Background: We had a lovely, devout Muslim couple who had a baby a while back in my hospital. Their requests were clear but simple; no meat diet and no male care providers other than the ones already assigned to their care. (meaning no lab techs, nurses, housekeeping, etc). I passed this on in report but apparently poorly and ineffectively, as two days later, to their their horror, a male doctor entered the room to examine the baby. The baby was under the care of a female dr at first, but on-call assignments changed and and this gentleman took over, entering the room unaware of the situation. (He was not told and we had nothing on the door/chart, unfortunately, indicating the situation). The lady did not have time to cover her head/face before he entered, which was the main problem for them.
They handled this very well and politely--- but were extremely upset, understandably. Obviously, this is not information to be left to report alone, as such facts can and (were) lost as the days passed.
So, here is my question. We want to avoid a similar situation in the future. How do you handle such cases, where as you know, staff change by day, and housekeeping/lab/other personnel may enter care and need to be made aware of such mandates or preferences made by patients based on cultural or religious reasons? Do you use signage on the door? Kardex reports that spell it out clearly? Mark charts? My concern is NO ONE enter such rooms before we gain permission, yet there are administrators who feel signage may be inappropriate or offensive to such patients.
SO, what do you do to avoid the faux pas I caused this couple?
We did apologize and they were very understanding and accepting......... we just never want this to happen again and I have to come up with a plan of action that is spelled out clearly in writing, in time for our next staff meeting in 2 weeks.
I was just thinking there are so many people who ignore the signs on the door- doctors ignoring the isolation precautions. I would think staff would think a sign saying to check with the nurse was geared towards visitors and not towards them. Perhaps a symbol would be better- like the falling leaf for fetal loss. It could be specific to your facility and that way even those who would be tempted to ignore the sign would understand what it meant. I don't know what kind of symbol you would use though.
Hi this is just a thought ...but when there are contact, droplet of other precautions to be taken by staff, there is a big red stop sign with the words report to nurses station on it. Vital information is passed to caregivers assigned to the individual. Maybe a modified version be set up for a situation like this; of course it should be stated in the chart at the begining of the pts stay.....like I said just a thought
Hi Dedream: I like your idea!
And, oh, by the way SmilingBluEyes you should NOT be shouldering the entire blame(nor the majority of the blame) for that situation--after all, you DID pass along the info to the next shift....nursing is a TEAM effort.
SBE, you're not at fault. We have had several Muslim patients in the past few months and we do the "stop at the nurses' station first sign." It is already on our doors for families to use. The other side says "knock first before entering." That is used in case mom is breastfeeding or dressing, etc. We only have five OB docs and a CNM on our staff. As the patients are having their prenatal care, it is explained to them re. the call schedules, etc. The one group which has 2 men and 2 women tells the Muslim patients that they cannot promise a female caregiver. The patients know this. Some have decided to seek care in a neighbouring town or in the Baltimore area with practices which have only female providers in their groups. These patients are also told that there are cases where it may be very difficult to not have a male care provider. We do not currently have any female anesthesiologists and several of our OR nurses are male. If they need a C/S in the middle of the night, then it may be that a male RN or LPN comes in w/ the OR. team. In the daytime, the assignments could be swapped so that only female staff are in the OR, but anesthesia is going to be a male provider. All we can do is try our best and be very respsectful. It is important to discusss limitations to accomodations before there is a problem and document accordingly. This helps to set reasonable expectations if your resources to meet the patients' needs are limited. It is important to make the birth experience the best that we can for all of our patients.
You know what I'm thinking about after reading the OP and replies? This was a male DOCTOR that entered the room, right? While we, as nurses, make great efforts to report off to each other after every shift, perhaps if the doctors did the same thing, this incident would never have occurred. I know it's a pipe dream, and I know that we are ultimately the patient's advocate, but for once I would like to see a doctor come on call knowing something about the patient. Making cultural accomodations is important and every member of the healthcare team should be on board.
Oh, and I like the idea about a sign that reads "See nurse first", but I wonder how many staff members would ignore it?
SBE, you're not at fault. We have had several Muslim patients in the past few months and we do the "stop at the nurses' station first sign." It is already on our doors for families to use. The other side says "knock first before entering." That is used in case mom is breastfeeding or dressing, etc. We only have five OB docs and a CNM on our staff. As the patients are having their prenatal care, it is explained to them re. the call schedules, etc. The one group which has 2 men and 2 women tells the Muslim patients that they cannot promise a female caregiver. The patients know this. Some have decided to seek care in a neighbouring town or in the Baltimore area with practices which have only female providers in their groups. These patients are also told that there are cases where it may be very difficult to not have a male care provider. We do not currently have any female anesthesiologists and several of our OR nurses are male. If they need a C/S in the middle of the night, then it may be that a male RN or LPN comes in w/ the OR. team. In the daytime, the assignments could be swapped so that only female staff are in the OR, but anesthesia is going to be a male provider. All we can do is try our best and be very respsectful. It is important to discusss limitations to accomodations before there is a problem and document accordingly. This helps to set reasonable expectations if your resources to meet the patients' needs are limited. It is important to make the birth experience the best that we can for all of our patients.
good, i am glad it is being addressed ahead of time. And the fact that it may not work out....safety has to come first....or our lic would be on the line.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
a word about signage: as a muslim woman, i can tell you without a doubt that i would *not* want a sign on my door. you have no idea how many well-meaning people feel that they need to witness to me as soon as they discover that i'm muslim. or feel the need to make terrorist jokes. or ask how i feel about being so oppressed. the list goes on. i am happy with my religion and don't hide it. but at a time of stress, such as hospitalization, the last thing i want is for it to be the major factor in my care. not saying that muslim women don't have special circumstances, but i question whether obvious signage is a good idea.
