Patient Modesty - page 3

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. Visit  ewattsjt profile page
    0
    Actually, I have had several procedures done and it is also the reason for me coming to surgery (it was all before becoming involved in health care). I trusted that the people doing my procedure would be professional. Being in the health care setting; I see that they are when it comes to things like modesty. So I still stand by what I had written.

    I do think if something is specifically asked for, it should be granted or explained why it can not be (ie. where I work, when a woman asks for an all female team ,they get it. When a male asks for an all male team, they do not get it. It is told to them that there are not enough men employed to do so). If they are still uncomfortable with the staffing issue, they can cancel the surgery. <<<It is really that simple.

    Modesty is to be respected to the up most but there is a necessary exposure level to ensure the surgery goes well without complications. To be covered as much as possible is not too much to ask but aren’t all patients covered in this manner? If not, you violated them.
  2. Visit  GadgetRN71 profile page
    0
    I try to maintain the patient's modesty as much as possible. That said, I have had quite a few patients come up for major procedures with their underwear on and then they are shocked that the undies have to be removed(foley catheter). Or the middle aged woman who came in for a cysto and was horrified that she was going to be in stirrups and the surgeon was going in through her urethra. This woman had no clue of what the surgery entailed.

    We simply don't have the people on my shift(evenings) to accomodate preferences for staff of a specific gender. I don't think that particular practice should be encouraged anyway-just makes it that much harder to run the schedule when there is a shortage of OR nurses(at least in my area) to begin with. I think most reasonable people kind of know that when you have surgery, people may see your private parts. Like I said, I protect the patients privacy as much as I can, but sometimes, the staff may see you naked. (especially for laminectomies. the gown is completely removed so that the patient can be flipped onto the wilson frame) Oh, and I have had several major abdominal/GI surgeries and one cysto, so many of my coworkers have seen my naked fanny as well as my vajayjay...I have no modesty left, but personally, I find that kind of freeing. I also have no problem with patients being educated about their procedures, but the surgeon needs to do that. I don't have the time to be explaining every single step of the prep and obtaining permission to do my job from someone who's "shy" . If the surgeon explains what is going to happen before the surgery, anyone who is uncomfortable with being seen by the staff can cancel.

    Just so you guys know, I have been known to tape blankets up over every last window in the OR suite to protect my patient. We've gotten teenagers that needed to have their underwear removed to do the surgery but before taking the child to PACU, I will put the underwear back on so they don't freak out...I believe that we must value the patients dignity. My problem is only with carrying it too far..as the poster above said, we need to be realistic also. I have worked with male RNs and techs that I would choose hands down to do my procedure(even a GYN one) because they are good at what they do, and compassionate. I also know fellow female RNs that I would not allow within 10 feet of me. I know those not in healthcare don't believe it, but when we are doing a procedure, we really couldn't care less how a patient looks naked. In my day, I did lots of Cysto cases. I saw more penises than probably most hookers. When you have a procedure, you need to be able to trust the people taking care of you. IMO, if a patient can't do that maybe they need to postpone or cancel their surgery.
    Last edit by GadgetRN71 on Jan 12, '08
  3. Visit  Scrubby profile page
    0
    I take protecting my patients dignity seriously no matter what their religious considerations. There is no need to expose a patient before applying the prep solution so i make sure they are covered (also to help prevent hypothermia) until i need to paint so that the time they are exposed is shorter.
    Last edit by Scrubby on Jan 12, '08
  4. Visit  dutch92602 profile page
    2
    Quote from iceyspots
    I dont know how much this will help, but here's an interesting blog

    Bioethics Discussion Blog: Patient Modesty: A More Significant Issue?


