Patient modesty concerns pertaining to surgery - page 9

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. Visit  Intern67 profile page
    0
    Quote from Cul2
    "The whole idea of same gender teams is absolutely ridiculous."

    I wouldn't use the word "ridiculous." That's a value judgment based
    as much on emotion as anything else.
    If the shoe fits...

    It could be a value judgement based on reason and evidence more than it is on emotion.
  2. Visit  Cul2 profile page
    0
    "If the shoe fits...It could be a value judgement based on reason and evidence more than it is on emotion."

    Okay -- then use reason and evidence to back up your statement? Let's hear your case.
    It's easy to say something is ridiculous. Anybody can do that. It's more difficult to
    quantify that statement. All we have to do is look around the world to see various
    customs and beliefs so different from ours. We can say some of them may not
    recognize human rights or the dignity of the human being. We could base that on
    the philosophic foundations upon which our Declaration of Independence and
    Constitution rest. But to say these customs and traditions are "ridiculous" without
    using our brains to reason it out, that's obtuse arrogance.

    So, go for it. Reason out why your position is a valid and those of posters who
    think people's right to preserve their modesty as they see fit is unreasonable.
  3. Visit  SandraCVRN profile page
    1
    Quote from slineb
    >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?
    I have NEVER been anywere that a pt was left in the OR unattended. PERIOD

    Draping and prepping are 2 different things. You can't change a gown for a drape and still have a sterile field. If I am prepping an abdomen for a Lap Chole for instance. The gown is pulled up to the nipple line and the blanket down to right across the groin. The abd is then prepped and covered with the sterile drapes. You HAVE to prep out a little farther than the actual opening in the drape. There are landmarks the surgeon must be able to see.
    Last edit by SandraCVRN on Jun 5, '10
    RetRN77 likes this.
  4. Visit  Scrubby profile page
    3
    Quote from Cul2
    "If the shoe fits...It could be a value judgement based on reason and evidence more than it is on emotion."

    Okay -- then use reason and evidence to back up your statement? Let's hear your case.
    It's easy to say something is ridiculous. Anybody can do that. It's more difficult to
    quantify that statement. All we have to do is look around the world to see various
    customs and beliefs so different from ours. We can say some of them may not
    recognize human rights or the dignity of the human being. We could base that on
    the philosophic foundations upon which our Declaration of Independence and
    Constitution rest. But to say these customs and traditions are "ridiculous" without
    using our brains to reason it out, that's obtuse arrogance.

    So, go for it. Reason out why your position is a valid and those of posters who
    think people's right to preserve their modesty as they see fit is unreasonable.
    I find it ridiculous because you cannot staff according to gender in a nursing speciality that is struggling to provide adequate skill mix as it is. For example someone who is requesting for an male team had better go to another hospital considering we have a shortage of male RN's in my workplace.

    Anyone undergoing an orthopaedic procedure who wants an all female surgical team better travel to another state because we don't have female orthopaedic consultants in my hospital. And it's the same with our hepatobiliary surgeons-all of them are male so if you require a liver resection then you simply have no option but to have a male surgeon unless you want to travel or interstate. Unless you want the only female registrar in the clinic who takes 4 hours just to do a lap chole doing the operating all by themselves in which your putting yourself at HUGE risk of bleeding and probably death.

    So the fact is the ratio's don't add up. More female nurses than male nurses, more male surgeons to female surgeons.

    And quite frankly it's a PUBLIC hospital which means that the government is subsidising everything-this is Australia not the US so I don't know how it works over there. Patients in the public system don't even have a choice of surgeon, let alone the operating room team. If some patients get to dictate who they get it's not fair on all the other patients. If it's a private patient then they do get a certain level of choice for their surgeon but it still comes down to skill mix and staffing.

    As for modesty I never said that people don't have the right to modesty, they just need to understand that their ideas will not work. Modesty is of paramount importance to all of us who work in the operating room, we have ACORN standards that address this very issue and we strive very hard to maintain patient dignity. If a patient tells me they are embarrassed etc then I discreetly let everyone in the team know so we're all aware of the issue. Modesty is something I take very seriously. I just don't believe that the idea of having all gender teams is viable at all and yes even ridiculous given our staffing issues. IF we had equal ratio's of male-female staff then it could possibly be arranged but this isn't going to happen anytime soon.

    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.

    I ask the people who want this ridiculous option who would you prefer? The top person in the field who happens to be of opposite gender? Or the same gender who isn't as good as their male colleague?
  5. Visit  Rose_Queen profile page
    2
    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.
    Scrubby and SandraCVRN like this.
  6. Visit  advo-kate2 profile page
    0
    "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.
  7. Visit  Scrubby profile page
    1
    Quote from advo-kate2
    "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.
    GadgetRN71 likes this.
  8. Visit  advo-kate2 profile page
    0
    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.
  9. Visit  carolinapooh profile page
    2
    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.
    GadgetRN71 and Scrubby like this.
  10. Visit  carolinapooh profile page
    1
    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.
    GadgetRN71 likes this.
  11. Visit  advo-kate2 profile page
    0
    "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.
  12. Visit  tbrd450 profile page
    3
    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.
    advo-kate2, Scrubby, and morte like this.
  13. Visit  advo-kate2 profile page
    0
    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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