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The tenets of dignity, safety and privacy are potentially challenged when patients are required to remove their own clothes and wear the hospital gown for medical procedures. The current study aimed to explore healthcare workers’ views (n = 3371) on the utility of the hospital gown and its perceived impact on patient wellbeing using a cross-sectional online survey with closed and open-ended questions. Findings suggested that the gown was often used when it was not medically necessary and that it was perceived to negatively impact on patient wellbeing (leaving patients feeling uncomfortable, vulnerable, cold, exposed and self-conscious). The majority of healthcare workers suggested alternatives and/or modifications to the hospital gown in order for it to be more patient centred. Barriers and practical challenges in promoting patients wearing their own clothing were identified with recommendations for improving choice, quality, safety and dignity in patent clothing across diverse healthcare settings.

Chapter 9 focuses on how to handle cardiac events, symptoms, and medical procedures, and it reviews the recommendations for specialized, lifelong cardiac care. The concept of becoming a patient expert and advocating for care is discussed, along with a review of the Affordable Care Act in the United States. Advice on preparing for medical appointments, cardiac procedures, and surgery by assembling a team, hospital self-care, stress reduction exercises, and visualization are all covered. Coping strategies for taking medication, dealing with COVID-19, deteriorating health, heart failure, and transplant are all discussed. Information on heart failure and heart transplant is provided in two personal interviews by Yale cardiologist Dr. Dan Jacoby and social worker Dawn Lorentson.

Grounded in a cognitive behavioral therapy approach, the focus of Chapter 7 is how to recognize and manage vicious cycles of unhelpful thinking and behaviors. Techniques to recognize and challenge any underlying negative core beliefs are provided while recognizing how these patterns may have developed to cope with difficult early experiences. Strategies such as thought challenging, behavioral activation, exposure hierarchy, and the use of humor are explored. Healthy coping strategies are offered to replace unhelpful coping habits such as worry-checking behaviors, avoidance, drugs, and alcohol. Common misconceptions about congenital heart conditions are also challenged. When to seek professional help is discussed, and red flag symptoms are listed.

Chapter 12 provides three separate guides—one for family and friends, one for healthcare professionals, and one for mental healthcare professionals—to support individuals with congenital heart conditions (CHCs). For family and friends, strategies for getting through a medical crisis are discussed, do’s and don’ts when trying to support someone with a CHC are reviewed, and the importance of self-care is stressed. For healthcare professionals, an approach termed “Psychologically Informed Medicine” is detailed to minimize the psychological effects of CHC for their patients. This approach comprises compassionate-reflective and trauma-informed practice while promoting the soothing presence of loved ones and social inclusion. For mental health providers, a review of the psychological effects of CHC and recommendations for treatment approach are discussed.

The focus of Chapter 6 is managing uncomfortable feelings. It encourages readers to use their emotions as a guide as they give us important messages about what we need. Healthy emotional regulation, learning to accept uncertainty, and tips to label and express difficult emotions are reviewed. A wide range of techniques for managing overwhelming feelings and increasing psychological safety are provided. Some examples include how to identify trigger responses, emotional labeling, emotional release, distress tolerance, positive affirmations, grounding exercises, visualization, the divers’ response, pelvic floor exercises and somatic exercises. Tips for recognizing and managing anger are reviewed. A therapeutic letter writing exercise is outlined.

The focus of Chapter 5 is to develop the reader’s toolkit of strategies to proactively optimize self-care, build resilience, and reduce baseline stress. Self-care is encouraged and multiple suggestions are given. The importance of sleep, a healthy diet, physical exercise (and barriers to this), and scheduling relaxation and pleasant events are explored. The concept of sleep hygiene is outlined, and recommendations are made. Readers are also provided with general lifestyle suggestions and techniques to improve overall mental health and wellness, including breathing techniques, progressive muscle relaxation, mindfulness, meditation, distraction, and somatic exercises. Anger management strategies, guided visualization, assigned “worry-time” and therapeutic letter writing are also described.

