Modesty Issues

[ToryAdore]

Looking for words of wisdom from those who are more experienced with prepping a pt for surgery or catheterizing adult male pts with modesty issues. It has only happened a few times in the past year but it's still something I need to be able to deal with better. I hold a pts dignity high on my list of priorities. What do you do or say prior and during the procedure to ease their anxiety...? Any advise would be greatly appreciated.

Tory

[PTismyname]

I never said it wasn't gender discrimination. Yes, women are accomodated more frequently, but they usually don't even need to ask because an all female team is what they have. As for the affirmative action, I was always taught that it was in the instance of two candidates of SIMILAR qualifications, the minority applicant would be hired. I'm talking two people with DISIMILAR qualifications. There isn't much difference between 1 year's experience and 14 months' experience, but there's a heck of a lot of difference between a new grad and someone with two year's experience.

When it comes to a patient stating gender discrimination, we have patient reps that can be called who are specially trained to handle such situations.

This has nothing to do with gender, but here's a true story from where I work. A male patient came in for a lap chole. Stated that he only wanted white staff to care for him. Hospital policies say no, we are not to accomodate this request. Surgeon hears about this. Tells the patient he will not do the surgery if he continues with this request. Why? He's discriminating against the staff, and wouldn't that kind of be what the patient is doing to a nurse when making a gender request?

Not really! The patient has a right to decide who provides care. You wouldn't think it might be discriminating when

your 17 year old daughter visits a clinic for her mammogram and only women techs do the service. Please

don't tell me differently,I spent 6 months researching the united states on genders in mammo.There are no male mammographers in the united states. I've never seen a male nurse in L&D either. Your birthing experience is no more unique than my uro experience. What kind of legal standing does a hospital have when they provide an all female staff for women patients in mammography and Labor and delivery.Yet, men are not provided all male staff in areas such as urology and surgery.The fact is males just might be told to take their business elsewhere.

I only hope that in time that would happen to me so I can get someones name and discuss this matter with the

hospital ceo and my insurance company. I seriously doubt that in todays healthcare market that person would

have a job on the next day. Because of issues of distrust and unprofessional behavior men have serious issues

with opposite gender care. It has nothing to do with modesty but rather respect and advocating for the

patient.

[dianah, ASN]

Thoughtful, balanced comments appreciated. :)

However, this is a reminder to please keep posts to the subject matter, that of the OP's original question (which, BTW, was asked in 2005).

Thank you.

[Cul2]

Alright. Let's get back to the original question: "Looking for words of wisdom from those who are more experienced with prepping a pt for surgery or catheterizing adult male pts with modesty issues. It has only happened a few times in the past year but it's still something I need to be able to deal with better. I hold a pts dignity high on my list of priorities. What do you do or say prior and during the procedure to ease their anxiety...? Any advise would be greatly appreciated. -- Tory

1. Don't forget that there are several facets to "experience." When you ask for those with more experience, that doesn't eliminate patient experience. There's a significant amount of patient experience on this thread. Don't disregard it's value.

2. You say a pts dignity is high on our priority list. I applaud you. I believe the vast majority of caregivers feel that way. But consider this: Dignity is a vague concept, an idea that not doubt has some objective, universal elements, but also is quite cultural. There's your definition of what it means to treat a patient with dignity, and the patient's definition. They may or may not be the same.

3. For some patients, a high level of respect for dignity involves asking them how they feel about what will be done to them and who will do it. That may mean asking them if the prefer a nurse of the same gender. As has been pointed out on this thread, due to logistical reasons, females more often have that choice. Males don't. Consider that -- and realize that even though you practice all the elements of what you consider dignified treatment, because you are an opposite gender provider, the patient may still not feel he is being treated with dignity. Bottom line is that if one gender can define her dignity and be given choices, and the other can't be offered a choice -- that's gender discrimination.

4. Communication is important. How you approach the patient is important. Whether the patient feels safe and respected is important -- and, frankly, that may already have been determined by the patient's past experiences, or what went on before you met the patient. How was the patient treated by the receptionist? How did the EKG tech treat the patient? How did other nurses before you came on treat the patient? Gender and modesty may not be high on the patient's concerns if the patient has been treated with respect all along the way and feels safe and respected by the time he/she gets to you.

5. I've had males tell me that caregiver gender didn't matter to them, but being asked in situations like you describe whether they preferred a male provider -- made them feel more respected. Don't forget patient autonomy. The more choices you can give a patient, the more in control they may feel, the safe and more respected they may feel. But if you work in an environment where choices are never available for males, don't kid yourself that superficial actions on your part will always ease the anxiety and make the patient feel respected. Be honest. Having no choice is having no choice. Ask yourself how one of your female patients would feel if a male tech came in to cath her and she asked for a female nurse and she was told she had no choice. That would rarely happen.

