Article

Impact of nurses clothing on anxiety of hospitalised children

Behavioral Sciences Research Center, Isfahan University of Medical Sciences, PO Box 81465-993, Isfahan, Iran.
Journal of Clinical Nursing (Impact Factor: 1.26). 07/2009; 18(13):1953-9. DOI: 10.1111/j.1365-2702.2008.02745.x
Source: PubMed
ABSTRACT
To investigate anxiety levels in two groups of children exposed to nurses with white vs. coloured clothing in a university hospital in Iran.
Hospitalisation causes anxiety in children and it is documented that nurses have an important role in alleviating children's distress and anxiety. Nurses characteristics, including their clothing is a factor that affects quality of care through child-nurse relationship.
Clinical trial.
Children (n = 92) aged 7-15 years old hospitalised for 3-5 days in paediatric surgery ward were exposed to nurses in white or coloured clothing. Children's anxiety was assessed on admission and at discharge using Revised Children's Manifest Anxiety Scale.
Children exposed to white nursing uniforms showed higher anxiety levels compared with children exposed to coloured nursing clothing (p < or = 0.05). Besides coloured nursing clothing, female sex, age >11 years old (guidance school) and living in families with more than four members were predictors of lower global anxiety scores.
Providing a child-friendly environment through colourful nursing clothing can promote nurses' relationship with hospitalised children. This can satisfy children's expectations of the nursing care and alleviates the need for meeting ideals of nursing care through wearing a white nursing uniform provided that standards of nursing care are favoured.
Using colourful nursing clothing in paediatric wards reduces anxiety as a psychological parameter which delays improvement and provides a child-friendly environment that helps promotion of quality of nursing care.

Full-text

Available from: Afsaneh Pirnia
ORIGINAL ARTICLE
Impact of nurses clothing on anxiety of hospitalised children
Hamidreza Roohafza, Afsaneh Pirnia, Masoumeh Sadeghi, Nafiseh Toghianifar, Mohammad Talaei and
Mahmood Ashrafi
Aim. To investigate anxiety levels in two groups of children exposed to nurses with white vs. coloured clothing in a university
hospital in Iran.
Background. Hospitalisation causes anxiety in children and it is documented that nurses have an important role in alleviating
children’s distress and anxiety. Nurses characteristics, including their clothing is a factor that affects quality of care through
child–nurse relationship.
Design. Clinical trial.
Methods. Children (n = 92) aged 7–15 years old hospitalised for three to five days in paediatric surgery ward were exposed to
nurses in white or coloured clothing. Children’s anxiety was assessed on admission and at discharge using Revised Children’s
Manifest Anxiety Scale.
Results. Children exposed to white nursing uniforms showed higher anxiety levels compared with children exposed to coloured
nursing clothing (p £ 0Æ05). Besides coloured nursing clothing, female sex, age >11 years old (guidance school) and living in
families with more than four members were predictors of lower global anxiety scores.
Conclusion. Providing a child-friendly environment through colourful nursing clothing can promote nurses relationship with
hospitalised children. This can satisfy children’s expectations of the nursing care and alleviates the need for meeting ideals of
nursing care through wearing a white nursing uniform provided that standards of nursing care are favoured.
Relevance to clinical practice. Using colourful nursing clothing in paediatric wards reduces anxiety as a psychological parameter
which delays improvement and provides a child-friendly environment that helps promotion of quality of nursing care.
Key words: anxiety, children, clothing, nurses, nursing, uniforms
Accepted for publication: 26 October 2008
Introduction
Historically, nursing clothes have been developed under the
religious and military influences in the nineteenth century. At
that time, the main point was uniformity of nurses’ clothes
(Pearson et al. 2001). Later on, the uniforms were noticed to
develop a professional view of the competent nurse, non-
verbally denoting professionalism (Newton & Chaney 1996).
