Spouses being asked to leave the room

Okami_CCRN, BSN, RN · May 10, 2012

I usually ask people to please step out while transferring patients between beds because the rooms are very small and I personally do not want family members looking at my bum as I bend over to pull the patient to the new bed.

As for examination that requires a patient to undress I generally ask the patient how is the visitor related and would they like them to stay in the room. I generally only do that for EKG's if the doctor is doing a lady partsl exam/rectal exam we usually ask people to please step out no matter what the relationship is.

Understand that patient privacy is a huge concern for many of us in the healthcare field, and you would be surprised at the number of people who do not feel comfortable with their spouses/family members being in the room.

allnurses Guide · May 10, 2012

I don't think you are crazy or neurotic for feeling the way you do - nor does it seem that weird if a wife or husband were to ask me why it's necessary. I know you'd ask it in a pleasant way and not a as if you're accusing them of anything, so you may be worrying a bit too much about how they perceive you.

The other idea I had is that if you really don't want to ask, next time something like that comes up your husband could say, "it's OK, she can stay" or something along that line and see how they react to that. It's OK to ask questions. :)

MPKH, BSN, RN · May 10, 2012

In the first situation, the consultant was indeed protecting your husband's privacy from you. While you are the most intimate person to your husband, you are not privy to his healthcare information unless he consents to it. It matters not if he introduces you as his wife; unless he explicitly gives consent for you to be privy to his healthcare info, there is no obligation to include you in his consult.

In the second scenario, perhaps you would've been in the way or interfere with the transfer. And upon the discretion of the healthcare professional, spouse/family member can be asked to leave the room when a procedure is being done on the patient. Some people are uncomfortable in doing tasks with an audience in the room.

jadelpn, LPN, EMT-B · May 10, 2012

The rooms are small, therefore, you would have been asked to please step out while we get the patient settled and into bed and a johnny on. Initial assessments ask questions pertaining to "if you feel safe at home" and other questions that are all part of protected health information. They are questions asked of everyone, and even if a spouse says "it's ok, he/she can stay" I still explain that I need a few minutes 1:1 to get patient settled. When a form is signed saying that yes, in fact, I can share one's health information with a spouse (release of medical information) that is fine, however, just because one is someone's "health care proxy" (doesn't kick in until patient can not speak for themselves) or patient agrees to letting people know that they are patients in the facility ("yes, the are a patient, in stable condition") I can not do an assessment with anyone in the room. If you were a patient, the same rights pertain to you as well.

allnurses Guide · May 10, 2012

We transferred a trauma patient the other day who was arriving new on the floor. The patient was still bloody, in a lot of pain, still unstable and it was a very small room. We asked the family to step outside while we "got the patient settled". This was for several unspoken reasons:

1. So we could discuss the logistics of transferring the patient from a medical perspective without family input, who may not understand all the components that have to go into making said transfer and may not yet be aware of the true extent of the patient's condition. While we respect and want the family to be very involved in the patient's care, there are moments when leaving it up to the "experts" is appropriate and at times, in stressful situations such as this, the helplessness of the family is difficult for them. Controlling family members can be a hindrance and we have no idea yet if you are one of those types. We also have no idea how well briefed you are on what is going on with the patient. They may have things that will be affected by a transfer that you know nothing about...and this is NOT the way to disclose that to you, if disclosing it to you at all is appropriate (based on whether the patient themselves have authorized disclosure).

2. To allow the patient to voice concerns/needs without the family present. There are MANY times the patient has desires that they will not/can not voice in front of spouses or family members. They deserve an opportunity for privacy without offending their family members by having to ask for it. It also allows us to screen history and get information that the family may not be privy to. You would be amazed how often there is a diagnosis or a situation surrounding the hospitalization that the spouse or family do not know about. Could be anything from herpes to drug/alcohol involvement to "I wasn't really at work when this happened" to "I want/need pain medication but I don't want my family to see me take it" to "I want to discontinue treatment".

3. As mentioned above, space. This is probably the number one issue. An anxious family hovers. There is no room for hovering when four to five people are trying to get around a patient to make a transfer. Under this heading is also the issue of privacy for a roommate. In the above scenario this was not a private room. The only place for the family to go would have been into the space of the other patient in the room. That's not okay. This plays both into the space issue and into privacy laws. The room was big but occupied by two patients. Private rooms tend to be much smaller. Either way, there is no space really convenient for the family to go. The family's right to be near their loved one does not override another patient's right to a private, dignified and healing environment. And the last thing we want to see happen is for a family member to move into the wrong space at the wrong moment and next thing you know they have a bloody nose from an elbow or something.

4. Relationship issues between us and the family. We want this to be a good experience for the family and to feel their loved one is being well cared for. Hard to build that relationship when the first thing we do is hurt the patient/make them cry or cry out from the pain of being moved from a stretcher to a bed. It is easy for families to misinterpret this as callous or careless on our parts, when in fact it is simply unable to be helped. We do all we can to make it swift, smooth and painless, but sometimes all the logistics and medications in the world can't make that particular moment more pleasant. For a stressed family already struggling with what has likely been a long, horrible day, this can put them over the edge and create a mistrust that is hard to recover from.

