What should pharmacists wear by etssetcf

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									         WHAT SHOULD
         When you start work you may find yourself wondering what to wear to your
         particular job. Different work environments require different standards of dress.
         Lin Nam Wang looks at whether pharmacists should be concerned about how they
         dress or whether they should just focus on their jobs

         Lin Nam Wang is senior contributions editor at The Pharmaceutical Journal

      For personal use only. Not to be reproduced
            without permission of the editor

            lothing protects, decorates,          dress might influence patient-             and in professional practice related

     C      identifies, unites and displays
            status. According to Desmond
     Morris, author of ‘Manwatching: a field
                                                  pharmacist relationships as well as how
                                                  relationships with other health care
                                                  professionals are formed, and this leads
                                                                                             laboratory sessions,” says Holly Mason,
                                                                                             associate dean of academic
                                                                                             programmes at the Purdue University
     guide to human behaviour’ (Triad             to the question: what should               School of Pharmacy, Indiana. Anthony
     Books, 1978), it is impossible to wear       pharmacists wear in order to be            Smith, principal and dean of the School
     clothes without transmitting social          positively perceived?                      of Pharmacy, University of London, told
     signals. Other authors suggest that                                                     The PJ that white coat ceremonies are
     people make judgements on credibility,       Comments in The Pharmaceutical             something the school is thinking about.
     likeability, education level and             Journal have blamed “the medium of         Should professionalism, in terms of
     trustworthiness — important attributes       the T-shirted pharmacist” (PJ, 28          clothes, be instilled from university? The
     for pharmacists — based on clothing          October 2006, p516) and pharmacists        school’s dress code is currently under
     and, over several decades, researchers       arriving for work in jeans (PJ, 4          review (a previous version included that
     in social psychology and                     November 2006, p545), among other          it “takes a dim view of baseball caps in
     communication have built an evidence         things, for tarnishing the professional    class”) but Professor Smith says: “We
     base to support such theories. Studies       image of pharmacy.                         would not want to be too prescriptive
     that look at the influence of apparel                                                   while [students] are at the school, but if
     typically involve showing people             White coats                                they are on a work placement, they
     photographs of a model dressed in                                                       should observe professional norms —
     different styles and asking them to          At the other end of the spectrum is the    that’s a collar and tie for boys.”
     appraise each one using adjectives,          white-coated pharmacist. Surgeons
     such as “knowledgeable” and “friendly”       started wearing white coats in the late    A white coat may spell professionalism
     or to score each for descriptors, such as    19th century as a new aseptic method       but some believe that it intimidates
     “confidence in ability”. Targets for these   — dirt is clear on white — and, by the     patients — staff on psychiatric or
     types of study have included students        1950s, many pharmacists were wearing       paediatric wards shun the white coat
     (judging what teachers wear) and             them. Advocates of the white coat          for this reason — and contributes to the
     patients (judging doctors’ attire).          claim it makes it easy for patients to     anxiety of a consultation, hence the
                                                  identify the health care professional      term “white coat hypertension”, where
     What a person wears can also affect the      and may lend an air of authority.          blood pressure is elevated in clinical
     behaviour of others. For example, one                                                   settings.
     study showed that pedestrians are            Although the sight of a community
     more likely to ignore a “red man” at a       pharmacist in a white coat is less         Approachability
     crossing if they see a person dressed in     common these days, for some, the coat
     high status clothing ignoring the signal.    is a symbol of the profession. Many US     Approachability was a factor
     Another found that people are more           schools of pharmacy, for example, hold     considered by Superdrug in its dress
     likely to comply with a request made by      “white coat ceremonies” in which           code for pharmacists. Martin Crisp,
     someone dressed in a uniform than            incoming students are presented with a     head of pharmacy for Superdrug Stores
     with a request from someone not in           white coat and take an oath. “The          Plc, says the company’s pharmacists are
     uniform. It has also been shown that         ceremony and coat signify the              issued with a white shirt with the
     levels of political support and              movement into a professional               Superdrug logo attached, which is worn
     charitable donations are affected by         programme. . . . Students typically wear   with black trousers or skirt. “We do
     what the recipient wears. It makes           the coats throughout their programme,      allow our pharmacists to wear their
     sense, therefore, to assume that style of    during their early clinical experiences    own clothes if they prefer but they

