Patient Modesty - page 2

Want to get feedback about how we all handle pt concerns about modesty and/or being naked as part of surgery. Concerns about who sees them and for how long? Why do they need to be naked? When is the... Read More

  1. by   RN BSN 2009
    Quote from nurseangel47
    MY religious convictions are none of your business and do not have a THING to do with the original text of the above thread. Either you need surgery or a procedure or you don't either you want it done or you don't. I personally have better things to do with my time than worry and wonder whether or not the unconscious patient is muslim or otherwise and if they are there for a procedure or surgery, then the part to be uncovered is uncovered, period. I am not into vulgar strip the covers back, let it all hang out kinda of health care professional....I am a PROFESSIONAL, period.
    I don't get kicks outta seeing ANYONE naked....except maybe my husband.
    So...this has not a thing to do with my religion. Nor yours if you want/need the surgery badly enough.
    Ya want us to cut a hole in the bed sheet next time and just aim blindly for some body part? Geez...you're the person who'd sue, too, in case we missed the body part we were going in for thru the hold in the sheet to contain "your modesty due to religious preferences..."
    The only reason I asked is because I was trying to gain insight into your insensitivity towards this topic. It's a lot easier to understand the issue of modesty if it is within the realm of your beliefs/religion/conservative upbringing. Given the current trend in U.S. demographics, it is likely you will encounter patients with these concerns, especially with the influx of immigrants from eastern countries, where being modest is a norm, India, Middle East, Bengladesh, North Africa, Sub-saharan Africa.. etc etc etc.

    It does mean something to a lot of people. There are some extreme conservatives who would rather die or suffer whatever it is than be seen. It's important that nurses are culturally competent, to be awarwe of the issues that may arise. It's pretty obvious surgery is something that provokes anxiety in the patient, and the patient should have the right to know what is going to happen in the procedure from start to finish. The OP is clearly asking how to address these issues with the patient. At that point the patient can choose to go through with the procedure, or maybe even decline to have the procedure performed.

    I don't know where you're trying to go with the "cut the hole in the bedsheet and just aim blindly" statement. If you read my previous posts, I stated that I had requested to have parts covered up that were not actively being operated on and so long as care isn't being hindered, if that was possible.

    No need to be defensive or condescending.
  2. by   ewattsjt
    [font='times new roman']creinkent, we are all professionals and must expose the patient in order to perform the surgery and ensure patient safety. there are some differences from place to place and dr. to dr. but, all is performed for the patient’s procedure and safety.

    the post sounds to me to be more in nature of a concerned patient instead of a student wanting to become a better patient advocate. just observation.

    no offence is meant, i just recently was dealing with a patient on another board who was asking almost the same exact questions. we tried to answer at first but saw that she had not talked with the surgeon or facility about her concerns.

    while patients have the right to know what is going to happen to them, there are things that are not addressed directly. if everything was addressed directly, we would have to have the patients come in a day early to explain exactly what is happening. questions such as: why is hibbicleans used instead of chloraprep, duraprep, iodine paint, iodine scrub or alcohol or any combination of physician choice? the use of what prep is a very small detail. as you can see, it wouldn’t take long to fill an entire day of answering questions in detail.

    it goes to say that what is considered an accepted standard practice may not sit well with all patients. explain the basics and if they still have questions, direct the patient to ask the physician.

    the religious belief of the staff should be of little consequence to the procedure. we all have had training geared toward understanding the various patient religions, customs etc… we are to respect these beliefs and cultures.
  3. by   canoehead
    I think your concerns are justified- but most ORs will respect them just as a matter of routine. I think that just telling your doc and nursing staff will do the trick, they will be extra careful. We all know the fear of having our butts hanging out while not able to care for ourselves because we've seen it happen. Tell your doc how concerned you are. I am sure you will feel better when you hear the reply, and if you don't it shouldn't be difficult at all to find someone better.

    On our OR consents it says you give permission for the doc or his/her delegate to do the procedure, and that you consent to additional procedures if needed, and also that students may be involved. Read your OR consent and cross out the parts you are not OK with. For myself, I would cross out the student part, and tell the team that specific students and specific procedures could be added if they told me in advance. I'm a real control freak and want to know exactly what's going to happen while I'm under. But if they told me ahead of time they would have a lot of leverage.

