Patient modesty concerns pertaining to surgery - page 4

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   ~Mi Vida Loca~RN
    Quote from dudette10
    I'm a student, so we do the bed baths during clinicals. My biggest pet peeve is when other non-nursing members of the team come in during a bed bath and just stand there, waiting for me to finish. Not all of them do that, but enough do that I wanna scream! I know they are on a schedule, so I try to find a good stopping point (even if I'm not finished) telling them, "Give me two minutes to get her ready for you".

    The WORST encounter was a dietary volunteer who came in while the patient was undraped from the neck to the waist. (BTW, I'm not a fan of the "totally naked" bed bath for modesty and temperature reasons.) She just started talking to the patient, saying "I need to get these done in the next hour. Can I read this to you, and you can tell me what you want?"

    My patient had her breasts out for all the world to see when this conversation was initiated! I used a towel to drape her while the dietary volunteer finished. But, I was annoyed!

    That is when you tell them you will be done in about 15 mins (or however long)and you would be more then happy to let them know if you get done sooner and make it apparent that is their que to leave. We have done that before when OT/PT/Dietary/Social or whoever else has come in.
  2. by   Cul2
    Someone who had an eye operation, recently asked me why they had to be completely naked under the gown. She was out completely for the operation. She asked if she could wear her loose briefs and they said no. She said it would make her feel more comfortable. They said no. They gave no reason. What's the medical reason for their response?
    Don't tell me it's because of a sterile environment. Her whole body wasn't sterile. Her hair probably had more germs in it than a pair of briefs. Give me a medical reason.
    Don't tell me it was in case they had to get to femoral artory. How difficult would that be. I think we can readily assume they have sharp things in the OR, sharp enough to cut through some briefs in a second.
    Give me a medical reason for their answer to her -- not, "This is policy," or "To prevent infection," or "In case of emergencies." Give me a specific medical, scientific reason that doesn't involve routine or the convenience of the OR team.
  3. by   brownbook
    I'm no expert but I think you covered the topic well, there is no good reason. I can only think the surgeon or nurse has obsessive compulsive disorder and it has to be done their way. I tell the patients that IF an emergency arises their briefs would be cut off. No patient has chosen their briefs over their modesty/comfort. In nursing school our instructor told about seeing a child getting ready for OR. He was screaming "I don't want my underpants off," as staff fought with him. She said just take the poor child to OR, you can remove his underpants after he is sedated!
  4. by   Cul2
    Thank you, brownbook, for your thoughtful response. I beleive most, I say most, not all -- most patients are reasonable. That's why I posed my question the way I did? Give me medical, scientific reasons. What's the best practice and why? What have studies shown? Do people who wear their underwear for certain operations (eye, ear, nose, hand, finger, etc.) die at specifically higher rates because they are wearing their underwear? If so, by all means, explain that to them and requre the best practice. Most people respect the science of medicine and want the best treatment that science can provide.
    The case you give of the screaming child brings up a few issues. First, how absolutely necessary was it for him to have his underwear off? If it was essential, then be honest and communicate with the child honestly. I'm sure most caregivers would never treat a child like that. It was an anomoly. But still, that child was probably traumatized.
    But I would caution medical professionals -- be careful of your secrets. In the case you describe, if you're going to take his briefs off when he's out, tell him. Don't let him find out that you did it secretly. This idea that once the patient is "out," the patient doesn't really care -- that is not the case with all people. Frankly, some people just don't want to know. But they'll tell you that if you ask them. Others do want to know. They may have false assumptions about what will happen. Describe what will happen and why. But don't tell people one thing and then do another with the thought that once they're out it really won't matter. Now, I don't think this happens most of the time. But I've heard enough accounts from people, people whose opinions I trust, to realize that all too often, things happen in the OR that the patient wouldn't have approved -- unexpected "visitors," perhaps a student, a tech, or even an equipment salesman; being left too exposed in the recovery or the ICU after surgery; hearing shop talk during a procedure, talk they weren't supposed to hear, talk that upset them. When these kinds of things happen, people lose trust in the system.
    And, frankly, I'm not asking a rhetorical question. I want to know the medical reason for the question I posed. I'm open to what I may not know. If there are medical reasons, someone explain.
  5. by   canoehead
    Quote from Cul2
    Someone who had an eye operation, recently asked me why they had to be completely naked under the gown. She was out completely for the operation. She asked if she could wear her loose briefs and they said no. She said it would make her feel more comfortable. They said no. They gave no reason. What's the medical reason for their response?
    Some people urinate or defecate involuntarily when they are asleep. The staff can clean the patient, but not her underwear, and it's tasteless to give her back soiled drawers (and embarrassing for her). There is also the issue of keeping track of personal belongings. That's why they take off all jewellery, including wedding bands. The OR staff don't want the responsibility or aggravation passing off clothing etc.
  6. by   Cul2
    canoehead -- Now that's a reasonable answer. I've little concern with the OR's
    "aggrivation" or their concern for responsibility over personal property. How valuable
    can a pair of underwear be? And the OR's aggrivatrion should come second to the
    patients feelings and values. But some questions do arise. How often does this urination
    or defication happen during short surgeries? 10% 20% of the time? More often? What are
    the odds? And why aren't patients who ask to wear something under their gowns told
    this information? Perhaps concern for their feelings? Could be. What if a patient told you
    "Oh, if I do that go ahead and clean me up and just throw the underwear away." How would
    the OR feel about that?
  7. by   canoehead
    I have no idea how often, I don't work in the OR. But I do know when getting patients ready for surgery, the people that really mind having their underwear off throw a complete fit when they think they might pee on themselves, and have strangers clean them up. I completely understand why they'd find that hard to take, and being stressed already, it seems kinder to say "I know, it's a stupid rule, but that's what they want. You'll be totally covered except the body parts they have to deal with." That statement is a bit of a fudge, but gee, if they were told everything I know about surgeries, exposure, and who is in the room they'd cancel outright, and remember, they'd still be sick and have to do it later anyway.
  8. by   P-medic2RN
    when i was in the a.f. working pacu we received one of the o.r. tech's post-op with all kinds of sweet drawings all over her body. the o.r. crew liked to take care of their own. we had 23 o.r.'s and they did about 120-150 surgeries a day.
  9. by   morte
    Quote from canoehead
    I have no idea how often, I don't work in the OR. But I do know when getting patients ready for surgery, the people that really mind having their underwear off throw a complete fit when they think they might pee on themselves, and have strangers clean them up. I completely understand why they'd find that hard to take, and being stressed already, it seems kinder to say "I know, it's a stupid rule, but that's what they want. You'll be totally covered except the body parts they have to deal with." That statement is a bit of a fudge, but gee, if they were told everything I know about surgeries, exposure, and who is in the room they'd cancel outright, and remember, they'd still be sick and have to do it later anyway.
    but if you purposefully omit facts, you dont have informed consent...
  10. by   canoehead
    Quote from morte
    but if you purposefully omit facts, you dont have informed consent...
    Yes,you are right.