JCN
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Author Received: No. of pages: 7 PE: Ilamathi
Authors: Hamidreza Roohafza, MD, Assistant Professor, Behavioral
Sciences Research Center and Isfahan Cardiovascular Research
Center, Isfahan University of Medical Sciences, Isfahan, Iran;
Afsaneh Pirnia, RN, Head Nurse, Department of Pediatric Surgery,
St Zahra Hospital, Isfahan University of Medical Sciences, Isfahan,
Iran; Masoumeh Sadeghi, MD, Assistant Professor, Isfahan
Cardiovascular Research Center, Isfahan University of Medical
Sciences, Isfahan, Iran; Nafiseh Toghianifar, MD, Research
Assistant, Isfahan Cardiovascular Research Center, Isfahan
University of Medical Sciences, Isfahan, Iran; Mohammad Talaei,
MD, Statistic and Evaluation Department, Isfahan Cardiovascular
Research Center, Isfahan University of Medical Sciences, Isfahan,
Iran; Mahmood Ashrafi, MD, Associate Professor, Department of
Pediatric Surgery, Isfahan University of Medical Sciences, Isfahan,
Iran
Correspondence: Hamidreza Roohafza, Assistant Professor of
Psychiatry, Behavioral Sciences Research Center, Isfahan University
of Medical Sciences, PO Box 81465-993, Isfahan, Iran. Telephone:
+98 311 2222135.
E-mail: roohafza@crc.mui.ac.ir
2008 The Authors. Journal compilation 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing 1
doi: 10.1111/j.1365-2702.2008.02745.x
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White uniforms may convey some other meanings as well,
such as identity, infection control, modesty and occupational
health. In this way, the picture of a nurse has been so blended
with a white uniform that even today a white dress is still the
‘symbol’ of a nurse (Campbell et al. 2000). In modern
nursing, views toward nursing uniforms have altered and that
traditional view is changing (Lehna et al. 1999). The image
transferred to patients by nurses’ appearance may affect their
perceptions of nursing care and may also impact quality of
care through affecting patient–nurse relationship. This image
can be of more importance in children that are more
interested in and influenced by a relaxed atmosphere (Pearson
et al. 2001).
For children, hospitalisation is a stressful event that can
cause anxiety (Campbell et al. 2000). The new environment,
unfamiliar faces, different routines, medical and surgical
procedures are all frightening and distressing to the child.
Hospitalisation can be emotionally traumatic to the child.
Numerous studies have investigated children’s responses to
hospitalisation stress and interventions to reduce the adverse
psychological effects of hospitalisation (Thompson 1991).
Usually, the parents are asked about their view about quality
of care during hospitalisation of their child, while few studies
have measured the quality of care from children’s point of
view. However, it has been shown that considering children’s
views and needs during hospitalisation helps to improve their
satisfaction as well as health outcomes. Research studies that
address this topic can improve hospitalisation care and
decrease distress and anxiety (Curtis et al. 2004, Miceli &
Clark 2005, Coyne 2006).
The main concerns that children have mentioned about
their care include pain management, receiving insufficient
information and problems with communication (Curtis et al.
2004, Coyne 2006). Nurses play an important role in setting
an interactive communication with children. Nurses who are
supportive, gentle and cheerful and communicate openly help
to relieve the stressors of hospitalisation (Curtis et al. 2004).
Provision of better communication, through both verbal and
non-verbal ways is one way to deliver appropriate care and to
help the child adjust to stress of hospitalisation (Pelander
et al. 2007
1 ). Several studies on hospitalised children have
provided some insight about children’s views toward nursing
uniform and its colour. A study performed by Meyer (1992)
showed that children preferred colourful smock tops the most
and traditional uniforms the least. Moreover, children may
not be able to present their fears and anxiety verbally, which
requires more precision in recognising the causes of their
anxiety and distress.
Contrary to many countries that nurses’ clothing is various
in colour and model in different hospitals, in Iran all nurses
still wear traditional white uniforms compatible with Islamic
norms. The present study aimed to investigate anxiety level in
two groups of children exposed to white vs. coloured nurses
clothing in one of the university hospitals in Iran.
Methods
Sample and procedure
This clinical trial was performed in 2006 on children
hospitalised in a pediatric surgery ward of a general hospital
that covers related cases from the central part of Iran. All
children aged 7–15 years old who were hospitalised in this
ward for 3–5 days and were staying with their biological
parents were included in the study. Those patients who had a
chronic disease, mental retardation, motor disability or
handicap, prior history of hospitalisation due to physical or
mental illnesses or an emergent condition, or those who were
taking anxiolytic medications were excluded. Based on
sample size calculation, 47 subjects were enrolled in each
group, to detect a difference of at least two (effect size) in
global anxiety score changes between two groups with 90%
power (b =0Æ1) at the two-tailed 0Æ025 level of significance
(a =0Æ05) and standard deviation of three in both groups.
