Dress sense

With NHS Employers currently working on an NHS-wide dress code, Mark Gould looks at the issues surrounding dress and body adornment for physiotherapists

'Rolled down tracksuit  trousers showing underwear and very tight polo shirts make the students vulnerable to sexual  innuendo from cognitively impaired residents.' So said a physiotherapy placement provider responding to a survey on dress codes for student placements. The survey of over 400 providers registered with the Physiotherapy Placement Information and Management Service was carried out last year by principle physiotherapy lecturer Diana Davis at the University of Hertfordshire. It followed protests by students at the  university at what they described as a stringent dress code which did not reflect  clinical practice. The code was introduced for physiotherapy exams when it became apparent that some students on placement had never worn the uniform they were supplied with. For a physiotherapist coming into intimate physical contact with total strangers every working day, first impressions in terms of dress and appearance can have a far-reaching effect on the therapeutic relationship. CSP international development adviser Liz Carrington is currently writing a briefing paper in response to issues raised by managers at last year's conference of the Association of Chartered Physiotherapists in Management. She says it's important to recognise  that your appearance and what you wear could have a direct effect on a patient - for good or ill. 'When dealing with patients with mental health or learning difficulties, inappropriate necklines for women could create problems. When I was a young student, ward patients were always asking me to stand on a chair to open the window and they would bend down to look up my skirt.' Delegates to the ACPM conference were concerned about a lack of central NHS guidance on dress. As well as the issue of hospital-acquired infection and other areas of health and safety, it was also felt there was a need to take account of the cultural and racial diversity of staff. NHS Employers, which represents NHS management in England, is currently wrestling with the final version of an NHS-wide code of appearance that will 'address situations where dress codes, staff uniforms, religious considerations and health and safety come together'. Ms Carrington says the CSP is keen to see such an NHS-wide code. At present individual trusts produce their own dress and appearance codes that by-and-large contain similar messages. These do generally allow for some flexibility, especially for people working in the community where adhering to a dress code rather than a particular uniform is becoming the norm. However, while street fashions may percolate through into the professional world, some looks, such as large and distinctive tattoos or facial piercings, might seem intimidating to certain patients. Ms Carrington says it's a useful exercise to put yourself in the mind of your patient. 'It's thinking about how you come across. Somebody may have an appearance that patients feel disturbed by, but of course on getting to know that person you can come to appreciate they are a highly-skilled professional. But if the relationship never gets off to a good start (because of appearance) then you are not providing an effective service. 'We have to be aware of what cements a relationship with patients and what might be less helpful. We have to be patient focused and ask what the patient prefers.' Ms Davis agrees that while body piercing, tattoos and exposed midriffs might now be considered normal street attire, students need to be aware that their workplace is different and appearance can cause problems. All the respondents to her survey said that tattoos or piercings should not be visible at work. However she says educators must take the lead as role models. 'You tell students to keep jewellery to a minimum and have their hair tied back and they say, “Well, that's not what our educators do”.' Many NHS trust policies emphasise  the importance of a strict appearance code to help combat hospital-borne infections like MRSA and Clostridium difficile. This particularly applies when dirty uniform cuffs or  sleeves or long nails, for example, could become the vector for infection. Ms Carrington says while tackling  hospital-acquired infection is a priority, physiotherapists must also be aware that  appropriate dress, jewellery and appearance have an important role to play in safe and  sterile procedures. 'What if you are working up close to a patient, perhaps in neurorehab, and you have a piercing that is sticking out, or a piece of other protruding jewellery, and it damages the patient's skin?' However, questions of body adornment or fashion pale into insignificance when compared to the issue from hell - smell. Brent teaching primary care trust's dress code makes specific reference to personal hygiene. It states: 'All staff should pay attention to their personal grooming and dental hygiene, for health reasons and so as not to discomfort others. This includes discomforting odours such as body odour and poor oral hygiene as a result of smoking or eating pungent foods.' Liz Carrington agrees physiotherapists must be 'squeaky clean'. She says: 'How often do you change your uniform, especially if you smoke? Think how nice it is for a patient if you are working close-in covered in tobacco smoke or BO?' FURTHER INFORMATION   If you have any interesting experiences as a result of tattoos, body piercings or other aspects of dress or  body adornment, Frontline would like to hear from you.  Please write to frontline@csp.org.uk  and state  if your comments may be published in a letter

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