The first chapter sets the scene by providing a brief, easy-to-read overview of the medical history of congenital cardiology. This provides a broader context for readers to further understand this novel “collective story” while recognizing the huge variation in congenital heart conditions, treatments, complications, and resulting lived experiences. In addition to acknowledging the “medical successes” and significant advances that have gifted life to many, the chapter also introduces the challenges that people living with a congenital heart condition can face from infancy. Such adversities can include a focus on survival with limited understanding and support for the psychological impact, the challenges of navigating transition from childhood to adult healthcare, the challenges accessing adult healthcare provision, and dependence on lifelong pioneering medical treatment. The growing need to address the psychological and social impact of congenital heart conditions is noted, including an interview with Paula Miller, the Adult Congenital Heart Association’s senior education manager.

Chapter 8 emphasizes how supportive social relationships are crucial to mental health and overall well-being, and how the reader’s self-esteem and confidence can impact the quality of those relationships. This chapter offers strategies, such as how to challenge self-critical thoughts, letter writing, love and kindness meditation, and self-compassion. This chapter also provides advice on managing the impact of living with a congenital heart condition on the parent–adult child relationship, dating, intimacy, friendships, and parenting. Healthy communication strategies, tips on becoming more assertive, and the importance of limit setting, boundaries, and developing a supportive social network are covered. Increasing independence and recovering from the loss of a primary caregiver are also discussed.

Chapter 4 develops the reader’s understanding of low mood, shame, grief, and anger. These feelings are normalized as an understandable response to the losses and adversities that can result from living with a congenital heart condition. Challenges such as missing out, difficulties having a family, feeling different, and facing discrimination are discussed, as well as unhelpful coping strategies such as denial, alcohol and drug use, and social withdrawal. The development of this distress into more serious mental health difficulties, often due to a lack of appropriate understanding and peer support, is also discussed. Red flag signs and symptoms of depression are listed.

Developing the reader’s understanding of anxiety and panic is the focus of Chapter 3. Readers are provided with an in-depth description of how the body responds to perceived threat, which can result in its “alarm system” being activated, leading to feelings of anxiety. This response is normalized as a survival mechanism which originates from the autonomic nervous system to facilitate protective “fight, flight, or freeze” behaviors. At times this response can be triggered unnecessarily in a “false alarm” or panic. Congenital heart condition–related stressors, including repeated exposure to invasive medical procedures, medical uncertainty, and childhood trauma, are discussed as potentially contributing to increased vulnerability to feelings of anxiety and panic. The chapter explores different ways in which anxiety can present, including panic attacks, heart-focused health anxiety, and posttraumatic stress disorder.

Chapter 2 develops the reader’s understanding of the psychological, emotional, and social challenges that the congenital heart condition (CHC) population can face while recognizing that everyone with a CHC has a very different experience and story. Social inequalities and life challenges such as the potential impact of medical disruption to early attachment to significant caregivers, grief and loss (e.g., of a “normal” childhood), the impact of CHCs on relationships, social inclusion, self-image, education, career, finances and overall quality of life are explored. Further, medical challenges such as managing hospital visits, medical procedures, cardiac events, heart failure, implantable cardiac devices, medical uncertainty, COVID-19, and mental health prevalence are considered.

Chapter 11 focuses on some of the psychological benefits that have been reported after certain adverse or traumatic experiences, and it explores the concept of posttraumatic growth. Many individuals report having changed priorities, spiritual growth, a greater appreciation for living life, the ability to develop closer relationships, increased empathy for others, and having a clearer view of what is most important in their lives after living with a congenital heart condition. Tips on nurturing post traumatic growth are outlined. The connections among resilience, mental health, gratitude and congenital heart conditions are addressed. Findings on the quality of life of individuals with a congenital heart condition and the “disability paradox” are included.