Approvals were made with the ethical committee of the
provincial University of Medical Sciences and hospital presi-
dent for performing research study with children and using
coloured nursing clothing. This is the usual practice for ethical
Figure 1 Study profile.
6,7
LOW RESOLUTION FIG
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approval of research projects in Iran. The bioethical committee
of the Provincial University of Medical Sciences is the regional
office of the National Bioethical Committee governed by the
Ministry of Health, with members from faculty members inside
and outside of the Provincial University of Medical Sciences.
Hospitalisations were for elective surgeries. Samples were
primarily screened on admission by a psychiatrist and then the
questionnaires were filled by included subjects. Written
informed consents were obtained from both parents and
children after describing the study for them.
All included subjects had undergone minor surgeries
without any complicated or emergent cases. Patients in both
groups received analgesics routinely as soon as they were
discharged from operating room so that they were pain-free
during hospitalisation. One of the parents accompanied the
child through the hospitalisation.
Nurses’ clothing in pediatric surgery ward was shifted from
white uniform to an alternative coloured clothing every two
weeks. The alternative colour was green, blue or yellow and
nurses were free to choose either of the colours. There was no
preference for either of colours among nurses so that nearly
equal number of all colours was used by the nurses. In Iran all
nurses still wear traditional white uniforms. These uniforms
especially for female nurses are compatible with Islamic
norms, a knee-length white slop with long sleeves, worn with
scarf and pants usually in dark blue or black. The children
were exposed to either white or coloured nursing clothing
during hospitalisation according to the time of hospitalisation.
Children, who were exposed to both colours during hospital-
isation, who were hospitalised at the end and beginning of the
two-week colour shift, were excluded from the study.
Measures
Data was collected with a questionnaire that included
demographic characteristics, hospitalisation data and anxiety
level. The questionnaires were filled by the help of a trained
questioner for those children aged 7–9 years old. Children
older than nine filled the questionnaire by themselves.
Demographic characteristics included age, sex, number of
household, educational level of the child (primary vs.
guidance school), father’s job (unemployed, wage earner,
salaried employed, self employed, retired), mother’s job
(housewife, salaried employee) and educational level
(£12 years, >12 years) of the parents. Hospitalisation data
included diagnosis at hospitalisation, type of surgery, nursing
chart including report of pain intensity and frequency, dosage
and type of the analgesic medication.
Revised Children’s Manifest Anxiety Scale (RCMAS) is a
self-report measure revised by Reynolds and Richmond
(1978). The original questionnaire, the Children’s Manifest
Anxiety Scales had been developed by Casteneda et al.
(1956)
2 . The RCMAS consists of 37 items that assesses
anxiety and gives a global score and three sub-scores in terms
of physiologic symptoms (10 items), worry (11 items),
problems with attention and concentration (seven items)
and a lie scale (nine items) with yes/no answers (Reynolds &
Richmond 1978). The score ranges from 0–28. The ques-
tionnaire is reported to have acceptable reliability and
validity (Seligman et al. 2004). Children’s baseline anxiety
level was assessed with this questionnaire in the first four
hours after admission. On discharge day the children were
reassessed for anxiety with RCMAS.
Statistical analysis
The statistical package for social sciences software, version
11Æ5 (SPSS Inc, Chicago, IL, USA) was used for analysis. A
p-value £ 0Æ05 was considered statistically significant for all
analyses. The studied population included 45 children
exposed to white uniform and 47 exposed to coloured
nursing clothing. Descriptive analysis of the study popula-
tion, was performed using mean ± SD for continuous
variables and percentages for categorical variables. Differ-
ences in demographic characteristics between two groups
were analysed with t-test and chi-square test. Differences in
global anxiety scores and three sub-scores between admission
and discharge anxiety levels were analysed with paired t-test.
Any difference between two groups was analysed using
independent t-test and Mann–Whitney test.
