Cone of Silence

caroladybelle, BSN, RN · May 27, 2007

There is not so much a "code of silence" as a loss for words.

The question is usually for what reason the asker "needs" to know.

Most people do draping and positioning as a matter of rote, they do not specifically remember what they do with a particular patient and surgeon,and anesthesia provider.

It's like placing an IV - you look at what you have to work with, what you need to with it and just do it.

When someone asks specific questions about something so rote, they are usually curious for a reason. And in our litigous society, they do not want to get in the middle of an issue.

As far as the draping and positioning, it depends on the surgeon, anesthesia provider/type, type of surgery and the needs of the staff involved.

NurseRoRo · May 28, 2007

If it's just a curiosity and desire/yearn for learning, why not invest in a textbook about scrubbing procedures? I know the AST (Association of Surgical Technologists) has a textbook that their students have to purchase to use in their classes as a surgical scrub tech. The book offers info on instruments, draping and positioning, and also basic info about scrubbing in and sterile technique. Good reference if you are thinking about going down that career path!

CritterLover, BSN, RN · May 28, 2007

i’m fairly new to this site and this is my first post, but was drawn to it when my wife recently had cancer surgery. (she is currently cancer free!) i became very interested in all things having to do with her care. it actually started me thinking that i want to make a career change and maybe go into or nursing in some way, maybe a surg tech to start.
when i got to the point of asking medical providers about or procedures and how my wife was prepped and draped, i ran into the “dear in headlights stare” by almost everyone i’ve asked whose associated with her surgery (circulars, cnra, anesthesiologists, including her doc). the answers i got was anywhere from a blank stare, non-answers, to her doc who did give me an answer after some persistence. after a while, it became quite amusing to see the reactions. she so far has had 3 surgeries, so i’ve had a chance to ask many people at this point.
at a baby naming for my niece’s kid, i happened to speak with an audiologist that is in the or all the time working with the or teams to monitor nerves during surgery. he was the only one that ever actually said straight out: “yeah, leave your modesty at the door. almost all of our patients are naked at some point in the or. but it is just a part of the job.”
i would love to get some feedback that sheds light as to why there is this almost universal “cone of silence” about something that is necessary for the care and safety of the pt? why not just answer any questions matter-of-factly? at least for me, knowing was better than being given a non-answer.
thanks
career chg

maybe because for the average person, being naked in front of the or staff is "big deal," while for the or staff, it is just routine.

the or staff isn't looking at the person as "naked," but as a "patient."

the or staff has learned to see the patient as just another patient -- doesn't necessarily see the patient as "naked," while the staff is well-aware how important this kind of thing can be to a patient and family.

there are very few surgeries that can take place on a clothed patient (even if "clothed" means a hospital gown."). maybe some ent surgeries, but that is about it.

i (personally) have the same issues when it comes to my annual exam. while i feel some level of anxiety with the assistant, i do realize, on an intellectual level, that to him/her, it is "all in a days work." even though it does bother me. i have been asked in the past if it bothered me to have a male assist. i have always had to say "no," even though on a certain level, it did bother me. this is because i realize that it probabaly bothered him more than it did me, and if it didn't, well, then all was ok. he wasn't there to get "cheap thrills.:" i know this, and that is why i won't object to having a male assist.

(i still remember, as an rn student, that very kind patient that allowed me to be in the room for her pap smear. she was also there for birth contorl conseling. the cnm i was shodowing that day told the patient that she had a "very fertile cervix; don't go home and have sex without backup contraception!" -- the pateint wanted oral contracptive pills -- the midwife then asked her if it would be ok if i (the nursing student) looked to see what a fertile cervix looked like. i still remember her (the patient) laughing and saying it would be ok. she may have been modest/nervous, and i suspect she was, but she was ok with me looking as an educational experience. and i still remeber the look of a "fertile " cervix, and the educaitonal opportunity i got from that.)

so anyway, my point is that much of what is done in the or is invasive an violates modesty. however, the personel arn't oogling her body, or making jokes about it. which is what most lay people (though not all) seem to expect. so, there is a bit of "secrecy" about what goes on, to spare the patient's (and their family's ) emotions.

for your wife, they arn't talking about her being naked; yet, they fear that you (and other "lay" peoplei) will think this the case, so they try to "spare" you.

it isn't meant to hide anything.

(disclaimer: have never worked in the or in any capacity, but have worked with surgeons, mdas, and crnas in recovery and surgical icus.)

TracyB,RN, RN · May 30, 2007

WOW... If you're really interested, check out a copy of Alexander's Care of the patient in surgery...

How your wife was prepped & draped completely depends on the type of surgery. If it was lady partsl, she was most likely on her back, with her rear-end at the edge of the table, her legs in special stirrups, her lower abdomen (mons pubis) inner thighs, perineal area, & lady parts cleansed with betadine prep solution, (scrubbed, dried, painted) then legs covered with sterile covers. Surgeon possibly sitting on stool while working.

People are probably mostly surprised & wondering why someone would want to know something like that.

MOST nurses, will do their damndest to make sure that the patient isn't unnecessarily exposed at any time during their surgical experience.

PS... Congrats on the current cancer free status. Prayers that your wife stays that way : )

CareerChg · May 30, 2007

NurseRoRo: Thanks for the tip - I have ordered some text books and video

TracyB: I got Alexandar already :-) Thanks for you kind thoughts and prayers. She had DCIS with immediate DIEP reconstruction. Path came back with all good news. Now we are in the multiple surgery stage to get the cosmetics right. It will end up being over a year! Any thoughts you have on prep & drape? At this point I have a pretty good idea, but any details are always helpful.

Thanks

mikethern · May 30, 2007

Another thing to keep in mind is that America is a very litigious society. Medical professionals work very hard and endure a lot of stress. If that weren't bad enough, we have to worry about being sued by our patients (including frivolous lawsuits.) When a patient asks specific questions about our technique, it is understandable that some practitioners will think, "hmmm is this guy looking for a reason to sue?"

TracyB,RN, RN · May 31, 2007

Wow, lots you 2 have been through. I don't do much gyne/uro stuff at all, but I'm gonna wager lithotomy position like I described in earlier post.

I'm all about the bones, broken bones that is...

Look at you, getting Alexander's already.

Ditto to what MIKE said. Gotta be careful with the "sue happy" types. They will look for anything.

Here's an example... I recently had surgery & knew what my positioning would be. I was sedated when brought back to the OR, but was STILL trying to check my table to make sure it was properly set up. I had a small bruise on my chest from the table, but knew that it was a small chance to get that bruise b/c of the table & the position, & I bruise if you look at me funny. Plus I'm not 100# that can just be flipped prone by 2 people. I'm a bit more solid than that... LOL Someone who didn't know how people are positioned could have been like, OMG, look at that bruise!!! What the hell happened?

Know what I mean?

My worker friends laughed at me about checking the table.... Once an OR nurse, I guess always an OR nurse, even while sedated & about to be intubated. . . Safety is ALWAYS priority.