Spouses being asked to leave the room

**canoehead, BSN, RN** · Sep 16, 2017

Susie2310 said:
Just because you think it entirely reasonable that spouses be asked/forced to leave the room during the nurse's assessment/other care, because you experienced it this way, doesn't mean that it is reasonable to impose this on patients and family members who don't share your views.

In a lot of the situations described, the nurse is asking the family to leave so s/he can assess what the PATIENT wants. Once the patient says they want family involved for all care, they are welcomed back in. But that bit of alone time is necessary to ask the question.

Susie2310 · Sep 16, 2017

canoehead said:
In a lot of the situations described, the nurse is asking the family to leave so s/he can assess what the PATIENT wants. Once the patient says they want family involved for all care, they are welcomed back in. But that bit of alone time is necessary to ask the question.

What you said is appropriate and applicable in some situations but not all. Your bio says that you specialize in the ER. Do you really always ask all family members to leave the room when you first introduce yourself to the patient? What typically happens when my family members visit the ER is the following: They either sign in at triage or arrive by ambulance. There is already a POA on file on the ER EMR together with other legal authorizations authorizing me to act on their behalf and request and receive protected medical information, etc. All drawn up at my family members wishes by an attorney who verified that my family members are not acting under duress etc. My family member and I tell the staff that these documents are on file and I am the POA/decision maker/etc. as soon as they ask, during triage. My family member is asked if they wish to authorize someone to advocate for them during their stay, and they say they want me to advocate for them, and I am authorized to advocate for them. My family member is either brought back to a gurney in a room or offloaded onto one by the EMS. The nurse comes and introduces himself/herself, opens the EMR, asks my family member to state their full name and date of birth while checking their ID band. Depending on how sick my family member is, my family member may look to me to tell the nurse their date of birth. The nurse looks at me and asks, "Is this your wife, (or sister, etc.)?" or "Can you tell me how you are related?" My family member confirms our relationship. The nurse asks "Do you have an advance directive?", and we both say "Yes", and I say: "I'm the POA and the documents are in the record and I have a copy of them with me." I think it's pretty clear by this point that my family member wants me involved in their care without asking me to leave the room to verify this, or would you disagree? The nurse verifies the chief complaint with us, asks my family member what medications they are taking, asks about allergies, and my family member looks over to me and says: "Do I have any allergies?." I provide the answer. The nurse asks about previous medical problems and my family member looks at me and says "My wife (sister, etc.) brought a list with her." And so it goes on.

My point is that while, of course, there are times when it is appropriate to ask family members to leave the room to verify with the patient that they want them to be involved in their care, in my opinion it is unintelligent and offensive to do this by default when the patient/family member provide abundant confirmation that the patient wishes the family member to be involved in their care right from the beginning of the nurse-patient-family encounter.

trytounderstand · Dec 18, 2017

I am not a nurse. I also grew up in a time when we were taught to respect doctors and nurses in general. Mainly because most of them were and are people who had and still have answered a higher calling that most of us would never be able to do. That being said, I am going to weigh in on this conversation although it is from 2012.

I believe that spouse or spokesperson should be allowed to stay with the patient as long as the patient wants them there or they need to be there out of necessity. In my own personal experience I wish my spouse or adult child had been with me when I was embarrassed by two techs during an stress echo and was not allowed to get dressed in private. And that was after the totally embarrassing test of having to walk on a treadmill with no gown to cover the front of my body.

I wish I had been present I had been with my spouse recently when dignity was totally stripped away by a nurse after the statement was made not to cut underwear off and the patient was told I either cut them off or pull them over your injury. Understand there was no injury to the area under the cotton underwear and no ems or er doctor had seen the necessity of stripping what was left of the patient's dignity. I wish I had been allowed to stay with said patient when diazepam was administered and now there is no memory of what happened while I was not allowed to stay in the room where the only thing that was happening was the patient was being monitored. No tear away shorts were offered and when they were requested it was like we had asked them to run a marathon. If a patient is coherent and says "no" it is "no". The only time dignity should be stripped is a life saving situation which I have been in and that is a totally different situation. But it should be the patient's choice and if they are going to versed then they should have a spokesperson present! I have checked with my pharmacist and yes diazepam is a benzodiazepine and all patients should be made aware of the effects other than it will help you relax!

