Patient modesty concerns pertaining to surgery

Specialties Operating Room

Published

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 you tell them? How do you handle pt that is concerned about students practicing pelvic exams on them without concent? How to handle the situation when after the surgery they realize they had been "exposed"?

Specializes in OR, Nursing Professional Development.

The idea of having a call team to provide someone with a surgical team of all the same gender works in theory. The reality of it is that there just aren't enough males in nursing to make it feasible. The opposite may be true elsewhere, but we have about 70 nurses on staff, and only three of them are male. I can only imagine the reaction if they were on call every three days and every third weekend. We also only have one female orthopedic surgeon, and she doesn't do joint replacements. We do have a female vascular surgeon, and there is one patient that travelled most of the way across the state for surgery. It was also communicated in advance that she wanted an all female team, and considering that there are so many more women in our department, that was easy to accomodate. For a male in the same situation, not so much.

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"And what about the rights of nurses and medical professionals not to be discriminated against in their workplace? I believe there are laws against this. If someone doesn't want me as their scrub nurse or circulating nurse I'd feel like I was being treated unfairly."

Nurses who have posted here of late seem to be caring and compassionate, and say they guard a patients emotional well being to the best of what is currently possible. To bring up discrimination regarding modesty just demeans the integrity of those nurses who practice that compassion.

No one is attempting discrimination. They are just asking for choices and are willing to work together to achieve it.

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Specializes in Operating Room Nursing.
"And what about the rights of nurses and medical professionals not to be discriminated against in their workplace? I believe there are laws against this. If someone doesn't want me as their scrub nurse or circulating nurse I'd feel like I was being treated unfairly."

Nurses who have posted here of late seem to be caring and compassionate, and say they guard a patients emotional well being to the best of what is currently possible. To bring up discrimination regarding modesty just demeans the integrity of those nurses who practice that compassion.

No one is attempting discrimination. They are just asking for choices and are willing to work together to achieve it.

Excuse me but are you implying that I'm not compassionate or something because I don't believe in a society which tolerates discrimination? I do my best to protect my patients dignity and show compassion with whatever resources I have.

And yes saying that we should have all gender teams because of patient preference is to me patients making a choice that is sexist and discriminatory.

from oxford dictionary online:

sexism:

noun prejudice, stereotyping, or discrimination, typically against women, on the basis of sex.

discrimination:

• noun 1 the action of discriminating against people. 2 recognition of the difference between one thing and another. 3 good judgement or taste.

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I think the discussion of preferences vs discrimination is best suited for another thread. It is going to take this discussion completely off topic.

If we are trying to work together, this just isn't going to get us there. It will create sidetracks that will negate the conversation.

I'm not unwilling to discuss it if it is really necessary, but I don't think it belongs here.

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To be perfectly honest with you, I could care less. (And I'm referring to ME and only me, not anyone else.) As long as the surgeon knows what the heck he/she is doing and the OR team does as well (and nothing illegal and out-and-out sick is going on), I don't care. I'll be out. I don't want to know and I don't need to know.

What others want is their beef, not mine. Because I just don't want to needlessly die or get an infection that I didn't bargain for. Really - that's what I want. If you need to laugh at me on the table (and I really don't think you'd find much about me that's amusing; I'm fairly normal, boring, and a size ten) - fine - all that proves is you're a very, very small person who probably has an assortment of inadequacy issues that no amount of ranting by me will change. You'll get yours at some point - I completely believe that.

But yes - do keep me clean. Please. That's just basic common courtesy.

Disrespect is not called for and should be dealt with. Some of it might be so-called "black humor" that anyone outside of the OR wouldn't get - I can live with that - but really, keep comments to yourself. As for draping, I'd be willing to bet each team and each surgeon has their own way of doing it that's worked for them, and I can't control that.

It's surgery; at some point we all have to give up a bit of our normal social mores and needs. If that makes me callous, then I'm callous. Can't help it.

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Not to say I'm not sorry someone feels violated - and again, I'm not talking about illegal or sick here, and I'm not talking about flat-out disrespect - but still, it's surgery. Fix the problem and let's get on with it.

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"one option, perhaps, is for a specific hospital or out-patient surgical facility to arrange staffing to allow for same-gender care on a trial basis to see if, a) there are enough patients for whom these issues are of paramount concern to warrant the extra effort, and b) to see if it is economically/practically feasible to make and sustain such arrangements"

good points. there are indeed many states where facilities and clinics are experimenting with this very concept. you will find that most are "female only", so either doctor's have determined the need or it has become a viable economic niche. most notable are female only colonoscopy clinics, where their mission /goal statements are to help women who are not recieving care due to gender issues.

now...how this effects or/surg...

i have sent letters and e-mails posing the question of "what next"? should a women in their facility find it necessary to have further proceedures, what is honestly available to her now? if she has gender issues (that brought her there in the first place), do they have a continuity of care available to her for surg.? otherwise, it just wouldn't make sense to acknowledge one need and not another.

perhaps this can help pave the way for 'male only'.

for anyone interested, i will post the follow-up responces.