To study the effect of groups and demographic character-
istic on global anxiety score analysis of covariance
(ANCOVA)(ANCOVA)
was used. Global anxiety score was inserted as an indepen-
dent variable. The patients’ group (exposed to coloured vs.
white uniform), sex (girl vs. boy), educational level of the
child (guidance vs. primary school) and number of household
(n > 4 vs. n £ 4) were inserted as fix factors.
Results
There were no significant differences between two groups
regarding demographic characteristics, parents‘ educational
level and job and number of household (Table 1). Table 2
shows the mean and SD of global score and three sub-scores of
anxiety. All sub-scores increased significantly during hospital-
isation except for the concentration score in coloured clothing
group (p £ 0Æ05). Except for the worry score, all sub-scores
are significantly higher in white clothing group (p £ 0Æ05).
Mann–Whitney test reported similar significant level in global
anxiety score and all sub-scores. Because of a marginal
Original article Nurses clothing and anxiety of children
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insignificant value for worry sub-score and small sample size of
this study, power analysis was performed for worry sub-score.
For detecting the difference in score changes between coloured
group (measured SD: 1Æ70) and white group (measured SD:
2Æ42), the power of this study was calculated 88Æ9%
(Zb =0Æ14), based on a sample size of 45 for each group given
the effect size of 0Æ8 (observed difference) and with confidence
coefficient equal to 1Æ96 (a =0Æ05).
Table 1 Demographic characteristics of subjects according to groups
Group White
*
(n = 45) Coloured
(n = 47) p-value Total (n = 92)
Age (Mean ± SD) 9Æ59 ± 2Æ38 10Æ46 ± 2Æ39 0Æ084 10Æ02 ± 2Æ41
Sex n (%)
Boy 26 (57Æ8) 28 (59Æ6) 0Æ906 54 (58Æ7)
Girl 19 (42Æ2) 19 (40Æ4) 38 (41Æ3)
Educational level of the child n (%)
Primary school 35 (76Æ6) 32 (68Æ9) 0Æ309 67 (72Æ8)
Guidance school 10 (23Æ4) 15 (31Æ2) 15 (27Æ2)
Educational level of the father n (%)
£12 years 32 (71Æ1) 34 (73Æ3) 0Æ950 66 (72Æ2)
>12 years 13 (28Æ9) 13 (26Æ7) 26 (27Æ8)
Occupation of the father n (%)
Unemployed 3 (6Æ7) 4 (8Æ9) 0Æ125 7 (7Æ8)
Wage earner 25 (55Æ6) 14 (28Æ9) 39 (42Æ2)
Salaried employee 7 (15Æ6) 11 (24Æ4) 18 (20Æ0)
Self employed 10 (22Æ2) 17 (35Æ6) 27 (28Æ9)
Retired 0 (0Æ0) 1 (2Æ2) 1 (1Æ1)
Educational level of the mother n (%)
£12 years 37 (83Æ0) 37 (78Æ9) 0Æ134 74 (80Æ4)
>12 years 8 (17Æ0) 10 (21Æ1) 18 (19Æ6)
Occupation of the mother n (%)
Housewife 43 (95Æ7) 46 (97Æ8) 0Æ616 89 (96Æ7)
Salaried employee 2 (4Æ3) 1 (2Æ2) 3 (3Æ3)
Number of household n (%)
n £ 4 24 (53Æ2) 24 (51Æ1) 0Æ703 48 (52Æ2)
n > 4 21 (46Æ8) 23 (48Æ9) 44 (47Æ8)
*
Exposed to white uniform.
Exposed to coloured clothing.
