patient privacy

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during my career i always did whatever i could to protect the patients modesty regardless of gender or age. i was recently a surgical patient at a VA hospital and had what i feel was a disrespectful experience. without discussion i over heard the surgeon and anesthesia resident invite a bunch of people in to "observe" my procedure. before i could respond i was put out. the procedure was a double inguinal hernia repair and umbilical hernia repair which meant i was totally exposed from the nipple area past my genitals for the prep. i also learned they placed a catheter at the time as well. the anesthetist and surgeon were male as was one of the nurses. the remainder of the people helping were two females and the balance "observing" were female totalling approximately 10. though i'm far from a prude, i was denied the courtesy and respect of being asked permission before hand so i could agree to observation and decide how many i would feel comfortable with. it was as if

i was a slab of beef on the cutting table without any regard to my feelings, dignity, or modesty. it was like being a cadaver for an autopsy class but i understand even there the body is draped. it makes no difference how many naked bodies one sees or whether they titilate you or not; it's about that particular patient and their rights, feelings, and concerns. to dismiss their concerns with comments that you've seen it all is disengenuous and demeaning of their feelings. as a man in nursing i've heard peers talking about male patients on numerous occassions. though i would never discuss such things you know there is a double standard. perhaps, if we truly are professional, we should take the time to let the patient express what they would appreciate and then adhere to it. remember, there may come a time when you become that patient and if someone is unthinking you can be the patient exposed for all to see, in the room, surgical suite, etc. ask yourself how you'd feel

having strangers gauk at your body and making comments.

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Let's do a little philosophy here, okay? Ontology -- no, this isn't about cancer. It's about the essence of what it means to be a "patient." What "is" a patient? And what "is not" a patient. A patient is a human being -- a person, an individual. Not just a body, but a mind and a soul. A patient, in essence, isn't a teaching tool to be "used" by professors and students. Now, many patients will agree to being used as a teaching tool if they are approached with respect and dignity -- if there's a clear understanding that it is the patient's right to refuse. Most patients do understand that doctors and nurses need hands on training in hospitals. But -- Hiding such consents in small print in documents, and putting people "out" quickly before inviting in the spectators -- that's not informed consent. It's a travesty, unworthy of the profession of medicine. It's an entitlement attitude, an us vs. them point of view, a complete disregard for the humanity of the flesh going under the knife. Frankly, it's an ethical violation. But apparently, it's so common these days that professionals have become oblivious to this disrespectful behavior.

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I don't think it's a big deal. The surgery you had was one that I was able to observe during nursing school and I remember the pt being draped during the procedure. He wasn't exposed or hanging out all over the place. I don't think you have the say of who is or isn't observing or in the OR during a surgery.
The patient does have a say regarding observers anywhere in the OR and anywhereelse in the hospital. An OR transcript of whose presence is done at the beginning or endof each surgery case. That information is made available to the patient if requested.
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I would be ENRAGED if I was you. That was a told violation of your rights. Even when I had my tonsils out, they had me fill out forms asking if I could be observed, filmed, or specimens from my body could be used for research. If I was you, I would file a complaint. Sorry if this seems a bit overboard, but my cut reaction is to be mad for your sake.

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you know, whenever this sort of thing has come up, i do my best to make a teaching occasion out of it. if that's not possible, i think to myself, "well, plenty of people have seen this body, a few more won't make a damn bit of difference." then i smile to myself about some of those past occasions, and wait for the sodium pentothal to kick in.

i hear you about asking permission, and i would do that for a patient. but i am not such a special snowflake that i really need to worry about what professionals are thinking about my corpus. they've all seen something like it before and will see a lot more of it before they retire, so what the heck. chill out.

"but i am not such a special snowflake that i really need to worry about what professionals are thinking about my corpus."

i don't disagree with that point of view, but it is a point of view. as i see it, it's not about what the professionals are thinking or how they feel. it's about what the patient is thinking and how he/she feels.

that's the crux of the issue. frankly, i assume that most professionals are so used to their work that they take it in stride. this is both good and bad. good if they don't ever forget how the patient may be feeling. bad if they become habituated or numb or routinized to such an extent that they just go through the motions without thinking. but the point isn't how the caregiver feels. it's how the patients feel. most patients don't have this done to them every day. indeed, many patients have never had this done to them before. this is were the abyss exists sometimes between the patient and the caregiver point of view.

Specializes in OR, Nursing Professional Development.

This is why you need to read everything very carefully before you sign it. Pretty much every consent for surgery I have seen includes a paragraph about photos for educational purposes and allowing observers, also for educational purposes. Quite honestly, if you don't take the time to read something as important as the consent for someone to cut into your body, then you've given that consent by signing that paper you didn't read. Let's be real, nursing isn't just about the patients, it's also about educating those who will one day take our places.