60   Miscellaneous
                                                                                                           Konstantin Tavrov/Dreamstime.com

should be businesslike (ie, shirt or         modernise, for example, choosing a          pharmacist Richard Needle. If
blouse). The whole pharmacy team is          jacket with a mandarin collar instead of    pharmacists wish, they can wear the
issued with the same white shirt or          a traditional one,” he says.                same uniform as technicians (tunic tops
blouse, which helps identify them from                                                   and trousers). Identification badges,
the other members of the store. By           Dress codes                                 therefore, are the chief means of
wearing the same we hope that the                                                        identification. When pharmacists go
pharmacist appears approachable and          Many organisations use dress codes          into a room where a patient is in
feels part of the team.” Sagar Patel,        and uniforms to support health and          isolation, they wear an apron and
pharmacist at Herbert & Herbert              safety and to promote a professional        gloves and, in infection outbreaks, they
Chemist, Hounslow, comments: “Ideally,       image and, last month, the Department       wear “theatre blues”.
I’d like to wear jeans and a smart top       of Health published an evidence-based
because people would feel able to talk       document to guide the development of        Infection control
to me. Why should I wear a white coat? I     local policies on uniforms and
don’t work in a laboratory.”                 workwear. The Welsh Assembly says           Although there is no conclusive
                                             uniform codes are at the discretion of      evidence that work clothes pose a
People want a community pharmacist           each NHS trust.                             hazard in terms of spreading infection,
who looks approachable and looks part                                                    the rationale behind many dress code
of the community, especially in small        Most trusts do not require their            requirements is infection control.
pharmacies, says David Sprakes,              pharmacists to wear a uniform, but to       White coats have been branded as a
manager of bespoke design at Simon           comply with a general dress code that       possible source of infections because
Jersey, a company that supplies              applies to all staff. Common to many        they tended not to be washed
uniforms to the NHS. However,                codes is the prohibition of shorts, flip-   frequently and, for the same reason, the
“[Pharmacists] also need that edge —         flops and jeans. Excessive jewellery,       British Medical Association has
that they are professionals. So while a      heavy make up and strong smelling           objected to tie wearing. Dr Needle says
casual element is a good idea, to make       perfumes or aftershaves are also not        that he has not worn a white coat for
[clothes] too informal breaks down           permitted and shoes should be “low          over five years — although he still has
respect.” Mr Sprakes thinks male             noise” so as not to disturb patients.       one hanging up in his office — because
community pharmacists should wear            According to the Norfolk and Norwich        it is an infection risk. However, the
shirts. A tie is not necessary but a polo    University Hospital NHS Trust dress         disappearance of the white coat is not
shirt would be too casual. And they          code and uniform policy, ties should        just about cleanliness, but about a
should also avoid too many colours. “If      reflect a professional image “Homer         change in culture: “[White coats] had an
you saw a pharmacist in a riot of colour,    Simpson saying ‘doh’ may not be             air of formality. There is a much more
would you take him seriously?                appropriate,” Andrew Stronach, head of      open and relaxed culture [now] and it is
                                             communications at the trust,                far less hierarchical. It reflects the move
Personally, I like white — it is crisp and   comments. However, the policy also          to a more collaborative approach,” he
clean — maybe with an accent of              notes “in an emergency situation,           says.
another colour. White can register           especially out of hours, medical staff
authority and is recognisable. That          may prioritise a timely response over       At South Tees Hospital NHS Trust, the
doesn’t necessarily mean a white coat;       keeping up appearances”.                    uniform policy is being reviewed, but
it could mean a tunic. There is such an                                                  the most recent version stated that the
ingrained history [of white in health        At Essex Rivers Healthcare NHS Trust,       dress code for pharmacists and senior
care], you need to bring white into the      the dress code for pharmacists is to be     technicians is “smart clothes with white
equation. You can tweak the style and        “presentably turned out”, says chief        coat as necessary”. An example of
     necessity is when making an                    the pharmacist’s role is becoming more        made where there are legitimate health
     extemporaneous preparation, but this           clinical and the chief pharmacists of         and safety issues, . . . or in situations
     reflects older practice, says Alan Hall,       both South Tees and Essex Rivers NHS          where communication with patients
     chief pharmacist at the trust. When            trusts told the PJ that their trusts have     and patient care may be adversely
     asked if he thought the white coat             talked about pharmacists (and doctors)        affected.”
     looked professional, he answered: “I           wearing theatre blues, as in the US.
     don’t now. If you’d asked me 10 years          “The way that hospitals clothe their staff    A test case brought under the
     ago, I probably would’ve said ‘yes’.” Mr       is probably going to be an issue in           regulations was that of the classroom
     Hall stresses that on wards, pharmacists       forthcoming years in an attempt to            assistant in West Yorkshire suspended
     have to follow infection control policies.     stamp out meticillin resistant                for wearing a face veil. Defences
                                                    Staphylococcus aureus, although much          included that when she was veiled, the