Table 2 Comparison of global anxiety score and three sub-scores between groups at entry and on discharge
At entry (Mean ± SD) On discharge (Mean ± SD) p* D (Mean ± SD) p**
Physiological score
Coloured
4Æ13 ± 2Æ05 4Æ55 ± 2Æ19 0Æ022 0Æ42 ± 1Æ19 0Æ045
White
à
3Æ93 ± 1Æ91 5Æ04 ± 1Æ94 0Æ000 1Æ11 ± 1Æ92
Worry score
Coloured
4Æ51 ± 2Æ76 5Æ22 ± 2Æ71 0Æ007 0Æ71 ± 1Æ70 0Æ052
White
à
4Æ17 ± 2Æ84 5Æ74 ± 2Æ61 0Æ000 1Æ57 ± 2Æ42
Concentration score
Coloured
2Æ60 ± 1Æ87 2Æ57 ± 1Æ85 0Æ904 –0Æ02 ± 1Æ23 0Æ000
White
à
1Æ93 ± 1Æ37 3Æ17 ± 1Æ72 0Æ000 1Æ23 ± 1Æ85
Global anxiety score
Coloured
11Æ24 ± 5Æ51 12Æ35 ± 5Æ64 0Æ005 1Æ11 ± 2Æ52 0Æ000
White
à
10Æ04 ± 4Æ71 14Æ14 ± 4Æ13 0Æ000 4Æ10 ± 4Æ60
p*, pair t-test; p**, independent t-test (Mann–Whitney test reported similar significant level); D, score change during hospitalisation.
Exposed to coloured clothing.
à
Exposed to white uniform.
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Table 3 contains the standardised beta weights for each
predictor across the global anxiety score. As is seen, group,
sex, educational level of the child and number of household
were found to be significant predictors of anxiety, so that
white nursing clothing increases anxiety score about three
times compared with coloured one. Besides, being a girl,
higher educational level of the child and higher household
number are associated with lower increase in anxiety.
Considering interaction of group with each variable, being
a girl was prominently related to lower anxiety level,
compared with each variable apart.
Discussion
Cultural view on nursing clothing is a traditional and religious
look in Iran. This view had limited free transformation of the
format of nursing clothing. However, in recent years,
approach to health and medical care issues has become more
evidence-based to improve higher quality services in medical
and health fields, which offers an opportunity for investigating
and making changes. Also, nurses are increasingly recognising
the importance of a professional and effective communication
with their patients. Now, the most important question to be
answered is the patients’ response and view to transformation
of nursing clothing, an issue that can be addressed better in
hospitalised children, due to their higher vulnerability to
hospitalisation stress. Findings of our study showed that
children exposed to nurses with coloured clothing experienced
lower levels of anxiety compared with children exposed to
nurses with white uniform, so that physiologic symptoms and
concentration sub-scores were significantly lower in this group
on discharge. Anxiety level increased during hospitalisation.
In addition, female sex, age more than 11 (guidance school)
and living in a family with more than four members were
demographic predictors of lower anxiety level. Another
finding of our study was that the effect of hospitalisation in
increasing anxiety in hospitalised children.
Similar to our study, another study performed by
Clatworthy et al. (1999) on 139 hospitalised children aged
5–11 years old showed increased anxiety in children based on
children drawings from the hospital environment such as
hospital equipment, nurses, physical environment and hospi-
tal building. Factors such as separation from family, fear of
the unknown, loss of control and unfamiliar faces have been
shown to be sources of stress that can cause anxiety in
hospitalised children (Brewer et al. 2006).
Several studies have investigated the factors related to
anxiety in hospitalised children. One important factor that
can have a considerable effect on anxiety level in hospitalised
children is nursing care. Children’s expectations of nursing
care seem noteworthy, as a good quality of care has been
related to the nurse’s appearance and nursing activities by the
children (Pelander & Leino-Kilpi 2004). In a preliminary
study by Glasper et al. (1991), children experiencing informal
nursing clothing during hospitalisation described it interest-
ing and satisfying. Meyer (1992) showed pictures of five types
of nursing clothing to 100 children. The clothing differed
from traditional white uniforms to casual clothing. While
children rated pictures, their pulse rates were measured. It
was found that traditional and white clothing increased pulse
rates; however, children preferred coloured clothing. In
response to the question ‘Is there a nurse you are afraid of?’
3
(p. 159), half of children chose the nurse in white uniform.
Rowland (1994) found that a therapeutic relationship was
enhanced by a more casual uniform, which supports the view
that uniform can affect the promotion of a relationship. The
imagination of children from a nurse is obvious in their
drawings. They draw their ideal hospital with a smiling nurse
with colourful clothing. Nurses are shown to have a sense of
humour and a good mood. Talking, explaining and listening
to the child by the nurses are crucial elements of quality of
care. Colourful clothing, warm communication and good
mood are all components of a child friendly nursing care.