have you thought about asking the imam at your local masjid? perhaps a focus group of muslim women arranged by the imam could help your facility come up with some other alternatives that would work for everyone.
if you do not wish your religion to be a major factor in your care and do not want a sign on your door, then perhaps you are more comfortable with the idea of males entering your room. someone who does want their religion to be a major factor in their care needs to allow for some way for that to be communicated to all staff -- from doctors to janitors. a sign on the door is the only way i can think of for that to happen. that said, perhaps the choice should be offered to patients on an individual basis. is it more important to you that males not enter your room or that there not be a sign on your door?
My first thought was people ignore or just don't see signage sometimes. This happens with infection control issues, where there is a big old sign and an infection control cart outside the door. And guess what? Some docs walk right in w/o gowning up KNOWING about the issue. And hardly anyone stops at the nurses' station to check in first even though there is a big ole sign too.
And I agree that the docs needed to communicate this issue more clearly. This wasn't your fault SBE. I actually think it was an unintended incident - no one meant to hurt anyone.
I really like the idea of checking with an imam.
My first thought was to verbally communicate this to staff - but then I work in a small rural hospital.
I agree with you that a generalized sign may be appropriate if you ask the patient's permission first. I had a patient that was Protestant, but was very modest and nearly checked herself out of the hospital when she was assigned a male nurse. There are a lot of different reasons some patients have a preference. It is not always religious. We do not always have knowledge of what occurred in our patient's lives prior to hospitalization. Even in this era, abusive situations are kept hidden in many instances. Patients still have a right to determine who sees them with or without their clothes on and we need to remain sensitive to this.:heartbeat
if you do not wish your religion to be a major factor in your care and do not want a sign on your door, then perhaps you are more comfortable with the idea of males entering your room. someone who does want their religion to be a major factor in their care needs to allow for some way for that to be communicated to all staff -- from doctors to janitors. a sign on the door is the only way i can think of for that to happen. that said, perhaps the choice should be offered to patients on an individual basis. is it more important to you that males not enter your room or that there not be a sign on your door?
perhaps i wasn't clear. my religion will always be a huge factor in my care and is something that is frequently discussed amongst the ladies in my group, nearly all head-scarf-wearing observant muslim women. the issue isn't that i don't want religion a part of the care plan, but rather that such a sign often serves as an invitation for the less-than-culturally-aware. and as frequently noted by previous posters, such signs are often ignored as many feel that it doesn't apply to them.
from an islamic perspective, care by males isn't really the heart of the issue. there's the modesty issue, which many people take out of context (thinking of an egyptian woman in labor with her head covered and the rest of her naked), and is really only a small part of it. it is technically haram (forbidden) for an unrelated man and a woman to be alone in a room together. if the woman's husband is present and the woman meets the modesty requirements, then no problem. the issue would arise when a man would barge into a woman's room when she is alone and not "properly" dressed, whatever that means to her culturally. in the case of an emergency, as described in a previous post, there is no harm in having a male anesthetist when no one else is available.
in short, it's not a matter of no male caregiver at any time, it's a matter of meeting certain obligations in the presence of certain men.
I think the generic signs and a little education are a good option. When our signs say check with the nurses before entering the room, that is exactly what they mean. It means the same thing for any patient. This may include the woman who does not want a certain relative visiting, someone who just got bad news and needs privacy, an employee who just delivered and needs some sleep, as well as someone who has religious "observances" which restrict various caregivers from entering her room. Our lab, dietary, volunteers, etc. are good about seeking out the nurses prior to entering a room where the sign is posted. As far as other patient care staff, like resp. therapy we would probably communicate with them directly that the patient does not want a male caregiver for religious reasons. If that could be honored, then it would be and if not we would talk to the patient about it. Something like IS can be done with the nurse if necessary. Treatments or resp. emergencies would be an exception if only male RT's were working at the time, this does not happen very often. Most people are very reasonable and understanding if they know that you care about respecting their beliefs. If you are disrespectful, then they are likley to be less receptive to you. Also, if you do not know or understand what they want..ask, don't guess. We shoulbe asking everyone. I'd be fine with a male nurse as a caregiver. My mother would be okay, unless they had to cath her or take her to the bathroom. We all have our limits.
Why are people entering the patient's room without knocking? Seems pretty simple to me--policy needs to be that you don't enter without knocking first and saying "It's So-and-so, may I come in?" I'm an Orthodox Jew and cover my hair fully. I've had 4 kids and people were always really good about knocking--I appreciated it.
Also it's good for the patient to realize the hospital isn't like being at home--people will be in and out all night for vitals etc.--so she should make sure she's covered adequately at all times. I never uncovered my hair at all in the hospital except when showering. Why can't you explain the situation to patients so they can plan ahead and maybe decide to keep covered up? Also suggest them pulling the curtain around their bed area so they can have more privacy if someone forgets to knock....
CEG
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I was just thinking there are so many people who ignore the signs on the door- doctors ignoring the isolation precautions. I would think staff would think a sign saying to check with the nurse was geared towards visitors and not towards them. Perhaps a symbol would be better- like the falling leaf for fetal loss. It could be specific to your facility and that way even those who would be tempted to ignore the sign would understand what it meant. I don't know what kind of symbol you would use though.