5. Relationship problems between family members. We have no idea how stable your relationship is and the stress of this moment frequently leads to family drama that has no place in this moment. It interrupts the continuity of care and creates chaos for everyone. The easy solution is to have the family step out while we get the patient settled, then let them back in to continue whatever was happening prior to their arriving to us, whether that be good or bad. Because trust me, once the ugliness starts, getting anyone out of the room is a much different, more difficult task.

6. Time. Getting this done quickly is a priority. Family members with lots of questions and concerns have a different priority list. They need time with the patient's actual nurse and that will be provided after the urgency of this moment passes. Family members have questions and concerns. Most of the people involved in the trasnfer have nothing to do with the situation itself beyond that moment of transfer and need to quickly get back to their other patients.

7. And sadly, liability. We have no idea if you are the sue-happy sort who will watch us for any percievable thing that might make you get upset with us and start shouting about lawyers. Only takes us getting burned by that once.

blondy2061h, MSN, RN · May 10, 2012

Usually when I ask the spouse to leave the room I try and make it seem like it's about privacy and for the patient's benefit when it's really about them being in my way. I also never assume anyone is the spouse, because I've mistaken children, cousins, friends, and the home health aid for spouses before, so I err toward the side of privacy if I'm not positive.

allnurses Guide · May 10, 2012

not.done.yet said:
4. Relationship issues between us and the family. We want this to be a good experience for the family and to feel their loved one is being well cared for. Hard to build that relationship when the first thing we do is hurt the patient/make them cry or cry out from the pain of being moved from a stretcher to a bed. It is easy for families to misinterpret this as callous or careless on our parts, when in fact it is simply unable to be helped. We do all we can to make it swift, smooth and painless, but sometimes all the logistics and medications in the world can't make that particular moment more pleasant. For a stressed family already struggling with what has likely been a long, horrible day, this can put them over the edge and create a mistrust that is hard to recover from.

This:

I once asked a daughter (who was one of the owners of the LTC facility we were actually at in this story) to leave the room while a coworker and I transferred her mother.

I did it because the daughter was hypercritical (she never let us forget she was an owner, the wife of a doctor and a former nurse :rolleyes: ), which made it things stressful enough...

Add that to the fact that her mother was a cancer-ridden, pain-wracked mess. It was always very stressful for us move her (even when the daughter wasn't around) because there was no way to do so without her being in extreme pain and crying out.

The daughter was standing at the foot of the bed, arms crossed, attitude cranked high and waiting.

Ah, no.

My partner gave me a nervous glance and I knew then, that if this daughter did not leave the room... oh, geeze...

So I asked her to please step out.

She raised her voice and demanded to stay.

I said, "Turning your mother is extremely stressful due to the amount of pain she is in. With you watching, it makes it hard for us to really concentrate to do it right. No matter how we do it, she will cry. We really need you to step out so we can focus."

The daughter stomped out and promptly reported me to her siblings-- all co-owners of the LTC (one was the administrator).

And you know what? They told that sister to back off and actually came to me and backed me up!!

Whoa!

They "got it" and I, as a very young CNA, was so grateful that they understood and didn't fire me (because that sister was mad).

My point is illustrate what not.done.yet pointed out.

That daughter (even though she had been a nurse and, perhaps, because of it) was looking for trouble.

Where you look, you will find it.

I didn't need her finding it with us and not when we were working so incredibly hard to treat her mother as gently as possible.

What we were trying to achieve and what she would have perceived were not likely going to be the same thing.

Indenial · May 10, 2012

Thank you very much for all your replies!

My husband suggested that perhaps it was a space issue, or that the staff don't necessarily know the state or dynamics of our relationship. It seems he was right!

He was sedated (but conscious) at the time of the transfer to the bed, and didn't think of asking if I could stay. He said he will try to remember next time, if the situation arises again (hopefully it won't!).

I must point out that the consultant was fine with me being present for the consultation. I was actively involved in the consultation, because my husband was in pain, and so was not able to give a full account of his symptoms on his own. It was just the examination part where the consultant protected his privacy.

Also, I fully appreciate the need for visitors such as parents and siblings to leave the room. I certainly wouldn't be comfortable with them seeing my body. I just thought it was taken as normal that a partner or spouse would not present any dignity or privacy issues. I would feel uncomfortable if I was in hospital and body parts were exposed, but that would be because of the Dr or nurse seeing me, not my husband (if he was in the room).

I suppose everyone is different though, and I understand that what seems normal to me, is not necessarily the case for everyone, and medical staff have to be cautious.

Thank you for clarifying this for me.

classicdame, MSN, EdD · May 10, 2012

sometimes an embarrassing moment occurs and it is more embarrassing if a visitor is around. Give them space to do their job

dirtyhippiegirl, BSN, RN · May 10, 2012

Honestly, pulling the curtain might have just been a reflexive action, without any thought put into it. It's something that you get into the habit of very quickly, even if there isn't a soul around to see. I'm sure the thought process was more like: pt removing clothing ---) shut curtain and not patient removing clothing ---) wife's in the room --) shut curtain.

allnurses Guide · May 10, 2012

Yeah, I had the same thought. PRoviding privacy becomes a reflex.