Interestingly, the children had drawn only nurses with
colourful clothing (Pelander et al. 2007). Our study similar
to Meyer study that traced increased pulse rate as a sign of
anxiety, showed a higher increase in the physiologic subscore
of RCMAS in children exposed to white uniform. As
Rowland documented that children’s imaginations from a
nurse is a nurse with coloured clothing, in our study coloured
clothing was associated with lower levels of anxiety.
Above studies have been in line with our study. There also
exist several contradictory studies like the one performed by
Table 3 Demographic predictors of anxiety (age adjusted)
Variable* Bt p-value
Group (coloured
vs. white)
2Æ995 3Æ843 0Æ000
Sex (girl vs. boy) 4Æ268 2Æ731 0Æ008
Educational level of child
(guidance vs.
preliminary school)
2Æ869 2Æ270 0Æ026
Number of household
(n > 4 vs. n £ 4)
2Æ882 2Æ769 0Æ007
Group · sex 3Æ846 1Æ970 0Æ050
Group · educational
level of child
2Æ293 1Æ325 0Æ189
Group · number of
household
2Æ945 1Æ975 0Æ049
*Binary variable were dummy coded with colour, girl, guidance
school level, number of family >4 coded as 1.
Original article Nurses clothing and anxiety of children
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Page and Lawrence (1992) that showed a negative perception
to t-shirts, skirts and running shoes in adult hospitalised
patients. However, this study was performed on adult
patients who have different perceptions of hospitalisation.
The study performed by Livingstone (1995) showed that
most patients preferred traditional clothing, so that expecta-
tions of hospitalised children regarding good care, was met
through wearing of white uniforms by the nurses. The
authors believed that this was related to a media-enhanced
picture of the nurses wearing white uniforms. Rumfelt (1980)
suggested that ‘children viewed the nurse as a person who
could be identified by apparel, namely, a white uniform,
white shoes, a cap and a pin’
4 (p. 22).The studies that support
white nursing uniform are older studies related to a time
period that this clothing signified the nurses’ presentation of
confidence, identification and accessibility to patients. How-
ever, this view has changed in developed countries in recent
years. Similarly, our study which has been performed in a
developing country is based on an evidence-based view to
nursing clothing and shows that public view has also changed
and that nursing skills and identity is no more symbolised in a
white uniform. Few studies have been performed in Iran
about the quality of nursing care and patient-nurse relation-
ship (Salimi et al. 2003). However, there has always been a
traditional emphasis on the role of the nurse in alleviating
patient’s distress and suffer through setting an effective
communication. This role can be better performed through
wearing coloured clothing by nurses who provide care to
children as it can enhance a close and friendly atmosphere
(Salimi et al. 2003).
Other predictors of anxiety in our study were sex and child’s
educational level and number of siblings. Studying the
relationship between sex and anxiety level, Tiedeman and
Clatworthy (1990) found that boys experience more anxiety
during hospitalisation. The authors believed that it was due to a
difference between boys and girls in coping styles. Boys usually
use physical methods for expressing their anxiety and aggres-
sion while girls usually use verbal methods. As physical activity
is limited during hospitalisation, boys express more anxiety
during hospitalisation. These results support our findings.
Higher educational level, as an accompaniment of higher
age is associated with less anxiety in the child. Margolis et al.
(1998) showed that younger children are more prone to
higher stress level. Piaget’s theory of cognitive development
may help explain the increase in anxiety level in this age
group. A review article in 2006 showed that children with
lower number of siblings are more prone to anxiety and are
more sensitive for social failure and separation anxiety
(Bo
¨
gels & Brechman-Toussai 2006), that our findings
support it, too.
A limitation of our study was failing to get a deeper
knowledge of the family characteristics, such as family
function, parent psychopathology and family stressors. The
study findings were strengthened by studying family param-
eters as it could help better detection of anxiety in hospita-
lised children. In spite of similarity of two groups, lack of
control on some confounding variables, such as medical
diagnosis, type of surgery, surgical and medical care was
inevitable. Children were not screened for colour blindness.
Also, the geographic setting of the study may limit general-
isation of its findings.
