Patient Modesty - page 3

by creinkent 48,873 Views | 85 Comments

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 gown removed, etc? How much do... Read More


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    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?
    58flyer likes this.
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    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
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    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."
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    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.
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    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.
    GadgetRN71 likes this.
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    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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    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.
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    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
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    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
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    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.


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