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"?

Ok, infants can sit in a soiled diaper for quite a while before anything horrible develops. Is it ideal? No, but their skin integrity isn't horribly sacrificed.

It should be left up to the patient to decide how to handle this.

As for this horrific smell, if this spontaneous defecation happens during surgery all the time (as said by some) - everyone in the OR should be used to it by now.

I certainly realize catheters are valid when output must be monitored, but for 'skin integrity'? really? Isn't this again just a matter of time? If I am gonna be in surgery for 3 hours, I am FINE with being left that way for 3-5 hours until I am fully able to take care of my own problem.

>>Why should I just blindly trust that I got all 'good ones' on my team that day? It >>seems to me that it makes a LOT more sense to hope for the best ... but to >>PREPARE for the WORST.

>'And yet you are trusting these same people to cut you open and manipulate >your organs. '

You state this as if I would have a CHOICE!

An unconscious/sedated person is at the mercy of EVERY person around them. From the MOMENT they doze off until they are FULLY aware.

Shifts change, schedules change ... all without any real consideration of patients.

Sure the 'continuation of care' is considered, but that is done as if every doctor/nurse/tech is interchangeable with one another. Maybe that is true about their technical ability (though we all know it isn't), but it certainly is NOT TRUE in the eyes of the patient who lost consciousness with one set of people handling them, and wakes with a whole different set.

You as well as I know that although a patient may have agreed to a surgery with a specific surgeon, that that may (or MAY NOT) be the actual surgeon performing the operation. Now, just consider what was just said. BEFORE we even consider who ELSE is in the room. The TRUST of the patient has ALREADY been violated by the ONE person they trusted MOST for this surgery.

Now, enter multiple other people in the OR that the patient likely has never and WILL never meet (or at least not consciously).

So now we have the trust violated BEFORE the surgery even begins, but the patient has NO idea since they are unconscious. Now, you want anyone to 'just trust' that anything that happens or whoever enters or leaves is for the best of the patient??

How exactly do you KNOW when liars are LYING and when they are telling the TRUTH?

The 'surgeon' that the patient expected comes to them and/or the family afterwards and tells them 'everything went just fine, no problems at all' ... to perpetuate the lie that he/she performed the surgery.

Often this 'switch out' is never even correctly documented, since that original surgeon was the 'overseer' or 'directed' the surgery (meaning he called in to check on it, or stopped by for a few minutes during). So the patient now has NO IDEA that they were operated on by a totally DIFFERENT PERSON!

How can anyone trust a system that would allow this to happen??

0 Votes
Specializes in Emergency Dept. Trauma. Pediatrics.
Ok, infants can sit in a soiled diaper for quite a while before anything horrible develops. Is it ideal? No, but their skin integrity isn't horribly sacrificed.

It should be left up to the patient to decide how to handle this.

As for this horrific smell, if this spontaneous defecation happens during surgery all the time (as said by some) - everyone in the OR should be used to it by now.

I certainly realize catheters are valid when output must be monitored, but for 'skin integrity'? really? Isn't this again just a matter of time? If I am gonna be in surgery for 3 hours, I am FINE with being left that way for 3-5 hours until I am fully able to take care of my own problem.

>>Why should I just blindly trust that I got all 'good ones' on my team that day? It >>seems to me that it makes a LOT more sense to hope for the best ... but to >>PREPARE for the WORST.

>'And yet you are trusting these same people to cut you open and manipulate >your organs. '

You state this as if I would have a CHOICE!

An unconscious/sedated person is at the mercy of EVERY person around them. From the MOMENT they doze off until they are FULLY aware.

Shifts change, schedules change ... all without any real consideration of patients.

Sure the 'continuation of care' is considered, but that is done as if every doctor/nurse/tech is interchangeable with one another. Maybe that is true about their technical ability (though we all know it isn't), but it certainly is NOT TRUE in the eyes of the patient who lost consciousness with one set of people handling them, and wakes with a whole different set.

You as well as I know that although a patient may have agreed to a surgery with a specific surgeon, that that may (or MAY NOT) be the actual surgeon performing the operation. Now, just consider what was just said. BEFORE we even consider who ELSE is in the room. The TRUST of the patient has ALREADY been violated by the ONE person they trusted MOST for this surgery.

Now, enter multiple other people in the OR that the patient likely has never and WILL never meet (or at least not consciously).

So now we have the trust violated BEFORE the surgery even begins, but the patient has NO idea since they are unconscious. Now, you want anyone to 'just trust' that anything that happens or whoever enters or leaves is for the best of the patient??

How exactly do you KNOW when liars are LYING and when they are telling the TRUTH?

The 'surgeon' that the patient expected comes to them and/or the family afterwards and tells them 'everything went just fine, no problems at all' ... to perpetuate the lie that he/she performed the surgery.

Often this 'switch out' is never even correctly documented, since that original surgeon was the 'overseer' or 'directed' the surgery (meaning he called in to check on it, or stopped by for a few minutes during). So the patient now has NO IDEA that they were operated on by a totally DIFFERENT PERSON!