Healing Hearts and Minds: A Holistic Approach to Coping Well with Congenital Heart Disease is a practical self-help guide written for adults affected by congenital heart disease, their loved ones, healthcare providers, and anyone with an interest in this population. The book is full of evidence-based, easy-to-understand information about living with a lifelong heart condition. It provides an overview of the unique psychological, emotional, and social challenges that can arise and is brought to life with real-life vignettes and quotations. The book aims to validate a normal response to the unique adversities members of this population can face while providing strategies to manage these potential challenges. Drawing on a range of psychological therapy tools and techniques, the book offers tips to help manage anxiety, low mood, relationship difficulties, physical symptoms, and medical procedures, while building resilience, finding hope, meaning, and connection. Further, information on supporting adults with congenital heart disease for loved ones and healthcare providers is included. The book is written by a chartered counseling psychologist and a clinical social worker who are both “pioneering” adult congenital heart disease survivors, each dependent since birth on cutting-edge cardiac medical science. Both authors have extensive experience in working therapeutically with the growing adult congenital heart disease population, contributing to the evidence base through academic publications. The book aims to meet a gap in addressing the psychological impact of living with a serious medical condition, lifelong from birth.

Reports an error in "A new measure of feeling safe: Developing psychometric properties of the Neuroception of Psychological Safety Scale (NPSS)" by Liza Morton, Nicola Cogan, Jacek Kolacz, Calum Calderwood, Marek Nikolic, Thomas Bacon, Emily Pathe, Damien Williams and Stephen W. Porges (Psychological safety is increasingly recognized as central to mental health, wellbeing and posttraumatic growth. To date, there is no psychometrically supported measure of psychological safety combining psychological, physiological and social components. The current research aimed to develop and establish the neuroception of psychological safety scale (NPSS), informed by Polyvagal Theory.The study comprised of 3 stages: (a) item generation, (b) item reduction, and (c) assessment of factor structure and internal consistency. Exploratory and confirmatory factor analysis was conducted from 2 samples who completed a survey online (exploratoryInitially, 107 items were generated. Item reduction and exploratory factor analysis resulted in a 29-item NPSS with subscales of compassion, social engagement and body sensations. The NPSS was found to have a consistent factor structure and internal consistency.The NPSS is a novel measure of psychological safety which can be used across a range of health and social care settings. This research provides a platform for further work to support and enhance understandings of the science of safety through the measurement of psychological, relational and physiological components of safety. The NPSS will help shape new approaches to evaluating trauma treatments, relational issues and mental health concerns. Research to establish the convergent, discriminant and concurrent validity of the NPSS and to explore its use with diverse community and clinical populations is underway. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Railway workers have provided an essential service throughout the COVID-19 pandemic. This study explored the effects of COVID-19 on the mental wellbeing of railway workers (n = 906) in the UK during the third lockdown period. The online survey included measures of COVID-19 related risk factors (perceived risk, stress, burnout, trauma) and protective factors (resilience coping, team resilience, general help-seeking) associated with mental wellbeing. Responses were analysed using multiple regression and content analysis. COVID-19 related risk factors negatively predicted wellbeing. Higher scores on adaptive resilience, intentions to seek help and team resilience significantly predicted higher mental wellbeing scores. Mental health decline throughout the COVID-19 pandemic and concerns for the future were reported. Building a resilient railway workforce requires attention to staff mental wellbeing and to ensuring that support systems are robust and accessible. [Abstract copyright: Copyright © 2022 American College of Occupational and Environmental Medicine.]