Conclusion and implications for clinical practice
Emphasis on nurses white uniform is based on the view that it
conveys authority, power and professionalism while wearing
coloured clothing is of great importance in promoting a child-
friendly environment that decreases anxiety level (Lehna et al.
1999). Promoting a child-friendly atmosphere should include
good communication in addition to appropriate appearance.
If nurses can satisfy children’s expectations by using mature
communication styles (Pelander & Leino-Kilpi 2004), they
can establish a warm connection with children, that helps to
create a sense of security and trust for them and declines their
anxiety (Pelander et al. 2007). Such styles are appropriate
ways for helping children cope with stressful experience of
hospitalisation and alleviate the need for meeting ideals of
nursing care through wearing a white uniform, provided that
standards of nursing care are favoured.
Acknowledgements
The authors would like to thank all nurses, surgeons and
pediatricians who helped them in performing this study.
Contributions
Study design: HR, AP, MS; data collection and analysis: HR,
AP, MA, NT, MT and manuscript preparation: HR, NT,
MT, MS.
References
Bo
¨
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Original article Nurses clothing and anxiety of children
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  • Source
    • "s other ways of knowing, such as authority to defend his claim where he informs us that 'the Head of the Clinica San Rafael hospital says: 'Wearing the skirt is an important part of the nurse's duty'. It has to be said that there is ample support in the literature for the contention that wearing a uniform is an important aspect of the nurse's duty. Roohafza et al. (2009) maintain that wearing colourful clothing in paediatric wards reduces child anxiety which in turn is conducive to recovery. Nazarko (2008) asserts that wearing a uniform is essential for infection control purposes. The symbolism of traditional uniforms makes patients feel secure and safe, and they also enable patients to recognise staff "
    Full-text · Article · Feb 2012 · Journal of Clinical Nursing
    • "Likewise, consideration of the impact of the environment by the provision of simple but effective measures may further help to moderate anxiety. Some examples include informal nurse uniforms (Roohafza et al, 2009), music, and aromatherapy (Cooke et al, 2005; Stirling et al, 2007 ). Planned preadmission and post-discharge contact within a purposely designed ESNU by dedicated, informed staff could also limit anxiety even with fleeting interaction (Mottram, 2009). "
    [Show abstract] [Hide abstract] ABSTRACT: Patients undergoing surgery in the UK are seeing a rise in the development of enhanced recovery programmes as a result of increasing medical advances. Enhanced recovery is concerned with helping patients get better sooner after an operation by following a meticulous regime of care. The practical application of these programmes is undertaken largely by nurses, despite encompassing explicit, medically-driven protocols. However, beyond the professional knowledge and skills required to aid the programmes, nursing knowledge has contributed little to this rapidly developing aspect of surgery to date. Nursing has much to offer through future creation of centrally coordinated, surgical nursing units focusing on patients' holistic experience. This article will briefly describe enhanced recovery, identify aspects of nursing knowledge that can have a positive influence, and outline practical changes to assist the development of such programmes, thereby benefiting all patients undergoing elective surgery.
    No preview · Article · Sep 2011 · British journal of nursing (Mark Allen Publishing)
  • Source
    • "In a large survey involving 460 patients (Mitchell 2010), most patients wanted to spend time waiting with a partner/friend (71%), talking with a nurse (71%), listening to music or reading magazines (76%) within a modern-looking clinical environment (70%). In paediatric day surgery, simple measures such as colourful uniforms have proven beneficial (Roohafza et al 2009). With little insight into medical and nursing practices, patients may evaluate the cleanliness of the building, their comfort and the waiting rooms as a proximal measure of quality that is not only reflective of commitment to the patient but also an indicator of the managerial focus on quality (Kaldenberg and Becker 1999). "
    [Show abstract] [Hide abstract] ABSTRACT: The pursuit of greater efficiency in modern day surgery has led to the adoption and development of many new and extended nursing roles. Such roles often focus on physiological measurement to ensure patient safety before and during surgery. However, studies suggest that patients require considerable care in relation to the social and psychological effect of hospital admission, general anaesthesia, surgery and discharge. This article discusses the effect of modern day surgery on nurses' practice and concludes by outlining the psychological care need of patients undergoing elective day and short stay surgery.
    Full-text · Article · Jul 2010 · Nursing standard: official newspaper of the Royal College of Nursing
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