Ditch the PJs!

As physios we must first accept that we are responsible for PJ paralysis – and then do something, says Pippa Collins.

Our profession has been a constant presence on acute hospital wards for at least four decades, during which time we defined ourselves as the experts in physical movement and function. It is an indictment on us that we have allowed PJ paralysis to take hold. So how did it happen?
When I am on a ward I hear nurses and healthcare assistants saying that they do not know how to help a person to get out of bed and move. I see people left in bed because there was no physiotherapist around at the weekend. I hear physiotherapists complaining that people are left in bed too long or left sitting in a chair for hours and not returned to bed. And I’ve heard physios saying that in acute hospitals there is no time for rehab.
So what is our definition of rehab? I believe that it is enabling a person to get up, to get to the toilet, to manage clothes and hand washing, to get into a chair and eat in a dignified position. I believe it is influencing ward culture and training and educating ward staff. I believe that it is leading by example.
Yet I see physios heading for lunch as the lunch trays arrive. Why are we not taking our patients to the sink to stand and wash their hands? Why are we not helping them to get into a chair? Why don’t we sit with them and eat our lunch together: to talk, socialise, bring humanity? 
I hear my colleagues say that we are not a toileting service, yet what could be more fundamental to rehab and dignity than being able to use a toilet?
I see physios using outcome measures such as Barthel or the timed up-and-go test. I have still to meet a patient who tells me that their goal is to improve their Barthel score, but I do hear that they want to get home and to be more independent.
Where is the teaching, training and leadership of ward staff? Why have we kept our skills to ourselves to such an extent?
I believe that we fundamentally need to change the way that we provide physiotherapy on acute hospital wards. I believe that we as a profession are responsible for allowing PJ paralysis to happen and until we recognise this, it will be very hard to improve things for our patients.

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Pippa Collins Clinical doctoral research fellow and advanced clinical practitioner in frailty, University of Southampton and University Hospital Southampton

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