6. Get together with your fellow nurses and really advocate for men in these situations. Talk with your supervisors. Talk with your unions. Make sure a schedule is created that offers gender choices. Actively recruit more males nurses into the fields where they're need to give men more choices. If as a nurse your a patient advocate, you need to advocate for both genders in situations like this.

7. Don't take it personally if a man doesn't want you to do an intimate procedure on him. It's not about you personally.

8. When you think of the many ways women have been are are discriminated in our culture, think of men in nursing. Consider how male nurse feel when a significant number of women will allow male doctors to treat them in intimate situations, but will refuse a male nurse. Consier how a male nurses feels when he has to have you as a chaperone to treat a female patient. Do you ever have to have a male nurse as a a chaperone when you treat a male patient?

9. Consider how differently we might treat your question if we were asked about "prepping a pt for surgery or catheterizing adult FEMALE pts with modesty issues" I would suggest many would regard the issue as quite simple -- get a female nurse. Male nurses will deal with this, try to assure the patient, treat them with dignity and respect -- but when push comes to shove and they want a female, that male nurse isn't going to say, "Sorry, you have no choice."

10. Finally, the fact that you're even asking this is a good sign. Some nurses and cna's are so busy and get so task oriented, or have such a gender neutral agenda, that they don't consider this an issue. I'm your assigned nurse, that's the way it is. Don't ever get like that -- or if you do -- at least admit that the issue of patient dignity has been tossed out the window in favor of efficiency and just getting the job done.

[PTismyname]

Absolutely and advocating for the patient is keeping with the subject matter,despite the fact that the op's

question was 5 years ago. Its important and relevant that there is ongoing education regarding these issues

and what makes the patient comfortable.

[advo-kate2]

I do agree that comments should be balanced and thoughtful, but we can not deny that this subject is a highly emotional one. Why has the subject seen a renewal of interest? Why do people go where the caregivers are to state their views? Why should this be an "off camera" issue in the medical field?

Not all recent posters have no medical training. Dignity and modesty, and medical training are not mutually exclusive. Quite frankly, one finds themselves in the area of need that they feel they have been compelled, and many times part of the need is exactly due to firsthand knowledge.

That being said, I can not speak for all but I for one appreciate the fact that this avenue has been kept open for these views. It is important. It is relevent. It is also a new undercurrent of patient concern that will indeed one day be more prevelant than we see here. So now may be the time to face it, address it, and be ready for the change.

Caregivers may seem annoyed that these types of posts keep popping up in all areas on allnurses, but it speaks to the need for communication. Some patients find themselves practically begging for caregivers to give this subject consideration and are dismissed. Perhaps if we face the issue and have the conversations we need to have, then people will not chase from forum to forum.

The medical profession needs to have these conversations with all of us. Too much anger and resentment is festering and I have to believe that this is not what caregivers want. It is not the healing hand they spent so much time training to extend. It is not the care they want to be known for. A step in communication could be many steps toward achieving mutual repect again.

[ImaWonderer]

Why has this subject seen a renewal of interest? I believe the interest has always been their but perhaps their hasnt been an outlet available in a structured way to vent these concerns.

When it comes to patient modesty I believe millions of people have had situations happen that left the patient feeling that something just wasnt right with the way something was done or carried out.

Just look at some of the posts here. There was a reference made to patients being brought up from the OR naked when there was no need for it.The poster said it made her upset but there was ZERO explanation of WHY it continuously happens.Another nurse made reference to a worker uncovering patients knee to chest when it wasnt necesary (or longer than necessary im writng this based on memory) The nurse said it made her angry and she would cover the patient but again NO explanation as to why this worker is exposing patients in this manner again when it is not necassary.Another nurse told the story of a guy who came in w something stuck around his member and came to the ER for removal. This nurse (on here and on her fB page) told how she was really just curious and wanted to see it so she admits she LIED to the patient saying she needed to see it so she could document it. The nurse says the guy had "no problem"showing her. If he has no problem why not say "Hey I have nothing to do with this object being removed but gee that sounds pretty hilarious.... let me just look at it so I can go home and post details about it on my facebook page! oh yeah dont worry I'm a professional" .Then there is my own story of being examined in stirrups as a teen only to have the door open (no knock)and 4 people walk in like they were just strolling in the park.This list could go on and on and on and on.

