Wear to Care – exploring the issue of uniforms in care homes

The ADS team has recently completed a project with Care UK to explore how residents, relatives and members of staff in two Care UK care homes feel about staff uniforms.

Suzanne Mumford, Care UK’s Head of Nursing, Care and Dementia Services for their approach to care and dementia services, had already started looking into the issue of uniforms, identifying arguments for staff wearing a uniform and for staff wearing ‘non-uniform’ options. Off the back of an initial literature review Suzanne noted that,

“The missing link appears to be actually involving people living with dementia and those who care for them both family, friends and professionally”

Called ‘Wear to Care’, this project was ideally placed to provide that missing link. All we had to contend with was trying to conduct research in care homes during a pandemic!

Getting things started

Luckily, before COVID hit we were able to kick off the project by meeting with representatives from the two Care UK care homes to plan the work and share ideas around uniforms. We discussed various uniform styles, personal experiences, colour, practicality, appropriateness, whole outfits versus just tops – the list went on!

We collectively decided on three uniform choices that represent the current breadth of uniform formality that we currently see across UK care homes:

1. Most formal – Traditional uniform
2. Casual – Polo shirt
3. Least formal – Own clothes

Although we all understood the great importance of colour, we also recognised that the study was small and we would not have the time or resources to delve deep enough into this area to do it any justice. The result was that we stuck to one colour. The three uniform choices were therefore all shades of purple, the colour that Care UK members of staff currently wear.

During our discussions we mutually agreed that ‘the badge’ was an integral part of a staff uniform, so it was decided that we would use the study as an opportunity to gain feedback on badge design. We developed three badge options (including Care UK’s current badge), varying the focal points between name, logo and job role as shown below:

In addition to the physical uniforms, it was frequently raised in discussion that the way in which a member of staff portrays themselves needed to be accounted for in the study. We wanted to analyse whether the approachability of members of staff had an impact on people’s views in relation to what they were wearing.

Once the research team had sourced the uniform choices (which was far more difficult than anyone had anticipated!), a mini photoshoot was set up. It was important to factor in that knowing the person in the photos may influence responses, so a member of Care UK staff who didn’t work at either of the participating care homes and wasn’t known to the participants was invited to be our ‘model’. They kindly agreed and, after battling local flooding at the time, we were able to get the model, the uniform choices and a camera in the same location at the same time. The model was photographed wearing each of the three uniform options, in different ‘approachable’ and ‘unapproachable’ poses.

The photographs were whittled down to a set of six which hopefully provided some consistency in terms of poses as shown below:

What did we do with the photos?

These photographs were included in surveys in a ‘mixed up but consistent’ order alongside supporting questions around preferred uniform choices in different situations for staff and relatives to answer.

A ‘table-top’ activity using the same set of photographs was also designed as a means of obtaining feedback from residents with dementia within the two participating homes. This involved a facilitator, such as an activity co-ordinator’ encouraging residents to select one of the photographs to fit with various activities. For example, residents were asked questions such as ‘which photograph shows someone that you would you like to go for a walk in the garden with?’ ‘which photograph shows someone that you would want to help you to get ready in the morning?’ with a visual prompt relating to each question and the uniform options to match it up with.

At this point, just as everything was ready to get going in terms of data collection, everyone went into lockdown and, understandably, it just wasn’t possible to proceed with the study at the time. When the two care homes were ready to even think about picking it up again, we were only able to provide support through Zoom calls, emails and phone calls. Despite all of these issues, we had a really good response from the care homes and lots of valuable feedback was given by residents, relatives and staff. Thank you to everyone who took part in the study, your involvement was really appreciated.

So what did we find out?

The full findings from this study will hopefully be published later, but the key headlines are as follows.

The more formal uniform option with the model in the ‘approachable’ pose, was the preferred option for staff to wear when formal activities were taking place. It was also the option that residents associated the most with personal care and physical assistance. Overall, it was thought that the formal uniform option made staff look the most trustworthy. Care staff also thought it looked the most practical option.

The polo shirt option, again in the approachable pose, was generally the second choice across the board for staff taking part in various activities. However, it was the preferred choice for many in terms of representing the person they would be most comfortable approaching if they were concerned about a resident’s emotional health.

The least formal ‘own clothes’ option, also in the approachable pose, was the preferred choice for the less formal (and more fun) activities such as going on a trip or taking part in activities outside of the care home environment.

From the study, it was clear that choice of uniform was an important consideration and people hold strong and important views around them. Additionally, the approachability of a member of staff was also highlighted to be an incredibly important element of the overall ‘uniform’. When residents were asked if there was anybody in the pictures that they would not want to care for them, only photographs showing the model in an ‘unapproachable’ stance were selected. Indeed, the three photographs featuring the ‘unapproachable’ pose were very rarely chosen throughout the study by any group of respondents.

In terms of the badges, there was a clear and consistent view from both the surveys and table-top activity that the badge which focused on the staff name, rather than the corporate logo or job title, was the easiest badge to read. Badges are particularly pertinent in a time of increased PPE, when aprons and masks may cover the uniforms and familiar faces of staff. Having a badge which allows you to easily know someone’s name (such as the preferred option below) is therefore essential.

Obviously changing clothes for different situations isn’t practical, but our study suggests that wearing a polo shirt with a clear name badge could offer a suitable compromise which is worth considering. It’s less formal than existing uniforms, could still offer the ‘feel’ of a uniform in that staff would be wearing the same thing, and is acceptable to everyone – even if it’s not necessarily their first choice. If you’re thinking about coming out of formal uniform but are worried about making the jump straight to ‘own clothes’, this could be a good way to test the waters. But remember, as our study showed, when thinking about uniforms, it’s not just what you wear but how you wear it that matters.

Thanks again to everyone who took part in this study, and watch this space for updates about the full article of findings.

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