Recently, I traveled back to Hong Kong to visit my grand aunt on vacation. One day, I accompanied her to the general hospital for her monthly body screening. While I was waiting in the lobby, I saw Hong Kong nurses dressed in short-sleeves tunic with cap on their head. Some of the nurses’ uniforms varied in color due to their department’s policy. However, no matter how different the colors in nurses’ uniforms were from each other, their uniforms were always short-sleeves tunic and a cap on their head. Then I started to compare the differences in nurse’s uniforms between two countries, America and Hong Kong. In America, nurses dressed in scrubs and varied in colors and designs. Many questions started to submerge in my mind: how did nurse’s uniforms begin to recognize as a profession in history; how were changes of nursing uniform style and design at present day affect nurses globally, and how was the impact of changes in nursing uniforms influence society.
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A uniform indicates affiliation with a group and provides a sense of pride to the wearer. Also, a uniform builds spirit of comradeship, enthusiasm, and devotion in nursing. Nursing uniform protects its wearer from exposure to disease and builds trust between nurse and patient relationship. Florence Nightingale, the person who brought nursing as profession during the Crimean War, demanded nursing uniforms to reform nursing career as a respected profession. Nursing uniform entailed both functionality and feminine virtue as a profession which women could be respected and became economic independence. During Nightingale’s day, nursing uniform was based on domestic servants’ uniform of 1860s or derived from nun’ habits. Nuns were the one who caring for the sick until 1860s. The nursing uniform consisted of a gray tweed dress, called a “Wrapper”, a gray worsted jacket, a plain white cap, and a short woolen cloak. In addition, a holland scarf was worn over the shoulders to describe as “frightful”.
Once germs and disease became more understandable, nursing uniforms did not change instead the technique in disinfecting the uniforms. Disinfection of uniforms changed to the use of sulphur fumes, which a nurse had to sit on a cane chair in their uniform over a burning pot of sulfur. Until World War 1, early 20th century, nursing uniform was changed into white color as well as material wise was changed into washable fiber and cotton due to new findings about germs and the role of spreading infection. During wartime, nurses saw white uniform as a symbol of angelic, demure, dependent woman. Symbolization of white color in nursing uniform was last until 1960s where feminists decided white symbolized diminished power. In 1980s, uniforms started to change due to rapid increase in male nurses. Caps and aprons turned out to be not fashionable; instead tunic and dark trousers were replaced. This has become a standard nurse uniform in UK and Australia today. A different variety of this uniform is the current standardized norm in Hong Kong society.
Later, Scrubs was introduced and changed nursing uniform from white tunic to pantsuits due to difficulty of lifting and maneuvering patients while wearing white tunic. Furthermore, scrubs were cheaper than uniforms. Countries started to replace tunic with medical scrubs as standardized nurse uniform. Scrubs uniform was originally come from surgeon as protective wear during the 1970’s and consisted of short-sleeved V-neck shirt, drawstring trousers and a surgical gown. Most hospitals in the USA and Canada, at present, recommend all nurses to wear scrubs while working. Colors of scrubs are usually in duller shades of blue, green or grey, though some scrubs come in different colors and patterns. However, the comfort ability of scrubs directed everyone in medical field professions to switch uniforms, causing patients to have difficulty in recognize nurses. In 2005, the white color symbolization returned and implemented to the nursing uniform after patient expressed the desire to be able to identify nurses. The return of white uniform reflected the nurses a level of respect and recognition that were achieved through years of practice and discipline. Also, white uniform helped nurses to be seen by the society as better professional image.
The evolution of nursing uniform from tradition to scrubs has submerged into a debate between dissenters and supporters of nursing uniform. The debate of scrubs was mainly about the balance of infection prevention against professional appearance. Scrubs provided infection prevention however at the same time; the free will of choice in appearance to patients seems to be confused between surgeon and nurse. Also to some countries that follow tunic and caps and remained the symbol of traditional style of nurse uniform as identity, considered to be more professional outlook and the mark of remembrance of nurse’s uniform in the old days.
Supporters of scrubs viewed the simplicity of design in uniform as a place where contaminants were difficult to hide and easy to clean and disinfect. In addition, scrubs were made of synthetic materials that were difficult to penetrate by dirt or fluids. Also scrubs are cheaper than uniform and easy to replace if it was damaged or contaminated. Scrubs were originally in white color; however, the choice of white caused a few issue. The sight of blood stains on white color scrubs made patient and nurses to feel uncomfortable. Especially, the confidentiality and trust relationship between patients and nurses were very important. For that particular issue, the variety in color and design pattern of scrubs existed, just to make blood stains to be less visible to others and trust building between patients and nurses relationship. Some nurses said that the style in appearance of scrubs is important to raise confident of a nurse toward patient’s care, but by the end of the day is more about the skill and knowledge of a nurse in health care settings.