In a previous post of mine I was making reference to staff just barging in,not knocking,not pulling curtains,not introducing who you are a nurse,doctor,tech,chaperone,CNA,chinese food delivery guy etc.........I asked why are these BASIC things lacking so much in healthcare. I wouldnt go to my parents house with out knocking on the front door so why would you think nothing of bringing a gang into watch a guy having his prostate examined. Ha .......i didnt get a response

I could never work in the medical field Im the firstperson to say you guys have a difficult job. I just ask that you remember that you are working with human beings....add a sickness and subtract their clothes and a group of strangers to the mix and maybe you will see why this is such an important issue .

Let me say a quick Thank God for HIPPa with as much gossip goes on about who has what,who came in today,who has this ,who has that now mixed with social networking EVERYONES details would be posted for the whole world to see from head to toe . With all the info that is given out down to the town and the hospital i would HATE to see my doctor/nurse posting the latest thing her patient did or came in for. ( the smaller the town the scarier) Why in the world are these people doing this (and it is COMMON)..........

I think these have ALWAYS been issues. Patients it seems now are WANTING to ORGANIZE,SPEAK OUT and SPEAK UP and DEMAND a CHANGE. The "you dont have anything we havent seen before" routine is OLD and has been used for a long time (even at times with the best of intensions) to dismiss patients concerns when it comes to modesty and it just isnt gonna cut it anymore.

I do not work in medical care but it doesnt take a medical degree to cover a nude person that doesnt need to be nude. It doesnt take years of training to realize a teen may not welcome 6 people (unnanounced) to watch her in stirrups sadly those years of training taught MANY to just barge in and unless the half naked,humiliated ,vulnerable patient speaks up well.......that must means its okay.

[advo-kate2]

" 'Why has this subject seen a renewal of interest?' I believe the interest has always been their but perhaps their hasnt been an outlet available in a structured way to vent these concerns.

When it comes to patient modesty I believe millions of people have had situations happen that left the patient feeling that something just wasnt right with the way something was done or carried out."

Exactly the point of my post. Thanx "ImaWonderer". We can not deny what is happening just because we refuse to discuss it. It needs to be out there. It needs to be addressed. We need to be heard.

[Cul2]

Let me try to sum up what I believe the issue is, for me at least. I believe that

the majority of doctors, and especially nurses, do look out for patient modesty

and work hard to protect their patient dignity. But let's say, just for the sake

of argument that it's 75 or 80% who do this. So, 20-25% don't for whatever reasons.

When the 75 or 80 percent see the 20-25% violating patient modesty, what

do they do? How many of them intervene, stop the violation, and make it clear to

the individual that this shouldn't happen and better not happen again? As I see it,

my guess is that the majority do NOT intervene. That's what bothers me. I'm willing

to accept that medicine, like all professions, has a few bad apples. But, I also

believe that the culture of medicine discourages those good doctor and nurses

from either turning the bad apple in or even correcting or chastising him/her. Of

course, other professions have this kind of culture, too. We find this in police

work or the military, too. And, like medicine, the stakes are extremely high when

the good allow the bad behavior to go unchallenged.

That's what bothers me most about this issue.

[tbrd450]

advo-kate, well said!.. I agree, it is as relevant today as ever before.

I want to request feedback directly from those working in the medical field (nurses, doctors, techs, etc.). I would like to propose that on our universal quest to improve overall patient modesty consideration within the medical setting, we begin simply by bringing the consideration afforded male patients up to the level already, minimally, afforded those patients whom happen to be female. that which is already done for women and girls by default. That would be a logical first step, woudn't it?

Nobody seems to want to talk directly to, specifically on, the disparate treatment issue I and others (including DonMd) raised before. Why the difference between that which is afforded males than that which is afforded females? And, let's not get bogged down on the all male team request issue. Let's consider everything else for a minute. Why the disparate consideration based on gender:

1) less concern for a male patient's modesty

2) less vigilence toward ensuring he is as covered as she is

3) a prevailing presumption that peripheral staff are permitted to participate in, or witness, intimate care delivered to male patients -- to view membere jewelry out of simple curiosity, to hang out in the room waiting for your girlfriend to finish her shift to accompany her home, etc..etc...etc...

4) And the apparent widespread conclusion that he is silly when he (the patient) speaks up, but she (the patient) is not?

I'm curious, why the difference? Let's begin improving things simply by affording men and boys that which we already afford women and girls. Doesn't that make sense?

Why so silent on this specific point?

[sirI, MSN, APRN, NP]

Thread closed for staff review.