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Specializes in I have watched actors portray nurses.

One of the problems with accommodating female only preferences is that it necessarily means that males will likely find themselves that much farther away from gaining access to one day gaining recognition and access to male only teams.

For those women and men that prefer that (same gender teams), to the extent possible, it should be extended. But only on an equal basis across genders. In much the same way Title IX ensures female student athletes get equal consideration in schools sports programs (even though the overwhelming vast majority of high school sports teams, try-outs, cuts, funding, revenue, is male oriented and generated.)

The reality is that as the medical community scrambles around trying to minimize female patients' perceived humiliations and indignities associated with care from male doctors and nurses, it results in a directly proportinoal, natural skewing of new hires being female. The incentive to hire females goes up, just by virtue of being female. When hiring nurses, administrators will prefer females because they are deemed universal, interchangeable, caregivers -- they can and will care for patients of both sexes. Administrators know, for example, that shooting down male patient requests for same sex caregiving teams is a slam dunk win every time (legally), but rejecting female requests is still hit and miss with the courts. Safe bet... hire women. Women will take care of women and girls. Women will take care of men and boys. No potentially lost lawsuit. A male nurse can be great...but he may not be permitted to serve a female patient somtimes.

As patient modesty consideration is ramped up to accommoding female patients, male patients necessarily lose ground proportionate to that which is gained by females.

Same gender teams should either be allowed or not allowed.

If they are allowed, then they should be allowed for everyone, equally -- men, boys, girls and women. If they can only be allowed for women, then they should not be allowed because that then serves to unlevel the job applicant playing field in favor of applicants that happen to be female. While certainly no administrator will come righ tout and admit that (for fear of discrimination lawsuit), he/she will have little trouble falsely justifying the female hires on general "qualification" terms.

I just want the darn nurses and doctors to begin this shift in thinking simply by beginning to throw a blanket over the boys and men as they lay there exposed and embarrased -- the same way they instinctively do for patients that happen to be girls and women.

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I agree with you tbrd450....that if this is extended to women it should absolutely be extended to men. The examples that I stated are what I can find at this time, and hopefully the beginning of a patient centered trend and not just a female oriented preference. Quite frankly, I wouldn't be happy/comfortable until everyone gets the care they deserve.

This is why it is so hard to advocate for men. (It's even tougher as a woman advocating for men.) People just do not seem to realize how under served men are in heathcare. Trust me though...it is not a message I'm easily letting go.

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Specializes in OR, Nursing Professional Development.

You oversimplify things when you say that more men need to be hired and that women are hired for being women. Traditionally, nursing has been a female dominated field, and for the most part it continues to be that way. I graduated in a class of 50. Only three were men. The class that graduated before mine had 60ish, but only 2 men. When the majority of applicants are female, the majority of hires are going to be female. Plus it seems that the men in nursing tend to gravitate toward certain specialties, such as ER, ICU, prehospital.

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Reading these additonal posts- here are two solutions that I would be happy with (as a patient).

1. A same gender advocate/ liason, perhaps a social worker. Really someone that would fight to make sure I was treated properly, and would tell me if there was anything wrong. This person would "police" each OR room, hired by an outside source. Yes, I know that we are professionals, but each profession needs checks and balance to KEEP you on the straight and narrow.

2. Some sort of video monitoring of the staff, again so you could be certain nothing bad was going on, and would keep staff from taking short cuts. I know they are doing this in the ICU where I live. They are video monitoring the patient room and techs in another city are "watching" to make sure the patient isn't trying to get OOB, staff washes their hands etc... I originally hated this idea(still do really) I guess I have no trust that these videos will remain confidential. A central station would be watching every surgery to ensure patients rights were maintained.

I think most people would agree that the quality of healthcare has declined over the years. I wish I could trust our profession to be 100% caring and appropriate, but it doesn't hurt to make SURE it remains so. (and yes, I would be offended if these interventions took place where I work, but it is about the patients comfort level not about me.)

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Scrubby -- I asked you to give me a reasoned, rational argument and you did. You make

some good points. And I'm not challenging that. You presented your position well. I want

to make clear that personally I would never require same gender OR for myself. At heart

I trust all of you, despite some of the horror stories you read. It's good to hear on this

thread your concern for your patients' modesty. But I will advocate for those whntalo have

other values and I will not use the word ridiculous to describe their position. We haven 't

back to the suggestion of an experimental hospital where this is tried. My contention is that

that there are enough potential clients for this choice to not only make it work, but turn

it into a money maker. I think we're talking about a small but significant number of patients

who would choose this option. Also, I'm very concerned with gender discrimination, and I agree

with the argument posted here that to allow same gender choice and OR options for one

gender would be considered illegal if someone wished to really push it and take it to court. Men

have just as many rights as do women, and there are case studies under the BFOP laws that demonstrate this. However, I dont' like to use the courts to solve these kinds of issues. I would rather see the healthcare community recognize the inequality and work to make it equal.

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