On the other hand, the dissenters of scrubs perceived that scrubs were nondescript in design, which were difficult for patients to recognize their nurses. Some reports from different nurses said that nurses were mistaken for cleaners by patients, who proceeded to ask for a real nurse. This problem was due to the variety of colors and patterns of design in scrubs. “A study by Skorupski (2006) found that patients tended to lose confidence in nurses who did not dress in white, as they were seen to be less professional.” The use of apron and cap in 19th century for nurse uniform was to present as pure and respectable image to patients and to people who needed help with care. The recognition of tunic and cap as nursing uniform made nurses to feel important, sense a strong feeling as being part of a healthcare facility, and contribute high self-esteem. Some said that nursing is business. The appearance is an important part of a nurse. The sooner a person acknowledge and recognize a person in nurse uniform, the more successful a nurse will be at the bedside and in the boardroom. In other words, a nurse in a recognizable uniform, the success rate and trust between nurse and patients relationship would be high. The goal in achieving patients care would be faster and successful.
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The change of nursing uniform between tunic-cap uniform and scrubs caused several impacts to the society. The change of scrubs into variety colors and acceptance of switching uniform in all different field of medicine, made patients and society to have difficulty in recognizing nurses. The comfort feelings and trust of patients toward nurses in scrubs were less than nurses in tunic-cap uniform. When patients saw nurses in tunic-cap uniform, patients felt a sense of safety and trust toward nurses. The appearance of tunic-cap nurse uniform led patients to understand that nurses had maintained and remembered the traditional standard norm of a nurse uniform. The colorful and varied patterns of scrubs made inpatients children hospitalization to have a greater acceptance toward nurses. There was a study being conducted based on new nurses dressed code. Inpatients hospitalization was being surveyed about the way nurses dresses.
“There were 31% of the patients thought that identifying their registered nurse (RN) in scrubs was easy. Whereas, 55% of patients thought that identifying their RN in scrubs was not easy. 94% of patients thought nurses in scrubs appeared to be professional, 64% of patients allowed nurses to wear any color uniform, but 80% of patients would like to identify registered nurses by the “RN” symbol on nurse’s name badge. 39% of patients liked to identify registered nurses by uniform color; however, 28% of patients preferred nurses to wear white uniforms.”
In brief, I was culturally shocked when I saw nurses in Hong Kong wore tunic-cap uniform. Right away, I could recognize nurses in the hospital not due to their name badges, but to their appearances in uniforms. In America, I identify nurses not by the way a nurse dress or the appearance of uniform, but rather I focus on the symbol “RN” on a nurse name badge. In my own perspective, I thought tunic-cap uniform and scrubs were worn by nurses in cultural differences and followed the trend of fashion industry. I had never thought that the acceptance of scrubs could create a problematic debate in nursing society. Also I had never thought that the existence of nursing uniform could have so many meaning to different society from different time. As Peter Berger mentioned: “sociological discovery to culture shock minus geographical displacement. A sociologist must peel away the layers of the world-for-granted.” It means that a person receives cultural shock not necessarily need to go to somewhere else in the world to get it, but cultural shock could happen anywhere close to where the person lived. Cultural shock could even be happening in a person neighborhood or in a person own backyard. In order to understand a culture and not accept the way as it is, one must peel the layers of the world-for-granted. In other words, to understand a culture, one must dig deep into the meaning of culture. One must travel back to history and understand how a particular culture or action, in which was being practiced in that culture, exist. Taken the world for granted means a person accepts an action or existence of an object as the way it is and not deeply seek out where the origin existence of the object or action come from.
In conclusion, the primary argument for scrubs as nurse uniforms focuses on preventing infection and maintaining safety for both nurses and patients. The existence of tunic-cap uniform and scrubs uniform is accepted differently in different culture. The existence of a nurse uniform was mainly to make nursing career as a respected profession and protect its wearer from germ contamination and infection. When nursing uniform started to change in style and outlook, patients were having difficulty to recognize nurses due to colors differences in uniforms. Later, white color uniforms returned. Patients were able to recognize their nurses and the trust and comfort of patients toward nurses grew stronger in relationship. However, by the end of the day, people do not pay much importance how a nurse looks like as long as the skill and knowledge of a nurse were effective in the care of patients’ health.
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