      This means short or rolled-up sleeves,        of this is budget driven,” Mr Sprakes         children did not engage as much with
     no watches or jewellery and no ties.           predicts. However, it may be difficult to     the assistant, they could not pick up
     Pharmacists off wards can also opt for         change attitudes if people have been          visual cues and that her diction was
     the open collar look. “The culture is          used to wearing their own clothes for a       muffled. Could this apply to
     changing. You’ve only got to look at our       long time: “High street [pharmacists]         pharmacists’ interactions with patients?
     politicians who choose to go open              might expect to wear a uniform but in a       Although none of his pharmacists wears
     neck,” he explains.                            hospital environment, which is more           a face veil, Mr Hall believes it might: “My
     Many trusts have evidence-based                relaxed, they may be more against it.         personal view is that I think it possibly
     guidelines for laundering uniforms             But there are lots of benefits to wearing     could be difficult in terms of patient
     within their policies. Those that permit       a uniform. Least of all it saves your own     consultations. With some of our elderly
     uniforms to be washed at home,                 clothes.”                                     patients there are communication
     generally stipulate that, for uniforms                                                       barriers already and [the veil] adds
     that have not been exposed to                  Religion and belief                           another.”
     potentially infectious micro-organisms
     or body fluids, a 10-minute 60C wash is        Following high profile debates, in            David Regan, solicitor at Mundays LLP,
     sufficient to remove most micro-               March, guidance from the Department           stresses that every case will be judged
     organisms. Some also recommend                 for Education and Skills allowed schools      on its facts, but says: “I believe that an
     tumble drying or ironing, or both, to          in England to ban students from               employer would struggle with this
     destroy any remaining bacteria.                wearing face veils. Schools of pharmacy       argument, as there is much less
                                                    have considered this issue and in its         necessity for a customer to rely on non-
     Uniforms are expected to be washed             offer pack to this year’s undergraduates      verbal cues and facial expressions than
     daily and items that might not be              the School of Pharmacy, University of         there is for a child to. If the customer
     washed daily, such as cardigans and            London, states that it has a “no face veil”   was deaf, then I could see this being an
     fleeces, are not allowed in clinical areas.    policy.                                       issue, however then the employee
     At South Tees Hospitals Trust, white                                                         could simply summon another member
     coats are classed as uniform, according        Employers who wish to adopt a dress           of staff.”
     to Mr Hall, and this implies that they         code must give careful consideration to
     should be laundered by the trust’s             ensuring that the proposed code does          Shazia Akhtar is a locum pharmacist
     laundry service daily. He admits that he       not contravene the Employment                 and practising Muslim. She does not
     is not aware if this is audited, but points    Equality (Religion or Belief) Regulations     wear the face veil but wears a headscarf
     out that few of his staff wear them save       2003. The Advisory, Conciliation and          and jilbab (long dress). She believes
     for “one or two of the older ones”.            Arbitration Service (ACAS) advises that       that the issue of the face veil has been
                                                    general dress codes that conflict with        politicised. “Professional Muslim
     Trusts expect non-uniform staff to wear        religious requirements may constitute         women, whether they wear the hijab
     clean clothes (in accordance with the          indirect discrimination unless they can       and jilbab or the face veil, want to
     Health Act 2006 Code of Practice) but          be justified. For example, in addition to     contribute to society by being a part of
     there is generally no specification in         a wedding ring, many Hindu women              the health care workforce. Any
     dress codes for how and when they              wear a necklace (mangal sutra) which is       legislation or policy (even at a local
     should be washed. In addition, although        placed around their neck during the           level) can become an obstacle to this.”
     there is an assumption that hospital           wedding ceremony. Some may find it            She says that if it is believed to be
     staff will wash their clothes daily, this is   distressing if they are not allowed to        necessary, a discussion should arise
     difficult to enforce, Dr Needle said.          wear it in their place of work, unless the    between an employer and the individual
                                                    rule was for justifiable reasons, ACAS        concerned, but adds that a Muslim
     Should trusts, therefore, require their        says.                                         woman who is working as a pharmacist
     pharmacists to wear a uniform? “Staff                                                        will, like any other professional, be able
     who [are required to] wear a uniform are       North Somerset Primary Care Trust’s           to make the best judgement regarding
     [those] in close physical contact with         dress policy has an equality and              her dress and whether it affects her
     patients on a prolonged basis.                 diversity clause which includes the           ability to do the job.
     Pharmacists are not in close physical          sentence: “Compromises to
     contact with patients,” Mr Stronach says.      accommodate individual preferences            Substance over style?
     “Our policy is adapted on the advice of        based on differences covered by
     microbiologists in terms of what is risky      legislation will be made where possible,      One of the few studies on the influence
     and what is not,” he explains. However,        but modifications are unlikely to be          of clothing in pharmacy was published

