Admissions and Privacy

classicdame, MSN, EdD · May 11, 2011

Remember, the JC allows 24 hours for the admission info to be completed. You might have to get some answers by asking people to leave while you "clean her up or help to the bathroom" and then ask questions. You are right, it is difficult at best

steelcityrn, RN · May 11, 2011

If that is your facilities policy to ask all of those questions, then so be it. I usually say something like " I know there are alot of questions here for you to answer, do you want family in to help, keep in mid some may be personal"? Usually this is answered " I have no secrets ", or " my life isn't exciting.....Then I plow through them. If they are too weak to answer them all, and they have no one there, its "unable to answer at this time r/t decline in condition".

somedaypeds · May 11, 2011

I blundered a bit and asked about menstrual history in front of the parents--in the future, I think we can wait until a female nurse is available to ask about that. And I didn't ask at all about sexual activity. Again, it could wait for a female, but we do need to know, because of the meds we're likely to give.

I disagree with waiting for a female nurse to broach these subjects. You are THE nurse - don't pawn it off on your coworkers because you are male. I would be upset about that if we worked together.

systoly · May 11, 2011

I agree with samedaypeds. I wouldn't have any problems asking those questions. A male OB/GYN would ask the same questions. I also doubt a modest adolescent would feel instant comfort just because the nurse was female. I think the approach weighs heavier than gender.

ChristineN, BSN, RN · May 11, 2011

I do adult nursing as well as peds/adolescent nursing. Alot of times with the teens if you make clear to them that they aren't going to get in trouble, you aren't going to yell at them, that you just need to know some important information so they can be safe while they are in the hospital. I recently had cause to believe a 15 year old post-op had a history of street drug use, that he had not confessed too on admission. I basically told the boy that I need him to be straight with me as street drugs could interact with anesthesia or post-op pain meds.

I also frequently have to ask teenage girls about periods. Normally I am not as careful about giving them privacy for their answer, but perhaps I should. And don't worry about making the girls uncomfortable by asking about their menses or sexual health. I just act matter of fact, and try not to show alarm or shock if their answers do surprise you. Also they are used to being asked about their menses at the pediatrician's, OB/GYN, etc.

Esme12, ASN, BSN, RN · May 11, 2011

I would appreciate thoughtful input on an ethic question I sometimes encounter when admitting new patients. Some of the questions are ones to which a patient might not want their families to know the answers. For example, we ask every patient whether they are being abused. Clearly, not many will answer truthfully in front of the abuser. We also ask about recreational drug use and suicidal ideation, problems with elimination, and sexual history. All appropriate questions that you might not want to talk about in front of your mom. Or spouse.
My problem is twofold. In many instances, the patient isn't able to complete his/her admission questions. Even some fairly walkie/talkie patients don't know their home meds, and I work on a neuro floor, so a lot of mine don't know their name or birthdate. Maybe 8/10 admissions couldn't be completed without a family member's help. So I sometimes have to ask whether the patient would prefer the loved one to step out for a moment, and sometimes it isn't an option since the patient can't talk. I've never had a patient ask the family to step out, but I wonder how many would, even if they did prefer it. And for a pt who can't answer, would it be more ethical just to leave the question unanswered?
The tougher call, for me, is that I sometimes admit pediatric patients. Actually, only once--most of our peds are admitted early in the day. I did ask the family to step out, because I felt we had a compelling need to know truthfully whether the kid smoked tobacco, or-especially-used illicit drugs. I blundered a bit and asked about menstrual history in front of the parents--in the future, I think we can wait until a female nurse is available to ask about that. And I didn't ask at all about sexual activity. Again, it could wait for a female, but we do need to know, because of the meds we're likely to give. But I was relieved when the kid gave the "right" answers, so I didn't have to page risk management for an opinion on what info I was obligated to share with the parents. I'm not a parent, but if I were, I would surely want to know if my child was smoking, drinking, using drugs, sexually active, and contemplating suicide. Hell, I'd want to know when they had their last BM. But I also know the kids won't admit to these things knowing we'll tell their parents.
I guess I've got some research to do in my facility's P&P. But I'm interested in other's views, too. I'm guessing in advance that there are some clear policies in place about kids, and they probably vary from state to state. Patients with altered mental status seem like a grayer area, even though I'm personally more comfortable trampling on their rights.
Maybe I should just continue with my standard disclaimer: I'm awfully sorry, but the good nurses cost extra.