    Nurseangel, I respect your frustrations- in an emergency you don't want your hands tied, and they shouldn't be. But before the procedure I think the patient has a right to have all questions answered. That said, the doc, OR team, and the patient all have a right to decline to have the procedure done. So if the patient needs to question the team for 12 hours (clearly inappropriate) they can decline to treat. I gotta say that "we will follow standard procedures" without answering specific questions does not treat the patient as a member of the team. If the patient is not on board recovery is going to suffer. Compassion and personalizing care is why they haven't yet built robots to substitute for nurses.
  4. by   nurseangel47
    Sorry if I was inflammatory here last night during posting. Did not intend to be. Apologies to all and any who are of a religious sect or otherwise who prefer to not be exposed during, before or after any procedure....guess my worldly views need to be widened, huh? LOL
  5. by   subee
    Quote from ewattsjt
    [font='times new roman']creinkent, we are all professionals and must expose the patient in order to perform the surgery and ensure patient safety. there are some differences from place to place and dr. to dr. but, all is performed for the patient's procedure and safety.

    the post sounds to me to be more in nature of a concerned patient instead of a student wanting to become a better patient advocate. just observation.

    no offence is meant, i just recently was dealing with a patient on another board who was asking almost the same exact questions. we tried to answer at first but saw that she had not talked with the surgeon or facility about her concerns.

    while patients have the right to know what is going to happen to them, there are things that are not addressed directly. if everything was addressed directly, we would have to have the patients come in a day early to explain exactly what is happening. questions such as: why is hibbicleans used instead of chloraprep, duraprep, iodine paint, iodine scrub or alcohol or any combination of physician choice? the use of what prep is a very small detail. as you can see, it wouldn't take long to fill an entire day of answering questions in detail.

    it goes to say that what is considered an accepted standard practice may not sit well with all patients. explain the basics and if they still have questions, direct the patient to ask the physician.

    the religious belief of the staff should be of little consequence to the procedure. we all have had training geared toward understanding the various patient religions, customs etc... we are to respect these beliefs and cultures.

    every patient should be treated in the or with modesty in mind. it constantly distresses me when or nurses completely uncover the patient to put a blanket on or throw the blankets off before a spinal. if it ain't being worked on, it should be covered - if for nothing else because its freezing! i really don't care too much about being culturally competent - its the same courtesy i'd extend to any patient. however, being in ny, we're probably more used to dealing with turbans, etc. that people in other areas aren't accustomed with. i haven't come across a request yet that couldn't be met and appreciate it when patient let me know what their needs are.
  6. by   tessa_RN
    I always try to keep my patients covered as much as possible....Before and after the surgery...I usually wont uncover any part until I am about to prep...If we are doing back surgery we will uncover the patient just to flip them onto their stomachs but I am always there to quickly cover up their behind and legs..I never leave my patient exposed..The only cases are hearts or AAA to where they have to be completly undressed for prep...Or its an emergency and we have multiple fractures....GYN cases how ever its hard especially an LAVH but I always keep the upper half above the sterum covered.....Ive had surgery and the first surgery I had before I worked in the OR I was nervous about that but now that I work there I really dont worry to much about it...Ive had a cardiac ablation done recently and I really didnt worry about what they see because I know these people see that stuff everyday and they really dont make a big deal about it....Like If I see a patient I really dont think nothing of it because its my job......
  7. by   creinkent
    Wow - what a great response. Just to let everyone know, the pt "was" 60 yrs old, her husband had died a year ago, her brother was coming in from out of state and she was diagnosed with pancreatic cancer. She was going into surgery (first time ever - never had kids) and was afraid (see tess rn comment about not knowing) that she would die soon and that she wanted to be treated with dignity ---- dignity = humanity = possible death = fear. I do not believe that the thought of being naked in front of strangers was her reall issue. She died on the table.

    This got me thinking - a lot - about how the medical community sometimes only treats the disease and not the person. And people know when they are not being told the entire truth - just as kids do. Simply, how well you are treated depends upon the luck of the draw of what care givers you get. Do you get "subee" or do you get nurse Crached (aka nurseangle47). If nurseangle47 acutually interfaces with patients, they will get the unease that they are a piece of meat - and that doesn't help their recovery and could scar them for life - regardless of competent she is. My only hope is that nurseangle47 has never had to be subjected to the treatment clearly she doles out to her "patients". It is up to us to treat the whole pt. In the old testament there is a discussion about the measure of a man is what he does when no one is looking. I would submit that our unconscious patients is that challenge. If we treat our patients with disrespect when they are not looking, how does that effect us when they are aware - aka - in the hospital room, in the dr. office, etc.

    Of particular note is non-consentual pelvic exams in the OR - I am very glad that this long accepted practice is coming under such scrutiny and has come into public view.

    I need to give more thought as to how I will answer questions from pts like my post in the future. I will post my thoughts soon and would appreciate feedback.

    In closing, it has nothing to do with being "naked" in the OR; It has EVERYTHING though to do with our humanity. Just because "we are professional" and see this stuff all the time, doesn't mean really anything to a patient. Tessa RN statement that knowing what goes on helps her cope with her own illness - GOES FOR OUR PATIENTS AS WELL.

    Sorry for the soap box, but my experience with the pt was very thought provoking for me.

