Patient modesty concerns pertaining to surgery - page 9

by creinkent

76,633 Unique Views | 222 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


  1. 3
    I'd love to hear a good reason for NOT having patients wear incontinence pads/briefs. Many patients are told they can't wear their own clothing due to 'sterile' issues ... but this is total BS.

    How can having a patient lying in their own excrement NOT be a problem with infection control/sterile field?? I just can't seem to get a valid explanation from anyone on this.

    If it is something nearly EVERYONE complains about (being naked) and there is NO valid reason for it (which we have established) ... then WHY keep doing it this way???

    Another thing I haven't managed to get a doctor to give a good explanation of is surgical prep/shaving. This was once thought to be also about cleanliness & infection control, but many studies have been done that show not only does NOT shaving have no detrimental effect ... but shaving DOES have a detrimental effect by causing microabrasions of the skin that harbor bacteria/germs & weaken our natural skin barrier to such things.

    I have found that if a patient is well-versed in this research AND they confront the surgeon about it -- they have a chance of keeping most of the hair in the area. I think this is a BIG deal for many procedures. I know some local providers were irritated when I started telling male patients that they did NOT need to be shaved for various things involving their private areas. Certainly the actual exact incision site may need hair removed so that the surgeon can work in the area without having hair in the way, but it ends up being a MUCH smaller area and often the hair only needs to be really trimmed (not shaved or totally removed). This is a BIG deal. I think any doctor that requires someone to shave their privates for surgery should be required to have it done to them.

    How stupid is it to cause itching & irritation exactly in and around the area that needs to heal?!?

    It seems yet another case of 'that's they way we do things, and who are YOU to ask us why'
    carolinapooh, mh356, and morte like this.
  2. 0
    Quote from Cul2
    but I left out the incontinence bit, or the fact that there may be 10 people in the room as the cleaning process occurs."

    canoehead -- Please, give me a good reason, a good medical reason why 10 people need to be in the room while this is happening. Please describe the specific role each of the 10 people have in the specific surgery and why they are essential and need to be in the room. Thanks.
    that isnt the way i took this post. I think the point was that those persons would be in the room, doing whatever, not that they would be involved with the clean up, BUT would be within "seeing" range.
  3. 0
    Quote from morte
    that isnt the way i took this post. I think the point was that those persons would be in the room, doing whatever, not that they would be involved with the clean up, BUT would be within "seeing" range.
    Yes, that's what I meant, but the minimum of personnel in the OR is five. Scrub nurse, circulating nurse, anesthesia, surgeon, surgeon's assistant...so more than five is definitely possible, especially if they are turning and cleaning and getting lifting help.
  4. 4
    Quote from slineb
    ok ... so if the entire valid reasoning we can come up with for being totally naked during surgery is due to incontinence issues & the need to possibly remove due to emergency - why can't the patient be offered the ability to wear some incontinence briefs?

    personally i would much prefer the coverage & there would be no reason for anyone to touch these unless an emergency occurred. i would be perfectly happy to be left in 'soiled' status until i am fully awake & can change myself.

    depending on the surgery, that could mean you'd be lying in feces/urine for many hours. that isn't good from an infection control standpoint. it also isn't good for your skin. not to mention the odor for the surgical team to have to contend with.

    most full incontinence briefs have 'quick release' tabs on the sides like diapers that would allow easy access if a cath or emergency need would occur.

    also for catheters, i just do not understand why most are so quick to place these.

    one reason is that urinary output is a way to gauge hydration and other dynamics. you can't measure the volume of that output or assess for character of the urine in a brief. other reasons are infection control and protecting the skin integrity of the patient.

    some on this site and others say that patients should 'trust their nurses or doctors' and i say, 'why would i?' i don't know you, and you don't know me ... there are good & bad people everywhere, there are considerate people & those who are just trying to get through the day. 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.

    also, i have mentioned before to many friends who are nurses (i was a cna while attending college, but chose to go into the computer field) why exactly can many of these patients not place the cath. themselves? there are plenty of people with continence issues that do this all the time with no problem, we learn to do it in a very short time, so why not show them how to do it themselves?

    serioiusly? this is a sterile procedure. it takes time to learn to do it correctly. i have a relative who straight caths himself but he has almost no feeling below the waist. even with lots of practice and great attention to cleanliness, he has utis.

    if i were going in for surgery, i would happily place my own before allowing anyone else to do it. i just don't see what the need is to touch people in private areas unless absolutely necessary. certainly if they are seriously injured or such, but then all effort should be made to provide for their modesty.

    you might be willing to cath yourself, but i don't think that would be the usual reaction.

    i got out of that work specifically because i couldn't get over seeing people treated in ways that were not right. just because a man or woman is unconscious doesn't mean that they don't care who touches them or sees them. in fact, i think for many it matters more when you are helpless (to me as well).
    and for those of us that did make any noise about it, we just got a lot of problems heaped upon us and nothing was done to stop the behavior.

    i'm sure there are occasional exceptions, but speaking as someone who has 16 years of nursing experience and 17 years experience as an emt, heath care professionals, as a rule, respect their patients and don't view their vulnerability in an exploitative fashion. 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.

    it all comes down to what is best for patient. it should not be about what is easiest or fastest for the or staff or er staff or any staff. why is it that some nurses can place ekg leads in mere seconds perfectly without ever exposing me at all, and others ***** & complain like it's totally impossible to do without showing everything to everyone.

    once i know it can be done the right way, why would i allow someone to do it otherwise?

    anyway, that's why i am a former cna who prays daily to never have to have emergency intervention of any kind.

    seems like that was a good decision.
    some of your suggestions might give you comfort, but they also have the potential to cause other problems. as in most matters, the trick is to find a good balance.
    RetRN77, carolinapooh, Rose_Queen, and 1 other like this.
  5. 0
    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??
  6. 2
    Quote from slineb
    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.
    LovedRN and SandraCVRN like this.
  7. 4
    >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?
    mds1, canoehead, advo-kate2, and 1 other like this.
  8. 1
    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.
    RetRN77 likes this.
  9. 1
    Quote from advo-kate2
    It would be helpful if one single thread was created just for such discussion.
    I thought this was it....

    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.
    canoehead likes this.
  10. 2
    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.
    RetRN77 and dishes like this.


Top