    Luckily the physician is responsible for getting the consent. I just verify the signature belongs to the right patient.

    There are lots things that are not mentioned when patients go for surgery. Imagine if every nurse took it upon themselves to list off about five to every patient in the name of "informed consent." You know that once a couple surgeries got cancelled the hammer would come down to keep your mouth shut or lose your job. There wouldn't be any thought that gee...the patients should have been told, or practice should change. I work in reality, not legal utopia.
  11. by   GadgetRN71
    Quote from canoehead
    Some people urinate or defecate involuntarily when they are asleep. The staff can clean the patient, but not her underwear, and it's tasteless to give her back soiled drawers (and embarrassing for her). There is also the issue of keeping track of personal belongings. That's why they take off all jewellery, including wedding bands. The OR staff don't want the responsibility or aggravation passing off clothing etc.
    Also, there is no such thing as minor surgery-you say this to people, but they look at you like you're nuts. However, we have had people booked for what seems like a simple operation, then something happens and 3,4,5 hours later, you're still working on that patient. Also, many times the patient needs a foley, now you are trying to take underpants off of an unconscious patient. Not so bad on someone small, a real PITA when the patient is obese.

    Actually, a good percentage of people soil themselves to some extent in surgery..this week seemed to be particularly bad for that. I cleaned up more Code Browns and Code Yellows...
  12. by   GadgetRN71
    Quote from P-medic2RN
    when i was in the a.f. working pacu we received one of the o.r. tech's post-op with all kinds of sweet drawings all over her body. the o.r. crew liked to take care of their own. we had 23 o.r.'s and they did about 120-150 surgeries a day.
    Ha..one of our male techs had surgery and someone painted his toenails while he was out..he cracked up when he came to.
  13. by   dudette10
    When I first read Cul2's question about a friend being naked for eye surgery, I thought, "I don't know anyone who isn't naked under a gown for surgery," then I remembered what type of surgery doesn't even make you gown up!

    It's dental surgery under general anesthesia.

    So, it does make one wonder about that practice if general anesthesia always makes you run the risk of defecation or urination while under.

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