Patient Modesty - page 6

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   elizabells
    I stand corrected. I guess my hospital is just awesome, then.
  2. by   GadgetRN71
    Quote from elizabells
    I stand corrected. I guess my hospital is just awesome, then.
    No, your hospital is pretty much standard...most elective surgeries(at least in my area of the country) are explained by the surgeon, in the office. If the patient is an outpatient, then the forms are given in advance and any paperwork not completed is finished in the pre-op area where patients are allowed to have their glasses and are allowed to have up to 2 relatives with them. When the relatives leave, they take the glasses/personal belongings and only when the patient is going to the room are they medicated.

    Obviously, emergency surgeries are different.

    Any filming or observers are explained to the pt. They have the option to refuse to have med students,or observers in there but they do not get to dictate the operative team.
  3. by   GadgetRN71
    Quote from dutch92602
    Personally speaking, I would obtain all consent forms at least 1 week in advance of a scheduled elective surgery. This would allow proper time to read everything. That way any issues could be addressed and if they could not accomodate to what a patient is willing to accept then you have the option of cancelling the procedure and going elsewhere.
    This is the first thing we can agree on! I think this is an awesome idea. Although, before I had my surgeries, my surgeons already did this...I had my testing and filling out of paperwork a good 2 weeks before.
  4. by   GadgetRN71
    Quote from Anxious Patient
    At the teaching hospital where I had my surgery, the general consent form was presented to me just before surgery. The form included vague paragraphs about patient photography, medical student participation, etc. Nothing specific. One signature covered everything. I asked if I could strike out the photography paragraph, but was told by the admissions clerk that the consent form could not be altered. If it was, it would be considered invalid, thus surgery couldn't be performed.

    I was told that I could make a verbal request to the circulating nurse that I would meet prior to surgery, which I did. (I would have made this request directly to the surgeon, but was already anesthesized by the time I was wheeled into the OR)

    My question is: Would the cir. nurse be obligated to pass on my request to the surgical team? And, if the request wasn't honored, what could/would she do about it?
    A question: was this elective or emergency surgery? It would depend what the request was...if it's for a team of all the same gender, and it's emergency surgery, you're pretty much SOOL. Heck, for elective surgery, it is tough to accomodate specific gender requests because of staffing.There is really not so much photography/video going on anyway...the most I've seen is when we're doing reattachment of fingers(dang snowblowers!) or limbs and they are doing extensive reconstruction, then they photograph, but it is just the hand, arm or leg. No faces are shown. I do believe even then, they ask permission. For general surgery(ie appendectomies, or gallbladder removal) they rarely, if ever, take pictures. Ditto for GYN or Cysto.

    Just as an FYI, it's common practice to sedate patients when wheeling them into the room...it's a kindness for the patients, IMO, most of whom are nervous. They don't actually anesthetize you until you're in the room.
  5. by   elizabells
    Oh, and I've watched many of those video streams - they don't start until the surgery is well underway, and the pt has been entirely draped except for the field. I've never seen the prep process or any of a patient's bits.
    Last edit by elizabells on Feb 6, '08 : Reason: because I can spell... honest!
  6. by   Anxious Patient
    Quote from WitchyRN
    A question: was this elective or emergency surgery? It would depend what the request was...if it's for a team of all the same gender, and it's emergency surgery, you're pretty much SOOL. Heck, for elective surgery, it is tough to accomodate specific gender requests because of staffing.
    This was elective surgery - an abdominal hysterectomy due to cancer. The hospital was a 950 bed tertiary facility. I only met the surgeon once (referred by my gyn) a week before surgery. The place was so big and busy, I felt about as small (and important) as an ant. This was the first time I was ever in a hospital and I was totally overwhelmed. On the day of surgery, when I discovered the photography reference and tried to cross it out on the consent form and was denied permission to do so, the admissions clerk suggested I make the request verbally to the circulating nurse. So, that's what I did. But I have no idea what happened after that. Of course, I never saw that nurse again.

    So, my original question to any of the nurses on this board is:

    If a patient has no choice to make their pre-surgery wishes known except through the cir. nurse.,(i.e. no photography or no med. students practicing pelvic exams) would the nurse be obligated to pass on those wishes to the surgeon? Whether the request would be honored, I suspect would be out of her hands. But, wouldn't she at least let the surgeon know what the patient asked for? Isn't the cir. nurse the patient's advocate in the O.R.?
  7. by   Batman24
    Anxious Patient:

    Have you called/written the hospital to let them know that you were told that you couldn't alter the document and were advised to let them know verbally instead?! Patients are being asked permission about the video, pics, etc. and it is customary for people to say no according to those I checked with. This is standard practice. I don't think this is an issue you should let go before getting some answers. You might save the next patient a lot of the stress you are now going through. They need to get this straightened out and at once. I would also let the surgeon know of your concerns on a follow up appointment. It's important for them to know as well.

