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Background: Uniform has traditionally been worn in psychiatric inpatient and other mental health settings, but there has been a move to non-uniform in recent years. Some services have made the change back to uniform, raising questions about the potential impact on patients and staff.
Aim: To review the impact of uniform within a psychiatric inpatient or mental health setting.
Method: Databases were searched for articles exploring the impact of uniform use using specified search terms. Articles were assessed for suitability with inclusion and exclusion criteria, critically appraised, then analysed for themes using thematic analysis.
Results: 17 papers were included in the review. Thematic analysis identified five main themes and 29 subthemes. Main themes were Attitudes and interactions,
A freer environment, Are you both nurses?, The 'ideal self' and There are more important things. A critical appraisal of the articles suggested issues with validity and reliability, which are discussed.
Discussion: Studies identified that wearing non-uniform facilitated positive changes in both patients and staff. This raises the potential negative impact of uniform on both patients and staff, and the role of power imbalance in these settings is discussed. Further themes around identification of staff out of uniform were considered.
Implications for practice: The use of uniform in mental health and psychiatric inpatient settings should be considered carefully, due to the potential negative impact, whilst also recognising the importance of staff identification and supporting professional identity.
Key words: psychiatric inpatient; mental health; uniform; power; therapeutic relationship
Introduction
Research into the impact of wearing uniforms in psychiatric inpatient units or mental health services dates back to the 1960s, when traditional white uniform was worn (e.g. Brown 1961; Goldberg et al. 1961;). This research looked at not only the perceived impact of uniform on therapeutic relationships between patients and nurses but also the impact of uniform on patients' behaviour, with mixed findings.
However, as mental health care moved away from treatment in 'Asylums' in the 1960s to 1980s towards care in the community (Turner et al. 2015), the use of uniforms was phased out, with research throughout this period raising potential issues of power imbalance and barriers to therapeutic relationships (Lavender 1987). It was also suggested that these issues might have an impact on recovery and whether a patient...