Modesty Issues

Editorial Team / Admin · Apr 1, 2010

In all of our requests, they were well known ahead of time and were for elective surgeries. If any patient who we had not known ahead of time, the patient did not communicate them to the staff. Nurses act as patient advocates, but we are not mindreaders. If a patient has a request, then they need to advocate for themselves and communicate.

As for modesty issues in general, yes, there are some nurses out there that do not have the same level of consideration as others. I currently work with someone who gets on my nerves to no end, because she routinely uncovers patients from chest to knees, even when we're doing something that doesn't require that much exposure. If I'm in the room, I'll cover genitals/breast area if feasible.

But it's like that in every field, where you have those who are better than others; it's not just nursing. The patient really needs to speak up for themselves, because if management doesn't know a problem exists, they aren't going to fix it.

ImaWonderer · Apr 1, 2010

Quick question to poetnuknowit

The medical professional who uncovers patients from Knee to chest even when it isnt neccassary...why exactly do you think she does it. Does she just not care? Is she being malicious or gets jollies from being able to uncover people to that extent? Is it just careless behaviour? Thank you for taking action and covering the patient but have you ever mentioned to her that she shouldnt leave the patient that way?I guess I identify with the patient....why am I uncovered this way in front of people when I dont need to be?

Thing is I'm not ashamed of my body but the whole hospital culture just seems to be out of this world to me.

I 100 percent understand that medical professionals arent mind readers but where I'm having problems in understanding is things I consider BASIC have been at times NONEXISTENT in the several medical encounters that I have personally had. I wont go through the whole story (i posted earlier) but I have been asked questions about my lady partsl health while standing in a hallway of a clinic. I have been in stirrups with people opening the door just walking in and out like they were at a park.(seperate visits by the way) To me this shouldn't require mind reading . This seems like basic common respect and decency. I wouldn't even walk into my sisters/parents/ friends house without knocking on the front door so why would I casually stroll in on a patient in a room having their prostate examined???(much less bring in an audience to watch)

To the medical person who was asking me intimate questions in the hallway there is no doubt in my mind she wasnt trying to embarass me or being malicious.(She seemed absolutely clueless) I am sure she has asked these questions a million times so she is simply on auto pilot. From my point of view I was mortified,not because of the questions themselves,but because I was standing in the hallway with people walking by as I was being asked about lady partsl odor/discharge. OH MY GOD WHY ON EARTH WOULD ANYONE DO THIS???????. She didnt even make an attempt to whisper ......absolutely ridiculous!

To end on a positive note I did go to a doctor and was ASKED if it was okay that interns/students observed. I said yes and was so HAPPY and THANKUL to be asked. I got up from the table and the doc was looking at a bad case of ezcema that I had on the back of my legs the doc took her hand AND CLOSED the back of my gown so I didnt have to moon an entire room of people when it wasnt necasscary.

I was BEYOND GRATEFUL!!!!!:yeah:Thing is the doc could have had the attitude well we see butts all the time no big deal. Thing is it is my butt and she was was amazingly professional from the way she handled the interns,the actual exam and having an understanding of Basic modesty. It made a HUGE difference to me. I was also happy for the students that was able to witness how conscience and respecful the doctor was.

I hope I'm not coming down on medical professionals to much. I dont want to come across as disrespectful or bashing the industry. I could NEVER be a nurse/doctor/CNA.I have simply been influenced by several of the experiences that I have had that came across as careless,disrespectful and humiliating.This can occur in ANY type of establishment from a restaurant to the DMV but in a hospital it can be particularly tramatic due to being undressed, having your "private" information known and being surrounded by people you only met 2 minutes ago.

To the professional who uncovers knee to chest when it isnt necassary my point is that if it was her daughter/son/mother she would more than likely not have them exposed that way unless it was required,and not for any longer than needed. I have been left pretty bitter simply because the humilation that I experienced was easily avoidable simply by closing a door,simply by letting me know what you're as you go along,simply by not turning my exam into a medical reality show and its everybody gets to watch day.

CaDad · Apr 1, 2010

I just can't resist adding to the statement from ImaWnderer!!

All of this conversation really boils down to just getting treated with some dignity, I immediately thought the same thing, why doesn't poet say something to the other Nurse? I hate to be redundant here, but it seems like the pt's are treated more like assembly line merchandise instead of the people they really are.