A growing body of research has highlighted the adverse impact of COVID-19 stressors on health and social care workers' (HSCWs) mental health. Complementing this work, we report on the psychosocial factors that have had both a positive and negative impact on the mental well-being of HSCWs during the third lockdown period in Scotland. Using a cross-sectional design, participants (n = 1364) completed an online survey providing quantitative data and free open-text responses. A multi-method approach to analysis was used. The majority of HSCWs were found to have low well-being scores, high levels of COVID-19 stress, worry, burnout and risk perception scores and almost half of HSCWs met the clinical cut-off for acute stress (indicative of PTSD). HSCWs with higher scores on adaptive coping strategies and team resilience reported higher scores on mental well-being. HSCWs were significantly more likely to seek informal support for dealing with personal or emotional problems compared to formal supports. Barriers to formal help-seeking were identified including stigma and fear of the consequences of disclosure. HSCWs mostly valued peer support, workplace supports, visible leadership and teamwork in maintaining their mental well-being. Our findings illuminate the complexity of the effects of the COVID-19 pandemic on HSCWs' well-being and will inform future intervention development seeking to increase positive adaptation and improve staff well-being. Addressing barriers to mental health help-seeking among HSCWs is essential. The implications emphasise the importance of lessons learned across health and social care contexts, planning and preparedness for future pandemics.

Purpose of review Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients. Recent findings Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents with CHD reported greater health anxiety than community peers. Health anxiety was commonly reported among adults with CHD presenting for psychological assessment. It was linked with older age, trait anxiety, perceived parental overprotection and greater CHD complexity in one study. Summary Adults with CHD face many potential health-related stressors, including cardiac symptoms, treatments and interventions throughout the lifespan (including surgeries and other invasive procedures), the impact of CHD on daily lives and longer-term health expectations. Providers should be aware that heart-focused anxiety among patients is understandable and perhaps common. Patient-centred education and psychological intervention should be integrated within a comprehensive approach to long-term disease management.

Objectives The importance of personalized and dignified care is increasingly being recognized in health care policy and practice. Despite the known impact of clothing on social identity and self-expression, the impact of hospital clothing on patient well-being has been widely overlooked. Patients are often required to wear hospital clothing, commonly a backless gown, during medical procedures and surgeries. The impact of wearing patient clothing on well-being, during this time of vulnerability, was explored. Design A sequential multi-method approach consisting of two studies. Methods Two studies were carried out to consider the impact of the hospital gown on well-being among adults with and without chronic health conditions. The first study consisted of conducting in-depth, semi-structured interviews (n = 10) with adults living with a lifelong chronic health condition (congenital heart disease). The second study was a cross-sectional online survey exploring adults' views (n = 928) and experiences of wearing the hospital gown. Results Qualitative analysis identified the following master themes: (1) symbolic embodiment of the ‘sick’ role, (2) relinquishing control to medical professionals, and (3) emotional and physical vulnerability. Quantitative analysis of the online survey data indicated that adults often reported wearing the hospital gown despite a lack of medical necessity. Its design was considered to be not fit for purpose and lacking in dignity. Conclusions The implications of these findings for health policy and practice are discussed, emphasizing the importance of challenging cultural norms in health care since dehumanizing aspects of care, as symbolically represented by the hospital gown, may adversely impact on patient well-being. Statement of contribution What is already known Getting dressed is a form of self-expression, which contributes to the construction of social identity, yet few studies have explored the impact of wearing hospital clothing on patient well-being. The few studies on hospital clothing that exist suggest it is predominantly associated with feeling depersonalized, stigmatized, and devitalized, being in the ‘patient role’, low status, and a lack of control and privacy. However, previous studies include a variety of hospital clothing including pyjamas (Edvardsson, 2009) and dressing gowns (Topo & Iltanen-Tähkävuori, 2010), whereas in the United Kingdom, a 'one-size-fits-all' backless gown, held together with ties at the back, is most commonly used. What this study adds This study furthers understanding about the lived experience of wearing hospital clothing for people living with a chronic health condition (congenital heart disease) and without. Wearing hospital clothing (most commonly the hospital gown) was associated with symbolic embodiment of the ‘sick’ role, relinquishing control to medical professionals, and emotional and physical vulnerability for people living with a chronic health condition. Findings from a wider sample, drawn from the general population, suggest that the hospital gown is often being used despite a lack of medical necessity often leaving patients feeling exposed, self-conscious, vulnerable, uncomfortable, cold, embarrassed, and disempowered. These findings are exacerbated for people living with a long-term health condition and women. Together, these studies suggest that the current design of the hospital gown is not fit for purpose and impacts negatively on patient well-being.