    This site is more than interesting. It really shows how much people are offended with being handled by the opposite sex with regard to intimate and personal procedures. Nurses, in my humble opinion, are very wrong to assume that just because a nurse does things of this nature routinely as a part of the job, does not make it acceptable to the patient. It is NOT okay with many people. Silence does not mean or equate to acceptance. People feel very intimidated and don't feel they can speak up. They feel paralyzed in a place that "controls" them. If more patients insist on having things done their way, the healthcare delivered will change. There is a double standard for men and there should not be. Men are not necessarily any more comfortable with having the opposite sex do genital procedures than women would be. Men deserve the same respect, dignity, and decency and choice.
    claybob and 58flyer like this.
  5. Visit  GadgetRN71 profile page
    1
    Quote from dutch92602
    This site is more than interesting. It really shows how much people are offended with being handled by the opposite sex with regard to intimate and personal procedures. Nurses, in my humble opinion, are very wrong to assume that just because a nurse does things of this nature routinely as a part of the job, does not make it acceptable to the patient. It is NOT okay with many people. Silence does not mean or equate to acceptance. People feel very intimidated and don't feel they can speak up. They feel paralyzed in a place that "controls" them. If more patients insist on having things done their way, the healthcare delivered will change. There is a double standard for men and there should not be. Men are not necessarily any more comfortable with having the opposite sex do genital procedures than women would be. Men deserve the same respect, dignity, and decency and choice.
    With all due respect, it is very easy to say that patients should insist on having things done "their way" when you are not a nurse. IMO, that is one of the huge problems in nursing today, the "customer service" mentality. Patients need to realize that the majority of nurses care about their patients, act professionally and are trying to do their jobs under increasingly difficult conditions. There are not all that many male nurses(something like 95% of nurses are female) so finding a male nurse to prep an overly modest male(or a male with an insecure wife) is going to be difficult. I do agree with you that there should not be a double standard. Both genders need to realize that the OR staff tries to keep you as comfortable and safe as we can, but we cannot accomodate every little whim/hangup/phobia that a particular patient may have. Done here with this topic, because I'm sick and tired of having the implication made that we OR nurses are somehow inaapropriate or unprofessional for doing our jobs.:angryfire
    Last edit by GadgetRN71 on Jan 19, '08
    Kim O'Therapy likes this.
  6. Visit  DutchgirlRN profile page
    2
    I've never seen a "naked" person in surgery. Partially uncovered and then draped, yes "naked" No.

    I have heard of patients requesting an all female crew and they do comply. I am personally not that modest. I don't have anything anyone hasn't seen before and I know that I will be treated respectfully while I'm in the OR even though I am anesthetized. I've had breast surgery and gynecological surgery in the hospital where I work.

    When it comes down to it I know I can trust these people to take the best possible care of me. If I go to another hospital I wouldn't have a clue as to quality of their staff.

    When I went to the surgeon (a doc I worked with on the floor) prior to my breast biopsy, it was so funny. He came into the exam room. He was unusually quiet and seemed to be uncomfortable about examining my breast but was doing his very best to be totally professional. He was looking me straight in the eyes and asking me "so how do you like working on the floor, what do you think of this, what do you think of that". I said "Dr. Smith I think you're uncomfortable but please don't be, it's a boob, just a boob, we all have them, it's not bothering me at all". Then he laughed and was able to be totally relaxed. When it came time to have the stitches taken out, the day prior to my appt I saw him on the floor and asked him if my friend could go ahead and take my stitches out at work. He said "oh yes please, that would be great". We both laughed.
    VivaLasViejas and GadgetRN71 like this.
  7. Visit  aquarius1 profile page
    1
    I don't take the patient's cover/gown until the surgeons are ready to prep...it's the least i can do in keeping the patient modest once inside theatre.....
    leemacaz likes this.
  8. Visit  ayla2004 profile page
    1
    Quote from iceyspots
    Would you consider my request too demanding?
    having spent some weeks in the Theater(OR) as a student i think you request is valid, i would certainly expect to be cvered and kept warm once the area to be operated on was isolated. and staff should be disreet in their converstaions
    leemacaz likes this.
  9. Visit  dutch92602 profile page
    2
    Quote from WitchyRN
    With all due respect, it is very easy to say that patients should insist on having things done "their way" when you are not a nurse. IMO, that is one of the huge problems in nursing today, the "customer service" mentality. Patients need to realize that the majority of nurses care about their patients, act professionally and are trying to do their jobs under increasingly difficult conditions. There are not all that many male nurses(something like 95% of nurses are female) so finding a male nurse to prep an overly modest male(or a male with an insecure wife) is going to be difficult. I do agree with you that there should not be a double standard. Both genders need to realize that the OR staff tries to keep you as comfortable and safe as we can, but we cannot accomodate every little whim/hangup/phobia that a particular patient may have. Done here with this topic, because I'm sick and tired of having the implication made that we OR nurses are somehow inaapropriate or unprofessional for doing our jobs.:angryfire

