethically right and serve to enhance the dignity afforded to people living with dementia. ^{2 –4}

While there are many ways of delivering person-centred care, one which has been explored in recent years pertains to the attire of care-staff in dementia care settings. ^{5 –7}

Case analysis

Discussion

The enhancement of person-centred practice is one that should always be encouraged in dementia care. Enhancing the care of residents who live with dementia in a care home often requires innovation and positive-risk-taking as highlighted in bodies of work on person-centred care in dementia. ⁴ The present debate is one which is difficult to resolve because, on one hand, there has been some positive empirical findings that support the first group of care-staff, but, on the other, it is probable that such a change may lead to a greater level of disorientation and stigma being generated, especially if all team members are not invested in the change. Given the paucity of guidance, there is also potential of maleficence, that is doing actual harm, particularly around the case of care-staff wearing nightwear. While the team acknowledge that people living with dementia should never be stigmatised, there is clinical evidence to suggest that some people living with dementia can see a change in their levels of inhibitions or their sexual behaviour which may put care-staff at risk. With consideration to these possible limitations, which would ultimately serve to undermine the person-centred care-staff afford, it was felt by senior management that wearing clinical uniforms was probably more likely beneficial to residents living with dementia on the unit at this time.

All care-staff agreed that the people living with dementia should remain at the centre of discussions. In short, both groups want to enhance the quality of care and experience of life that people living with dementia in the care home receive.