Railway workers are reportedly at risk of developing traumatic stress-related conditions, yet little is known about the effects of COVID-19 on the mental wellbeing of railway workers. The study consisted of a cross-sectional online survey exploring the effects of COVID-19 on the mental wellbeing of railway workers (n=906) in the UK. The aim was to explore whether protective factors (adaptive resilience, team resilience and help-seeking intentions) mediated the relationship between COVID-19 risk factors (stress, risk perception and burnout) and railway workers’ mental wellbeing. Responses to psychometrically valid measures were analysed using multiple regression and parallel mediation analyses. Free text data exploring railway workers’ views on the impact of COVID-19 on their mental wellbeing, were analysed using content analysis. Protective factors significantly mediated the relationship between mental wellbeing and COVID-19 risk factors. Railway workers reported that they experienced mental health decline throughout the pandemic, loss of workplace supports, increased need for psychological support, and concerns for the future. Work-based supports and access to psychological input for railway workers who need it is highlighted. Building a resilient railway workforce moving forward requires attention to staff mental wellbeing and to ensuring that support systems are robust, safe and accessible.

Rapid studies have highlighted the adverse mental health impact of COVID-19 on health and social care workers (HSCWs). Complementing this work, we report on the psychosocial factors that have helped HSCWs adapt to the adversities associated with COVID-19 and protect staff wellbeing in Scotland. The ENACT study collected data from HSCWs (n= 1364) in Scotland during the third national lockdown. Using a cross-sectional design, participants completed an online survey providing quantitative data and free responses. A multi-method approach to analysis was used. The majority of HSCWs were found to have low wellbeing scores, high levels of COVID-19 stress, worry, burnout and risk perception scores and almost half of HSCWs met the clinical cut off for acute stress. Adaptive coping strategies and increased perceived team resilience helped mitigate against the adverse impact that COVID-19 stressors have on HSCWs’ mental wellbeing. HSCWs were significantly more likely to seek informal support for dealing with personal or emotional problems. Barriers to formal help-seeking were identified including stigma and fears of consequence of disclosure. HSCWs most valued peer support, workplace supports, visible leadership and teamwork. Our findings illuminate the complexity of the effects of the COVID-19 pandemic on HSCWs’ wellbeing and will inform future intervention development to increase positive adaptation amongst staff. Addressing barriers to mental health help-seeking among HSCWs is essential. The implications emphasise the importance of lessons learned across health and social care contexts, planning and preparedness for future pandemics.

Objective: Psychological safety is increasingly recognised as central to mental health, wellbeing and post-traumatic growth. To date, there is no psychometrically supported measure of psychological safety combining psychological, physiological and social components. The current research aimed to develop and establish the neuroception of psychological safety scale (NPSS), informed by Polyvagal Theory. Method: The study comprised of three stages: (1) item generation, (2) item reduction, and (3) assessment of factor structure and internal consistency. Exploratory and confirmatory factor analysis was conducted from two samples who completed a survey online (exploratory n = 342, confirmatory n = 455). Results: Initially, 107 items were generated. Item reduction and exploratory factor analysis resulted in a 29-item NPSS with subscales of compassion, social engagement and body sensations. The NPSS was found to have a consistent factor structure and internal consistency. Conclusion: The NPSS is a novel measure of psychological safety which can be used across a range of health and social care settings. This research provides a platform for further work to support and enhance understandings of the science of safety through the measurement of psychological, relational and physiological components of safety. The NPSS will help shape new approaches to evaluating trauma treatments, relational issues and mental health concerns. Research to establish the convergent, discriminant and concurrent validity of the NPSS and to explore its use with diverse community and clinical populations is underway.