    It is not every whim or fancy. It is a patients' right not to be handled by the opposite sex. OR's should discuss this ahead of time with a patient and if it is elective surgery then a patient has the option of going elsewhere.
    Last edit by sirI on Jan 20, '08 : Reason: TOS
    claybob and leemacaz like this.
  10. Visit  core0 profile page
    2
    Quote from dutch92602
    It is not every whim or fancy. It is a patients' right not to be handled by the opposite sex. OR's should discuss this ahead of time with a patient and if it is elective surgery then a patient has the option of going elsewhere.
    Its not a right to make unreasonable demands which is what that is. The assumption seems to be that nakedness is the equivalent of a sexual display. In medicine that is almost never the case. Nakedness is part of what we do and it isn't something that we pay attention to.

    In our rooms we wouldn't even consider a request to dictate the operative team. Asking that would probably be a huge red flag that you are not a surgical candidate. And yes you have the option of seeking other providers. To be charitable most of our patients have been in the medical system long enough that modesty is no longer a consideration.

    Surgery is a team effort and you want your A team. Trying to dictate the team composition of something you know nothing about is almost certainly going to guarantee that your team is not composed of the optimal members in terms of experience or technical ability.

    I've read some of your other posts. I understand that you feel that something wrong has been done. What you need to understand in medicine (and surgery especially) is that Nakedness is not the same as sex.

    David Carpenter, PA-C
    Kim O'Therapy and GadgetRN71 like this.
  11. Visit  dutch92602 profile page
    2
    Quote from core0
    Its not a right to make unreasonable demands which is what that is. The assumption seems to be that nakedness is the equivalent of a sexual display. In medicine that is almost never the case. Nakedness is part of what we do and it isn't something that we pay attention to.

    In our rooms we wouldn't even consider a request to dictate the operative team. Asking that would probably be a huge red flag that you are not a surgical candidate. And yes you have the option of seeking other providers. To be charitable most of our patients have been in the medical system long enough that modesty is no longer a consideration.

    Surgery is a team effort and you want your A team. Trying to dictate the team composition of something you know nothing about is almost certainly going to guarantee that your team is not composed of the optimal members in terms of experience or technical ability.

    I've read some of your other posts. I understand that you feel that something wrong has been done. What you need to understand in medicine (and surgery especially) is that Nakedness is not the same as sex.

    David Carpenter, PA-C

    You have every right to your opinion. I agree with what you say in general, however, I suggest you read the regs hanging on the walls of your Atlanta institution and consult with the administration on the validity and legal ramifications of "Patients' Rights." Evidently, I can only assume that all of the laws and guidelines now in effect in this country in the healthcare setting was to allow the patient some personal choice for the beliefs including religious beliefs and this no doubt came from very unhappy patients and perhaps even a lawsuit or two. It used to be prior to these laws by JCAHO, HIPAA and the Patients Rights documents that it was only the way of the institution to provide care their way as you so state. I do not contend people are less than professional, talented, or are used to seeing nakedness. Those issues lie with the staff. It is the patient that has a few rights they are suppose to be able to exercise if they are not comfortable with it.
    claybob and leemacaz like this.
  12. Visit  core0 profile page
    5
    Quote from dutch92602
    You have every right to your opinion. I agree with what you say in general, however, I suggest you read the regs hanging on the walls of your Atlanta institution and consult with the administration on the validity and legal ramifications of "Patients' Rights." Evidently, I can only assume that all of the laws and guidelines now in effect in this country in the healthcare setting was to allow the patient some personal choice for the beliefs including religious beliefs and this no doubt came from very unhappy patients and perhaps even a lawsuit or two. It used to be prior to these laws by JCAHO, HIPAA and the Patients Rights documents that it was only the way of the institution to provide care their way as you so state. I do not contend people are less than professional, talented, or are used to seeing nakedness. Those issues lie with the staff. It is the patient that has a few rights they are suppose to be able to exercise if they are not comfortable with it.
    I assume you are talking about this:
    http://www.hcqualitycommission.gov/f...d_a.html#chpt8
    As far as I know there is no enforcement provision to these guidelines. CMS wants institutions to adhere to this but it is part of the overall rating of the institution.