    Thanks for everyones contributions - it has begun to clarify my thinking.
  8. by   Works2xs
    Hmmm. Just in the short span of time that I've worked in the OR, I've had several occasions to witness patient concern regarding modesty. This has ranged from the Muslim woman asking for an all female surgical team to the middle-aged housewife who just didn't like the idea of being exposed. Guarding someone's modesty just seems the decent thing to do, even if they are completely unconscious and unaware. I know that I'd appreciate the consideration if in their position, so the Golden Rule applies. And speaking of rules, protecting the patient's privacy in this manner is included in our intraoperative care plan. Kind of surprised anyone would take issue with someone voicing these sorts of concerns... Am I missing something?
  9. by   CNORSUE
    Thanks Works2xs for your excellent reply. As OR nurses we need to maintain our pts. dignity & respect for their modesty. As you stated, the Golden Rule applies. I don't think any of us would like to be unecessarily exposed! I always treat my pts. with the same respect, kindness & dignity as I would a family member, co-worker or friend. Isn't that why we're in this profession? To take the best possible care of our pts.-we are after all,the pt. advocate. For those of you who have no qualms about "ripping off the covers & gowns" of your pts. to make it easier to place monitor patches, grounding pads, etc. shame on you-maybe NURSING (think about what that means) is not for you. Would you like that done to you or a loved one? Think about that every time you CARE for a pt.
    Last edit by CNORSUE on Dec 23, '06 : Reason: sentence error
  10. by   creinkent
    I’m curious if the size of the hospital and if it is associated with a medical school has a bearing on maintaining pt "modesty" in the OR suite. Thoughts?

    Is it OK to tell the pt that their dignity will be protected – whether it is or not?

    Is it enough to say that if the patient is treated with modesty before going under, and they are properly covered up when they again become conscious, that their dignity has been protected? About the surgery my wife had a while ago, she reflected: "Well, if I were uncovered during the process, you would have to ask someone else, because -- I wasn’t there."
  11. by   Marie_LPN, RN
    My same post from "Naked in Surgery":

    We take a gown completely off for hip replacements and back surgeries (because of wrinkles). But the top half of the pt. is covered by a blanket and a forced air warming blanket.

    The lower half of a pt. is kept covered until the last second before prepping.

    Students never practice pelvic exams on our pts. in our OR. A 'practice' pelvic exam should be done in the office, where the pt. can be asked prior.

    We do explain to pt. prior about the position(s) they will be in for their surgery. And when the pt. is wheeled into the room, the nurse says "the people that are in here now will be the people in the room with you the whole time". If the pt. expresses concerns about 'exposure', we assure them that we are professionals, and we will do our best to maintain their modesty throughout the case.

    I should also say that if the gown is on, and it gets prep, blood or saline on it, we change it in OR before the pt. goes to PACU. If there weren't any extra gowns in the room and the pt. went to PACU before the gown was changes, i go to PACU and change it. Who wants to wake up in a wet or dirty gown? Yuck. And half the time if a pt. is in a wet gown, they wonder if they peed or something, and who likes the feeling that they wet the bed? :stone

    We don't tie the back of the gowns after surgery though. The knots are uncomfortable.
  12. by   ewattsjt
    Maybe my previous post was taken wrong. We do not do intra operative pelvic exams and do not have med students here so I can not comment on that part of the post.

    We do give the patient the up most respect for their privacy and decency. Nothing is ever exposed that should not be and is only exposed after induction if a general is given. Everything is explained as prior to it happening. I am a male, so I have a female in the room place electrodes on female pts. when possible.

    The other side of the coin is where I am coming from. As I said before I am a male, so when a female patient accuses me of possibly exposing them, so the accusations could snowball into something totally different. So yes I am very defensive.

    The patients, who do complain, do so afterwards. It is something that can not be changed. It can only be voiced with concern of why it was done.

    If a diagnostic laparoscopic procedure for possible endometrial adhesions is performed, it is AORN standard that the prep is from thigh to nipples and side to side. So nipples have to be exposed and so does the vagina for placement of the humi or other uterine manipulation device. The patient does not understand why her nipples were exposed when the trocar placements were in the peri-umbilical region. The patient awakens to find some missed scrub by her nipple and wants to know what it is; then refuses to understand and accuses that the staff exposes her unnecessarily. No matter how it is explained afterward, she insists that it should have been told prior to instead of calling it a standard procedure or practice.

    As I said in my previous post, it would take a day to tell the patient of everything that will happen and why. That is why it is listed as a standard. I am for the patient receiving as much information as possible but I am also realistic as well.
  13. by   cvrnfa
    As professionals in the operating room, we as nurses should make every attempt to preserve patient dignity and modesty. At our hospital, we keep the patient covered until it is time for the surgical prep. Although our patients accept the fact that complete modesty is not possible, they put their trust in us to see that it is taken care of for them in a professional manner.

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