How can anyone trust a system that would allow this to happen??

As a patient that has had many surgeries, is extremely modest, was horrified when I realized I was naked in the surgery room, that said, please don't leave me sitting in my feces or urine for hours, I have managed to never get a UTI and I would like to keep it that way. I also do not want to sit in a puddle of urine. I would rather have someone clean me up, I just would rather not know about it. I also DO NOT want to cath myself. The thought makes me cringe. Sure I don't like getting caths either but I will not want to do it to myself.

Lastly, bad things happen, it's a fact, it will always be that way. I don't think this is the norm though and if you were to have someone crossing lines, you would have to have an entire room going along with it which I think is a very slim possibility. In fact, I think I would feel safer with multiple people in the room than just 1 or 2. That way there are people watching over me and looking out for me. I would be willing to bet that the ratios of people crossing lines to how many surgeries are preformed is pretty small.

0 Votes

>It would appear that you see any exposure that isn't precipitated by a dire >emergency as "not right." I've been on both sides of this equation and I >understand that there are ways to be respectful even while seeing the patient >temporarily unclothed (like when they're being draped). And I understand that >modesty matters . . . to a point.

That is NOT AT ALL what I am saying, I am saying that exposure that is not MEDICALLY NECESSARY is 'not right'. I do NOT care about how 'respectful' those '10 others' in the room are, when there is NO REASON for them to see the patient 'unclothed' other than CONVENIENCE.

I have seen multiple unconscious patients have EVERYTHING removed and THEN it is noticed that 'oh, we need to go and get something from another room. Yep, they are working on 'draping the patient' ... the fact that it took 10 minutes from the time the patient was totally unconvered to the time anyone even STARTED draping ANYTHING ... apparently no big deal.

Now I say this as a hardware technician that was 'in the room' for a technical issue with a piece of electronics. I was there because it was a convenient time between 'actual surgery in progress' to get the phone system working correctly. I was more than once the ONLY person in the room with a naked unconscious patient ... sure it was only moments while others were in and out ... but GEEZ how is this okay???

I didn't know these patients, and I had NO BUSINESS seeing them. Was I respectful? Sure. Was I shocked and horrified at the treatment of these patients? YES!!! Did I say anything? Once I asked one of the busy people if they shouldn't 'cover that poor lady up' and she actually said 'it's okay, she's out' (like the fact that the patient was unconscious meant that it was OK to leave her lying there naked). I also told my supervisor about it, and he said 'happens all the time, you'll get used to it'.

So when you say 'like when they're being draped' ... I read this as 'like whenever it is convenient for the staff'. (Is this because I am hostile or think every nurse/doctor/tech is evil or even inconsiderate?!? Hell no, it is because I KNOW it happens ... I've SEEN it happen. Others have SEEN it happen. And yet, if a patient asks about such issues happening, they are spoken to as if all of these occurances are just figments of sordid imaginations.

We've got 'linearthinker' stating 'I had surgery at my hosp a few years ago and received merciless teasing about my tattoo from coworkers who should not have been in position to see it or know about it. ;-) '

And it appears that everyone is just OK with the FACT that this happened (because it is so COMMONPLACE).

So now I ask, why would ANYONE in their right mind trust that everyone in that room is doing what was best for the patient??? Sure, you tell me that you are respectful of seeing patients unclothed. Well, what about a tech that makes comments to his buddies later? Am I okay with the fact that this person saw me, and was outwardly respectful but has gotten an eyeful of things he had NO REASON to see? Are you okay with that being your well-endowed 15 year old daughter on the table?

So what I am asking is when you say

'>modesty matters . . . to a point. '

What point are you speaking of?

The point at which it inconveniences the medical personnel?

Cause I would agree that my 'point' is that it MATTERS unless there is a damned good reason why it shouldn't. Is it an emergency? Maybe, but modesty STILL matters even then. If I am having an asthma attack, it's likely an emergency. Does anyone then have a legitimate reason to yank off all my clothes? Hell NO!

If you are ever wondering ... is it OK to uncover this part of the patient?

The question literally should be if 'I keep it covered will it cause some medical problem'? If the answer is no, then the answer is NO!

When draping a patient, how hard is it to leave the gown on until the drape is already there??? I've seen it done. There was one nurse who was also a nun ... she was the model for what I would want in any caregiver. She would roll up the folded drape starting at the patients feet, and then as she got to the area of the gown (which was still in place) she would roll the drape over the gown 1 fold(about 6-8 inches), and the pull the gown out from under the drape and fold it up. I don't think she ever saw anything of a patient other than head, arms & legs. So how come she can manage this but others can't? Sure, some might say that it takes more time ... but I'd happily fork out another $500-1000 or even more for greater consideration in these matters.

Anyway, why would I accept any less consideration for my modesty when I KNOW that it CAN be done right?