Stressful working conditions among nurses have adverse effects on their physical and mental health. We investigated associations between self-reported stressful working conditions and psychosomatic symptoms among nurses in the Hebron district, occupied Palestinian Territory, and whether there are differences the sexes in the perceptions of working conditions and psychosomatic symptoms.We did a cross-sectional survey between Oct 7 and Dec 10, 2012, among registered nurses in all health sectors in Hebron district. A nine-point ordinal scale of working conditions was used to categorise perception of stress as low, medium, or high, and seven psychosomatic symptoms were recorded on a checklist coded as never (0), seldom (1), occasionally (2), or often (3), allowing for a total score between 0 and 21. All analyses were done with STATA (version 10). P values of less than 0·05 were significant. Participation in the study was voluntary, and written informed consent was obtained from each participant. The study was approved by the Regional Committee for Medical and Health Research Ethics, Norway. Permission to do the study was obtained from the Palestinian Ministry of Health.Among 372 eligible nurses, ten were on extended leave from work, 16 declined to participate, and four had incomplete data, giving a final sample of 342 nurses (92% response rate). 212 (62%) were women and 130 (38%) were men. Low levels of stress were reported by 42 (12%) nurses, medium levels by 206 (60%), and high levels by 94 (28%). The mean score of psychosomatic symptoms for the group was 10·4 (SD 4·02, range 0-21). Scores did not differ significantly between men and women. Mean symptom scores differed between nurses with self-reported highly stressful working conditions and those with low levels of stress (12.6 vs 8.4, difference 4·1, 95% CI 2·7-5·5; p0·001). Among male nurses, those with self-reported highly stressful working conditions had a mean psychosomatic symptom score of 13.0, compared with that was 7.7 among those working in low-stress conditions (difference 5·3 units, p0·001). This effect remained significant after adjustment for the covariates age, education, number of children, work schedule, and years of experience (12·6 vs 7·7, difference 4·9 units, 95% CI 2·6-7·2). Among female nurses, the scores among those with high-stress working conditions was 12.4 and for those with low-stress working conditions was 9.0 (difference 3·4 units, p0·001). After adjustment the difference remained similar (12·4 vs 9·0, difference 3·5 units, 95% CI 1·7-5·3, p0·001).We found that psychosomatic symptoms increased as self-reported perception of stressful working conditions increased, irrespective of sex. The study had a cross-sectional design and both exposure and outcomes were measured using self-report and, therefore, interpretation of the results should be made with caution. Longitudinal epidemiological studies are recommended. Future studies should investigate whether stressful working conditions affect the quality of patients' care in health services.Norwegian Programme for Development, Research and Education.

If you are what you wear what impact does wearing a backless hospital gown have on health, wellbeing and recovery? Research has yet to explore this and there seems to be institutionalised acceptance of the gown despite recent drives to empower patients with person centred health care provisions. We report on two small scale studies which were carried out to consider the impact of the hospital gown on wellbeing and recovery among adults with and without chronic health conditions. The first study consisted of conducting in-depth, semi-structured interviews (n = 10) with adults living with a life-long chronic health conditions (congenital heart disease), which were audio-recorded, transcribed and thematic analysis was used to identify themes from the qualitative data. The second study is a cross-sectional, online survey exploring adults’ views (n = 600+) and experiences of the hospital gown. Preliminary qualitative analysis has identified the following master themes: (1) loss of ‘healthy’ identity, (2) symbolic embodiment of the ‘sick’ role, (3) relinquishing control to medical professionals, and (4) vulnerability, disempowerment and embarrassment. Preliminary quantitative analysis of the online survey data indicates that adults often reported wearing the hospital gown despite lack of medical necessity with its design considered to be not fit for purpose and lacking in dignity. The implications of these findings are discussed, emphasising the importance of challenging cultural norms in healthcare since de-humanising aspects of care may contribute adversely impact wellbeing and recovery.