    In checking I found out from a friend that the nurse would pass on your request to the surgeon and chances are good they would honor your wishes. As Witchy has stated earlier pics are rare, and my friend reiterated that same thing to me when asked.
  8. by   GadgetRN71
    Anxious patient...I can almost guarantee you 100% that there were no pictures taken of you during your hysterectomy. I have never seen a med student doing a practice pelvic exam on a sleeping patient either. My last hospital, I would make the med student introduce his/herself and have them ask if it was ok if they were there for the procedure. If the patient said no-then they didn't go in...and I had a few say no.Med students are pretty much there to observe...if they're lucky, they may get to scrub in, but are under the eagle eyes of the doc and the circulating nurse. We do advocate for the patient and I've made known any little requests that the patient has too-like one lady who wanted the OR staff to say a quick prayer before putting her to sleep. We complied. We have your back!
  9. by   dutch92602
    Quote from elizabells
    Oh, and I've watched many of those video streams - they don't start until the surgery is well underway, and the pt has been entirely draped except for the field. I've never seen the prep process or any of a patient's bits.
    I will post a couple of video websites where this is NOT the case! Stay tuned.
  10. by   dutch92602
    Quote from WitchyRN
    No, your hospital is pretty much standard...most elective surgeries(at least in my area of the country) are explained by the surgeon, in the office. If the patient is an outpatient, then the forms are given in advance and any paperwork not completed is finished in the pre-op area where patients are allowed to have their glasses and are allowed to have up to 2 relatives with them. When the relatives leave, they take the glasses/personal belongings and only when the patient is going to the room are they medicated.

    Obviously, emergency surgeries are different.

    Any filming or observers are explained to the pt. They have the option to refuse to have med students,or observers in there but they do not get to dictate the operative team.
    This was NOT the case with a personal experience. The form was handed to the patient prior to when the nurses contacted the family member to join the patient in the OR holding area. Corrective lenses had already been removed. The family member was not aware that a form had been presented to the patient. There was no mention of the additional consent form when all other general consent forms and insurance forms were signed in the waiting area downstairs. None of the forms were given to the patient in advance. Two minutes before surgery! By the way, what do you think of a surgeon that puts together a two page H & P, incorporates it in a medical file, and NONE of it was done. All fraudulent. The surgeon also states he explained everything...etc. etc. Did none of it. PACU nurses chart all kinds of things that were not done. Is this medicine today?
  11. by   dutch92602
    Quote from dutch92602
    I will post a couple of video websites where this is NOT the case! Stay tuned.

    If you think this video stuff is ALL so inocent then go to the following:

    [This is just a sampling]

    http://www.or-live/hartfordhospital/1353.com

    http://www.or-live.com
    Revolutionary techniques in penile implant surgery March 26, 2007

    Watch the full video

    Shows no faces but shows ALL except for the hair removal. That has already been done in both videos. Would you want yourself or your husband displayed like this? For OR nurses..Is this how a genital prep is done on a male?
    Last edit by dutch92602 on Feb 6, '08
  12. by   Batman24
    Quote from dutch92602
    Shows no faces but shows ALL except for the hair removal. That has already been done in both videos. Would you want yourself or your husband displayed like this? For OR nurses..Is this how a genital prep is done on a male?
    If the patients consented to pics and video being taken during a personal procedure then I see no problem with it whatsoever. Some patients aren't shy or modest about their bits and pieces being seen by others. Their faces aren't shown so that does afford them a degree of privacy. It might not be a choice all of us would make but some don't mind being used for teaching, etc. It's a personal choice.
  13. by   core0
    Quote from dutch92602
    If you think this video stuff is ALL so inocent then go to the following:

    [This is just a sampling]

    http://www.or-live/hartfordhospital/1353

    http://www.or-live
    Revolutionary techniques in penile implant surgery March 26, 2007

    Watch the full video

    Shows no faces but shows ALL except for the hair removal. That has already been done in both videos. Would you want yourself or your husband displayed like this? For OR nurses..Is this how a genital prep is done on a male?
    This is standard CME video (continuing medical education). Neither of your links work as listed. If you add .com after the or-live part they do work (hint use the preview post button and check your links before posting).

    Obviously you would not want your husband displayed like this but someone didn't mind. In cases of CME broadcast there will be extensive waivers signed not only by the surgeon and hospital but also by the video production company. These are usually underwritten by the equipment company but are also put on by hospitals to garner referrals for advance techniques. While the cynic in me does not consider this completely innocent from a sales standpoint, as far as any other reason, yes it is innocent.

    David Carpenter, PA-C

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