0 Votes

It's great that there is still an open dialog here between potential patients and caregivers. Personally, I'm not going to ask for specifics on care. My distress would be that subjects such as these are coming up more and more and discussed less and less. The main worry would be that people are AVOIDING care due to these subjects, and that should be a viable medical concern.

It would be helpful if one single thread was created just for such discussion.

0 Votes
Specializes in LTC, assisted living, med-surg, psych.

It would be helpful if one single thread was created just for such discussion.

I thought this was it....:confused:

Seriously---let's please stay on topic here, folks. This isn't the place for discussions about changes in surgical teams or speculation about what else goes on during surgeries, it's a debate about modesty issues. Thank you.

0 Votes
Specializes in ER.

SLINEB

I agree with you that naked or even partially clothed patients should not be exposed to anyone but the medical team caring for them. If you chose to report that behavior I'd like to think the whole team would be reprimanded.

0 Votes
Specializes in I have watched actors portray nurses.

Is the real key in all this .. "necessity?"

What is medically necessary, not what is medically convenient. It ultimately becomes, I think, a weighing or balancing of patient modesty with medical necessity. The problem seems to come in when we try to define "necessity." It seems to be defined on a subjective scale that includes two endpoints: Total patient modesty/dignity respect/consideration at one end and clear, indisputable medical necessity at the other end. In between lies things like staff efficiency, low risk precautions, and even simple workday convenience. Ultimately, given the situation, medical necessaity will (and probably should) rule the day.

One person's most horrifying, embarassing nudity exposure imaginable is for someone else just a mildly awkward and discomforting experience soon forgotten.

I happen to believe that inconsiderate, insensitive and sometimes downright inappropriate things are sometimes done (in surgery, in medical settings, etc.) when it comes to patient modesty consideration. However, I also believe it is far more uncommon than common. I also don't think it will ever be completely eliminated.

0 Votes

"i thought this was it....:confused:

seriously---let's please stay on topic here, folks. this isn't the place for discussions about changes in surgical teams or speculation about what else goes on during surgeries, it's a debate about modesty issues. thank you. "

the title of the thread is "patient modesty concerns pertaining to surgery "

when discussing these types of issues, potential patients are going to want to get technical. they will want to find out attitudes caregivers have regarding protection of their modesty during shifts change, unknown staff who may come in, and how to mitigate situations that may help in comfortably giving up that modesty.

if it is indeed a place to discuss and try to solve all types of patient modesty issues, then i was mistaken about it's general intent.

thanx for the clarification.

potential patients these days are avoiding the care they need due to these issues which many here consider part of daily tasks, but others consider insurmountable obstacles. this is indeed the new health crisis that i would like to believe caregivers are concerned about and would like to help solve.

1 Votes
Specializes in Education, FP, LNC, Forensics, ED, OB.
I was mistaken about it's general intent.

Thanx for the clarification.

Thank you for your understanding.

0 Votes

I do not think that the modesty discussion will ever be debated to it's fullest extent. There are women (we know this) who do not want a strange male doing intimate medical proceedures. There are men (we know this too) who do not want strange women doing intimate medical proceedures. There are lots of reasons for modesty that goes with that person's body and mind. Moral? Ethical? Religious? Marital beliefs? All things that make a person want to protect thier nudity from strangers.

Would it really be offensive to the nursing arena to mandate staff be available for same gender care? I just do not see why this issue is so hidden.

"One person's most horrifying, embarassing nudity exposure imaginable is for someone else just a mildly awkward and discomforting experience soon forgotten."

And so this is part of the problem: many do not "get over" horrifying, embarassing nudity exposure issues. They stop seeking care. If for no other reason than this, the medical community should start considering this as a dangerous precedent that needs mitigation and resolution.

0 Votes
Specializes in Education, FP, LNC, Forensics, ED, OB.
I do not think that the modesty discussion will ever be debated to it's fullest extent.

Would it really be offensive to the nursing arena to mandate staff be available for same gender care? I just do not see why this issue is so hidden.

This issue, you are correct, will never reach a conclusion. Modesty issues will always be something that can be improved.

Nurses here are discussing this. And, that is a 1st step. Personally, here at allnurses.com, I see that this issue is not "hidden". Members have expressed concerns as well as participated in discussions to try and find an end-result solution.

the medical community should start considering this as a dangerous precedent that needs mitigation and resolution.

These issues are being discussed here and that is a 1st step.

0 Votes

Fair enough! Discussions such as these are certainly appreciated.

I would guess step #2 would be a question regarding opinions ( if allowed) as to the actuality of facilities ever reaching easily available staffing for those reqiring same gender intimate care. Difficult in some situations, but perhaps not impossible. Would help mitigate modesty circumstances and allow potential patients to once again seek the care they need.

** After much debate..does anyone really consider this a viable option?

Advocates would like to work with caregivers: not frustrate and offend them. It is not our (most of us) goal to disrespect any caregiver and their effort toward dignified care. They would also not like to keep seeking a solution that wastes more time than it does opening pathways.

0 Votes
+ Add a Comment