62   Miscellaneous
                                                                                                           Dmitry Galanternik/Dreamstime.com

by the American Pharmacists’                  performance for benefit, effectiveness      interest to evaluate intrinsic attributes
Association in 2005. This looked at           and helpfulness.                            or is in a situation where the intrinsic
whether or not different levels of                                                        attributes cannot be easily evaluated (ie,
communication and different dress style       Analysis of the responses indicate that     if the service is technical or complex),
affects a person’s satisfaction with a        only the level of communication             extrinsic attributes, such as attire, may
service. A male pharmacist was dressed        affected how the pharmacist was             take on greater importance.
in three styles, formal (shirt and tie),      perceived. The high performance
business casual (khaki trousers and a         interaction resulted in higher ratings of   Although not statistically significant, the
polo shirt) and casual (jeans and T-shirt).   quality and trust and made people want      study results indicate that wearing a
The pharmacist was then filmed giving         to use the pharmacist and recommend         white coat may lead to a more
advice in a community pharmacy. There         him to a friend. Dress style and whether    favourable response when a pharmacist
were two levels of advice, high               or not the pharmacist wore a white coat     is formally dressed and to a less
performance (where the pharmacist sat         made no significant difference to these     favourable response when the
down with the patient for five minutes,       perceptions.                                pharmacist is casually dressed.
gave in-depth, uninterrupted                  The researchers concluded that dress is
counselling using open questions,             not likely to influence a person’s          Behaviour
verified the patient’s understanding and      evaluation of a pharmacist when the
gave empathetic responses) and                performance of the pharmacist is also       What pharmacists wear could also
adequate performance (a one-minute            taken into consideration. However, they     influence how they behave and their
interaction in which the pharmacist           say that dress is an extrinsic cue, which   service delivery, although even less
provided the patient with basic               is more likely to be used as a quality      research has been done in this area. Mr
information, did not actively involve the     indicator when a consumer does not          Sprakes agrees: “If you have an
patient and was distracted by a ringing       have adequate information about             organisation that issues a uniform,
telephone).                                   intrinsic attributes (in this case,         depending on their feelings for the
                                              performance). In other words, what a        uniform, it can affect how staff perform.”
The six scenarios were repeated with the      pharmacist wears may mar or enhance a       If they are not happy with the uniform
pharmacist wearing a white coat. In all       first impression.                           they are not going to perform as well,
scenarios, the pharmacist was clean, had                                                  although this also depends on the
short hair and was closely shaven.            Furthermore, the researchers say that if    individual, he adds.
Almost 200 people were asked to watch         a consumer has little or no experience
the interactions and to rate his              with a service, does not have the time or

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