All of these questions are important ones to answer......you need to check you P&P and risk management as there are certain things that cannot be revealed to the parents. Children may seek care for addictions and reproductive help and treatment without parental consent at certain ages in all states......

http://www.pamf.org/teen/sex/righttoknow.html

is an example. YOu should ask the children sometime in the first 24 hours when the parents are not present about sexual activities, drugs ect. and seek social services assistance when appropriate. As an Emergency Room nurse I have been present at many the imaculate conception birth when they just finished their peroid.....and yes the good nurses cost extra....:)

nursemike, ASN, RN · May 11, 2011

I blundered a bit and asked about menstrual history in front of the parents--in the future, I think we can wait until a female nurse is available to ask about that. And I didn't ask at all about sexual activity. Again, it could wait for a female, but we do need to know, because of the meds we're likely to give.
I disagree with waiting for a female nurse to broach these subjects. You are THE nurse - don't pawn it off on your coworkers because you are male. I would be upset about that if we worked together.

You know, I've been arguing on another thread that gender shouldn't matter, but I've already had to back off from that a little and admit that it sometimes does matter, whether it should or not. I also agree with systoly that a lot depends on how you approach it. I think my greater mistake was asking in front of the parents--what if her last period had been 9 weeks ago? But when I was giving report to dayshift, I got whacked over the head with Kardexes for not pawning it off. I do suck it up and ask when it's relevant for an adult, although most of ours are obviously post-menopausal. I suppose I'll ask, next time I admit a teen, and if they seem uneasy (or, for that matter, if an adult does) I'll offer the option of speaking to a woman. Few, if any, of my coworkers would object, and I have never declined when they needed a male. I understand, and endorse, the principle, but in practice it usually doesn't make sense to freak the patients out unnecessarily.

In any case, thanks to all for their responses. If I had all the answers, I'd have less questions.

I_OYVEY · May 12, 2011

If I am being admitted to the hospital and family members should be present I want them out. If I am unable to speak for myself I have a Medical Power of Attorney on electronic file at the hospital who will speak for me. Just because someone shows up to the hospital with me doesn't mean I want them in the middle of my medical or personal business.

nickos · May 12, 2011

I am not a nurse yet, but work in the ED with mental health patients. It is standard practice for our RNs to do a basic domestic violence screen, alcohol/drug abuse screen, ask if pts have thoughts of self-harm, etc. Generally I hear them use the approach of "it is our policy that we initially speak with the pt alone, if you have questions or concerns I can come and speak to you afterwards" and direct family to the lobby or family room, etc. As I am not an RN and don't work on a "floor" I wonder, is this approach possible?

steelydanfan · May 12, 2011

It is all about finesse. If the pt. can speak, when I am at the part of the assessment that deals with abuse, sexual activity, etc., I politely ask the family to leave the room, as this is "sensitive". I have NEVER had a family refuse to comply. Remember, they don't know what you are about to ask, they probably think it's a question about elimination.

If the pt. is not able to answer, that's when your powers of observation come into play, to see how family members ineract with each other and the hospital staff. You can pick up many clues that way.

steelydanfan · May 12, 2011

You know, I've been arguing on another thread that gender shouldn't matter, but I've already had to back off from that a little and admit that it sometimes does matter, whether it should or not. I also agree with systoly that a lot depends on how you approach it. I think my greater mistake was asking in front of the parents--what if her last period had been 9 weeks ago? But when I was giving report to dayshift, I got whacked over the head with Kardexes for not pawning it off. I do suck it up and ask when it's relevant for an adult, although most of ours are obviously post-menopausal. I suppose I'll ask, next time I admit a teen, and if they seem uneasy (or, for that matter, if an adult does) I'll offer the option of speaking to a woman. Few, if any, of my coworkers would object, and I have never declined when they needed a male. I understand, and endorse, the principle, but in practice it usually doesn't make sense to freak the patients out unnecessarily.
In any case, thanks to all for their responses. If I had all the answers, I'd have less questions.

Well, I'm sorry you got whacked over the head, your colleagues sound a bit uneducated. Since most women have a male OBG-GYN, I don't see how sex enters into the admit process; especially since most hospital pt.s relate to a male figure as more authoritarian than a female. (Too many citations to cite).