    In particular you are probably talking about this:
    "Respect and Nondiscrimination


    Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system. Consumers must not be discriminated against in the delivery of health care services consistent with the benefits covered in their policy or as required by law based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.


    Consumers who are eligible for coverage under the terms and conditions of a health plan or program or as required by law must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment."




    There are two parts here. One part deals with insurance policies. The other part states that you cannot be discriminated against in the delivery of health care. This means that someone cannot refuse to see you because of a given characteristic. That does not mean that the institution has to follow all of your demands. Also generally to the extent that the "bill of rights" has any force, only organized characteristics are protected. For example a kosher diet would be an example of a protected area while a demand to ban meat from the floor because killing cows is murder would not be. The bill is about organized characteristics as opposed to non-organized personal beliefs.

    I would agree that to agree to your demands and then not carry the agreement out is deceitful. The mistake is agreeing to the demands in the first place. Basically while this is a straw man argument what types of demands are realistic. If someone belongs to a religion that does not believe in the sexes mixing could they demand male blood only? At a certain point operational realities intrude into this argument.

    You have the right to participate in your medical treatment. As a provider I have the right to refuse a demand that I deem unreasonable. If you don't like that you have the right to find another provider. As far as hanging on the wall, I can currently see two fliers for drug study. A grand rounds announcement and a pizza ad.

    David Carpenter, PA-C
    lpnflorida, Kim O'Therapy, Jarnaes, and 2 others like this.
  13. Visit  dutch92602 profile page
    1
    Quote from core0
    I assume you are talking about this:
    http://www.hcqualitycommission.gov/f...d_a.html#chpt8
    As far as I know there is no enforcement provision to these guidelines. CMS wants institutions to adhere to this but it is part of the overall rating of the institution.

    In particular you are probably talking about this:
    "Respect and Nondiscrimination


    Consumers have the right to considerate, respectful care from all members of the health care system at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality health care system. Consumers must not be discriminated against in the delivery of health care services consistent with the benefits covered in their policy or as required by law based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.


    Consumers who are eligible for coverage under the terms and conditions of a health plan or program or as required by law must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment."




    There are two parts here. One part deals with insurance policies. The other part states that you cannot be discriminated against in the delivery of health care. This means that someone cannot refuse to see you because of a given characteristic. That does not mean that the institution has to follow all of your demands. Also generally to the extent that the "bill of rights" has any force, only organized characteristics are protected. For example a kosher diet would be an example of a protected area while a demand to ban meat from the floor because killing cows is murder would not be. The bill is about organized characteristics as opposed to non-organized personal beliefs.

    I would agree that to agree to your demands and then not carry the agreement out is deceitful. The mistake is agreeing to the demands in the first place. Basically while this is a straw man argument what types of demands are realistic. If someone belongs to a religion that does not believe in the sexes mixing could they demand male blood only? At a certain point operational realities intrude into this argument.

    You have the right to participate in your medical treatment. As a provider I have the right to refuse a demand that I deem unreasonable. If you don't like that you have the right to find another provider. As far as hanging on the wall, I can currently see two fliers for drug study. A grand rounds announcement and a pizza ad.

    David Carpenter, PA-C
    Brilliant! I do not have the time at this moment to respond, but will plan to address your responses regarding these issue within a week.
    Thank you so very much for your wisdom. I will not plan on visiting your state at all which would possibly subject me to entering one of the facilities for healthcare. In N.Y. a patient was always accomodated.
    claybob likes this.

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