This is why you need to read everything very carefully before you sign it. Pretty much every consent for surgery I have seen includes a paragraph about photos for educational purposes and allowing observers, also for educational purposes. Quite honestly, if you don't take the time to read something as important as the consent for someone to cut into your body, then you've given that consent by signing that paper you didn't read. Let's be real, nursing isn't just about the patients, it's also about educating those who will one day take our places.
Truthfully, most nurses don' t even know that exists on the consent. You are in a hurry to getthe patient to sign it. And if the patient did sign that portion of the consent would you look for it and/or follow through. How about treating everyone like you want tobe treated.
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Specializes in OR, Nursing Professional Development.
Truthfully, most nurses don' t even know that exists on the consent. You are in a hurry to getthe patient to sign it. And if the patient did sign that portion of the consent would you look for it and/or follow through. How about treating everyone like you want tobe treated.

Where I work, it is the physician's responsibility to obtain consent. My signature only says that I witnessed the patient sign that paper. It all boils down to personal responsibility. The consent is a legal document. It should be read in its entirety before being signed.

That being said, if I have a student with me, I take them out to preop with me and introduced them to the patient. No one has ever had an issue with it that I've met. I've had one patient who did what responsible patients do and read the consent. He then crossed out the entire paragraph about photos and initialed next to it. No big deal, we followed his request and we didn't take photos (not that we would have anyway for the surgery he was having).

Patients need to be active participants in their own care. That includes reading all required paperwork/consents/whatever as well as following recommendations that are accepted standards of care, such as coughing and deep breathing and getting out of bed to a chair soon after surgery.

Specializes in Telemetry, Case Management.

Me? I don't care if students observe. I figure if they want to see a round little woman get whatever done, more power to them. However, I remember clearly my mother being horrified that "gobs" of people were brought into the room to observe her give birth to my little sister in 1966. (Oops, told my age, now I guess I am a Crusty Old Bat as well.) She carried on about it for literally years. So some people are not pleased with observers, and everyone should be given the chance to approve or disapprove of who sees them during a procedure.

A patient has an absolute right to refuse any and all observers, trainees, residents, intern or students of ANY kind to be involved in any facet of his/her care..surgery,exams or anything else...blanket "consent" forms signed before a procedure or surgery or inpatient amission mean nothing if the patient say: "no students (includes all residents, interns, med students, srna etc)... I'm a "bad" patient; I get really selfish when I'm sick or having surgery..I do not want observers/students involved..and I work in a university medical center teaching mostly med or health science students. I get my care at the university med center because it's high quality (and because it's free for me and for my family). Upon admission/outpatient surgery, I always cross out the part of the consent allowing ANY observers/students to participate. It's my right. During my recent endo procedure, a srna tried to start my IV with her crna "supervisor" instructing and I objected asking her to review my consent. A melee insued with the endo doctor going ballistic on the anesthesia nurses; the endo doctor was apologetc that my consent had been violated and the crna and the srna were given a written counseling; which I thought was harsh but necessary. I had no confidence in this "team" that was about to perform my colonoscopy and my endo doctor was livid....she called in an anesthesiologist to do my case, but I didn't trust them at that point. Nobody would. I had the colonoscopy done 1 hour later at another hospital, with an anesthesiologist, no students or crna involvement and the university med center paid for the entire thing. Patients have the absolute right to refuse student involvement in their care; my endo doc said that she would not want a crna much less a srna involved in performing her own colonoscopy.

At our hospital, the consent form for all procedures includes something along the lines of "agree to the presence of nursing students" and something else about observers. Patients are able to cross out and initial this if they wish to refuse this or any part of the consent. I am not saying this was the case with you, but before signing anything people really must read the paperwork thoroughly.

Does everyone who's going in to observe read the PTs consent form to see if they've crossed out that part?

edit:

During my recent endo procedure, a srna tried to start my IV with her crna "supervisor" instructing and I objected asking her to review my consent. A melee insued with the endo doctor going ballistic on the anesthesia nurses; the endo doctor was apologetc that my consent had been violated and the crna and the srna were given a written counseling; which I thought was harsh but necessary. I had no confidence in this "team" that was about to perform my colonoscopy and my endo doctor was livid....she called in an anesthesiologist to do my case, but I didn't trust them at that point. Nobody would.

Pretty much figured consent forms were frequently ignored... you just happened to catch yourself being violated.

Who's to say what happens when a PT is out.

if I ever need surgery, I'm going to insist on a trusted loved one be at my side the entire time with a cam corder.

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