There have been times when if one of us had not been with the other important information would have been missed such as allergies to drugs and there would have been no one to back up the statement I do not want blood thinner, I do not want my dignity infringed upon, no you are not placing a foley catheter to make it more convenient, no you are not leaving a curtain half way closed, no you are not allowing three members of the opposite sex to handle their practically nude body to make it faster and more convenient. If one us had not been there the nurses would have been much busier helping the patient with such things as urinals, feeding themselves, refilling their glass, swabbing their mouth, keeping track of the amount of output so there would not be a reason to place a foley catheter, changing gowns, helping with bed baths actually anything that we can help with that will keep the nurses and cnas from being bothered and make their job a little easier.

Of course any time it is a sensitive matter I am more than willing to step out of the room! Or if I am in the way I am more than happy to move out of the way and step into the hall to allow doctors, techs and nurses to do their job. I also understand the necessity of having time with the patient alone to make sure they are safe at home and that the injury or illness is not due to spousal or family abuse

There have also been times that if one of us had not taken due diligence to research medicines or treatments we would have not asked important pertinent questions that in a time of stress you tend to forget. I have also had the experience of reporting that I was allergic to a certain antibiotic and a doctor prescribed from the same family only to have the pharmacist catch it and refuse to fill the script.

I am not trying to sound rude or objectionable but this is something that has bothered me for a long time. It probably goes back to when I was a child and had to stay overnight in a hospital when I had a bad experience with a nurse who should have not been in children's ward.

Perhaps it is just me but my own feeling is that as with so many other things, respect for personal space and dignity are not as observed as they were in the past. Saying you are healthcare providers and have it seen it all does not mean that we want to bare it all to you and that should be respected. Just because you may have helped with several catheters, pap smears, baths, rectal exams etc during a day does mean that the patient or the spokesperson is not concerned about the patient's dignity. They have a right to stand up for the person who out of embarrassment will not utter a word or make a joke about what is happening to them rather than say I don't want you to see my or his/her bare body unless it is medically necessary.

Dany102 · Dec 18, 2017

Hello trytounderstand,

I certainly commend your courage in voicing your concerns here. However, brace yourself for some heavy-duty backlash. You are certainly going against the grain and your comments, however well meant, will not be well received. Because you know, they're professional after all.

As for versed, I see you did your homework. I only wish many more patients would before consenting to that. That drug is viewed as the holy grail in many hospitals, mostly because it's a legal way to circumvent consent. A patient is a little reluctant, skittish, or simply doesn't want to play ball, they will offer a "calmant" to help you relax. In goes a shot of vitamin 'V' as it is called and bablamo instant compliance ensue. And, as an added bonus, the patient won't be able to remember a thing. Wonderful thing, versed.

You have my support (for what it's worth) and I wish you good luck.

Dany

trytounderstand · Dec 19, 2017

As I stated in my post, I have great respect for the nurses, doctors, cnas, medical tech actually anyone in the medical field for what they do and if they have a true calling. There are some that I have met that are true healers and caregivers. That would not be happy doing anything else. But I have also met some who are as happens in all professions burnt out.

As for doing homework on drugs, medicines and treatments, I have learned to do research, research, research. I was very hurt and upset when I found that my spouse could not even remember having a test done while I was not allowed to be in the room. What else happened?

I am sure I have probably offended some healthcare professionals, but I do believe that you should stand up for what you believe in. And if it makes the difference for one patient that they may treat in the future then it will be worth it. Because I know how easy it can become to say "this is what I do all day I see it all the time" to forget that the patient you are treating or the family member who is witnessing the treatment might feel offended, embarrassed, scared and that much more traumatized by perhaps already a stress filled episode. I only wish that I had done my homework on the drugs that help you relax before the recent episode things would have been handled differently. Patients should be informed of all possible side effects and there should always be a spokesperson if there is one available to be with the patient as long as the patient wants them there. Whether it be the er, icu, doctor's office, hospital room and they should have answers when they ask questions. I know that sometimes nurses are too busy to answer the question but they should direct them to someone who can give the answer quickly and be able to mediate an issue fairly.

I realize that at times family members have to be asked to leave because they are causing an issue with other patients or being rude to nurses or doctors. But if they have viable concern someone should address that concern and there should be just as much consideration given to them that nurses and doctors should be able to expect.

Again, I respect the folks who have chosen to become healthcare providers it takes a special person to dedicate themselves to caring for other people and their families. I can still remember the nurses and doctors who were there when my father passed away and how hard they worked to try to bring him back to me and how our family doctor cried with me. How the nurses and doctors cared for a family member recently who was dying from cancer. But I also saw how careful they were to respect the dignity of the patient and family.

It is just that everyone, myself included, needs to take a step back and respect the other person and their right to make their own decisions. A patient should never have to feel that they cannot trust their caregivers or their family caregivers. A patient always has a right to say "no" and to have their concerns considered