Over the last few decades, medical and surgical advances have led to a growing population of individuals living with congenital heart disease. The challenges of this condition can reach beyond physical limitations to include anxiety, depression and post-traumatic stress disorder. To date, these psychological outcomes have been neglected; yet, they need not be inevitable. The factors contributing to these difficulties are considered here, drawing on current evidence and neuropsychological theories including the novel application of polyvagal theory. Suggestions for developing psychologically informed medical and social care to improve mental health, wellbeing and recovery and influence policy and training are proposed (See supplemental material for video abstract).

• Social Prescribing links patients in the Primary Care setting with non-medical sources of community support.

Background The importance of personalised and dignified care is increasingly being recognised in health-care policy and practice. Despite the known effect of clothing on social identity, few studies have considered the effect of hospital clothing on patient wellbeing. Although clothing can empower the wearer, it can also induce psychological distress, feelings of disempowerment, and lowered self-esteem. Despite drives to empower patients with person centred health-care provisions, the institutionalised acceptance of the hospital gown persists. Research has yet to explore the effect of wearing the hospital gown on patients’ wellbeing. Methods Recruitment for both studies commenced on Nov 1, 2018 and ended on the Aug 31, 2019. Two studies were carried out to consider the effect of the hospital gown on wellbeing of adults with and without chronic health conditions. The first study consisted of doing in-depth, semi-structured interviews with adults living with life-long chronic health conditions, which were audio recorded and transcribed, and thematic analysis was used to identify themes from the qualitative data. The second study was a cross-sectional, online survey exploring adults’ views and experiences of wearing the hospital gown. Ethical approval was sought and granted from the Psychological Sciences in Health Ethics Committee. Findings Ten people participated in the interviews. 928 people completed the survey, aged 18–80 years (mean age 43 [SD 12]). Participants were predominantly female (79%), white, living in the UK (86%), with 46% identifying as having a long-term health condition. Qualitative analysis identified the four master themes: loss of healthy identity; symbolic embodiment of the sick role; relinquishing control to medical professionals; and vulnerability, disempowerment, and embarrassment. Quantitative analysis of the online survey data indicated that 542 (58%) of 928 adults reported wearing the hospital gown despite feeling uncertain that it was a medical necessity. The gown's design was considered to be not fit for purpose, with 573 (61%) of 928 adults reporting that they struggled to put it on or required assistance, and 623 (67%) of 928 reported that they did not think that the gown fitted them. From the 928 adults, 670 reported feeling exposed (72%), 554 (60%) felt self-conscious, and 530 (57%) felt uncomfortable while wearing the hospital gown. Interpretation These findings suggest that hospital gowns might contribute towards patients experiencing an increased sense of exposure, discomfort, disempowerment, and embarrassment at a time of potential vulnerability while undergoing medical intervention, emphasising the importance of challenging cultural norms in health care. Dehumanising aspects of care, as symbolically represented by the hospital gown, might adversely affect patient wellbeing and increase distress. Funding None.

At a few days old, I was transferred to hospital, where, already in congestive heart failure, I was attached to an external cardiac pacemaker. When this restored life—in a world first for an 11 day old baby—I was diagnosed as having complete heart block and fitted with an implantable pacemaker. Now an adult and mother of one, I am tremendously grateful to the NHS, advances in medicine, and those pioneers for my life. Congenital heart disease is a success story of modern medicine—90% of babies born with this condition now survive into adulthood, compared with just 20% in the 1940s.1 Yet, medical advances raise questions about the psychological and emotional impact of being dependent on lifelong medical care. Growing up with a heart condition has not been easy. Early pacemakers were unreliable and often needed reprogramming. I remember lying still, surrounded by a team of men in white coats armed with a magnet, leads, cold gel, stethoscopes, and electrodes. They would make my heart beat faster, then slower, as they interrogated the pacemaker. I was a medical curiosity. I was also a little girl who just wanted to do things that other little girls took for granted. We were told I should be able to function normally, yet those early pacemakers were single chamber ones that propelled my heart to beat at a fixed rate whatever I did, limiting me physically. I turned blue when cold, vomited on overexertion, and often felt dizzy. I wasn’t …