News Nursing Opinion


by Brian Dolan OBE, RN, Director and Lynda Holt RN, CEO, Health Service 360 UK

Over the last 18 months, the world’s population has been participating in the largest social experiment ever, that of encouraging clinical and age-vulnerable people to stay in their own homes, often for months at a time. It has led to an unintended consequence in the form of another pandemic; that of deconditioning, which is the physical and psychological decline and loss of independent function brought about by prolonged inactivity, especially bed rest.

While deconditioning may understandably not have the profile of Covid-19, it’s certainly presenting a problem for health and social care as a result of people who are less fit, less socially engaged, and less independent than ever before. It’s where #EndPJparalysis, coined originally by co-author Brian Dolan, can help.

Encouraging individuals, whether in hospital or at home to get up, dressed and moving is neither a whim, nor a ‘nice thing to do’ without purpose.  It is a social movement which has had a real impact on patient outcomes, for instance, reducing falls, and has the potential to influence a change in the way care is delivered in the future as it turns ‘patients’ back into ‘people’ again. For those who are in hospital it means getting home sooner, with reduced risk of harm associated from deconditioning. Wearing pyjamas and staying in bed when not clinically necessary can reinforce the ‘sick role’ and leads to a loss of dignity and sense of healthy identity.

While we have known about the consequences of deconditioning since the mid-1940s, the essence of #EndPJparalysis is that it forces us to hold up a mirror to our practice and reflect on the evidence. As health and social care professionals it asks us to put the individual at the centre of our actions as it empowers them and their families to challenge some of our long-held practices. In doing so, EndPJparalysis has has united like-minded people who share their work for the wider benefit of those we serve and offers an amazing opportunity for nurses and allied health to transcend institutional walls and boundaries to work together.

To the credit of all the Chief Nursing and Chief Allied Health Officers of the UK, there has been great support for the EndPJparalysis movement right from its inception at the end of 2016, including a nationwide UK-wide EndPJparalysis in 2017 which saw over 700,000 patients up, dressed and mobilising while in hospital.

The Covid-19 pandemic means we now have to become even more ambitious to raise awareness of how important it is for people everywhere to keep moving, and indeed for all of us to pay attention to our future older selves. Our recently held 36-hour online Global EndPJparalysis Summit (www.EndPJparalysis.Org/join) had some 60 speakers from the UK, Ireland, Canada, the US, New Zealand and Australia and a reach over four million impressions on Twitter. This is a global issue in health and social care and the opportunity to share ideas, initiatives and thinking will continue as we launch our series of ‘Dear Deconditioning’ podcasts in September, along with a book of the same name coming shortly

#EndPJparalysis is about the importance of valuing patients’ time and keeping them safer while in acute and community hospitals as well as in social care and in people’s own homes. For those who may be in their last 1000 days, EndPJparalysis means they spend more quality time with loved ones and in the words of Dr Martin Luther King, ‘We must use time creatively, and forever realise that the time is always ripe to do what is right’.

You can access the free EndPJparalysis Global Summit presentations and get information on our blogs, podcasts etc via






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