Here's a recent example I saw yesterday.I was talking to a Doctor in er when a nurse came by and asked a PT if the student nurses could observe the wound and observe the treatment . This this poor guys was laying on a gurney, his knee all tore up from a skate boarding accident, they had to cut off his pants and he had a blanket covering him. The nurse pulled the blanket clear up to his chest exposing his gentiles when all they were suppose to see was the injured knee.The poor guy tried to cover himself with his hands-it was pathetic and the nurse completely ignored his obvious embarrassment and just continued talking about the injury and the student nurses were checking everything out except the knee, it was a circus. He complained afterwords and the reponse? Don't be childish, we are here to get you well, we have seen it all before. Well, actually not so, these were student nurses and they had not in fact seen it all., but that is not the point-the total disregard for this guys modesty was simply ignored.

tbrd450 · Apr 15, 2010

As a middle aged male myself (non-medical field), I do understand and relate to the obvious concerns expressed in this thread about the double standard regarding male and female modesty, and modesty in general (regardless of patient gender). It has been my experience that yes, a double standard does seem to exist. It seems to just reflect the double standard about modesty in society, in general. Think about the very concept of urinals attached to walls in public restrooms. From young ages, we as boys are socialized to become de-sensitized to our own natural modesty. We walk up to a wall and grab our member and urinate beside strangers in closely packed urinal units. Honestly, to this day, I've never truly gotten used to that. I think that I haven't is a good thing. And, these days, we are sometimes likely to see a female walk through to use the men's facility because the line at her restroom was just too long. That has actually happened to me several times. I was never asked beforehand... "do you mind if this gal comes in while you are standing there at the urinal?" My point though is that we as a society try to separate boys and girls in terms of modesty standards. Females' modesty is to be protected at all costs. Male modesty .. is well, just "silly," or "funny." I happen to think it is not a good thing that we do this to our sons. Granted, I think many people believe it is healthy for them to become desensitized to their own modesty. I happen to think it only serves to further alienate them from their own feelings and, on some level, it serves to devalue him as a class of people. There are countless other examples in society of how we do this -- group physicals for men and boys in front of nurses, female gym teachers in the locker rooms, female sports reporters in the locker rooms, male frat hazing involving male nudity in front of female students, etc. And, yes, my experiences in hospitals and doctors' offices also reinforce this. I will also say this about that, it occurs in the medical settings but I think it does so as much because the male physicians perpetuate it, generally speaking of course, more so than the female physicians and nurses. And, the male patients typically don't say anything. I think that is changing though and that is a good thing.

I have had a prostate exam done three times in my life thus far. Twice it was done by females and once by a male Physician Assistant. The manner in which it was handled the best -- in which my dignity, modesty and feelings were considered closely -- was when it was done by an older female physician. She had me lie on my side and I was only exposed where I needed to be exposed. It felt more clinical and I more like a patient. The other two times, I was told to stand and bend over a table. It's a humiliating position to be in.

All in all, I have been treated very well by nurses and physicians of both genders. I do think, however, there is room for improvement when it comes to modesty accommodations for patients, and modesty accommodations for male patients in particular. And, of course, it is not about what the nurse or doc has or has not seen...I couldn't care less how many memberes and nude bodies the nurse or doc has seen before. It's not about them. It's about me as the patient. That's a no-brainer, right?

And, yes, of course, if I am in the Emergency room I will likely be in no condition to worry much about it. But that doesn't mean I should be left unnecessisarily exposed. So, please throw a blanket over me. Put the foley thing in if you have to and I don't care if you are woman or man. Be gentle and do it right. I only ask this, I ask that you imagine for a brief moment that the patient is your father or your son. Other than that, just save my life!

Thank you for the profession you have chosen. It was always the nurses that made me feel most comfortable, relaxed and less worried whenever I found myself in the hospital or operating rooms. I have had some experience. Generally speaking, the docs are just in and out, matter-of-fact, clinical and before you know, out the door. The nurses were the real connections for me.

ImaWonderer · Apr 18, 2010

To CaDad

The story you told about the guy w the banged up knee being exposed that way. I cant help but think that these people get off on using their position over people. I have no medical training but 1.why would you expose someone to that extent for a knee injury? 2 How dare the nurse dismiss the guys embarrassment and have that " were here to help you so dont complain attitude" also the comment poet made about the nurse uncovering patient knee to chest when its not needed Poet said it bothered her but can you imagine what the patient is thinking and feeling........ Why is she allowed to continue doing this to patients?Just curious if their is any disiplinary action taken against healthcare workers who do this to patients? It sounds like she does this on a routine basis.

I just dont get it. I'm bothered because this is so common. Where is the advocate for the patient?

Yes patients should speak up for themselves but what is often missed is that fact is that a medical enviornment is not a patients comfort zone. Patients are often In pain, sick, scared, embarrassed, anxious overwhelmed so why cant people who are so "educated" understand some of the psychological things that happen to people when they are in these types of situations. You are meeting these people for the first time in a hospital..........you're not meeting them on a sunny day in the park surrounded by kittens.

I wonder what the students were thinking as well. I have zero medical training but if a nurse was showing me a knee and exposing a guys genitals at the same time I would think...OMG why in the world is this lady doing this? If i was a student seeing the embarrassment of the patient I would feel bad but at the very same time the students I imagine would never want to "complain" as they are students they simply want to fulfill their requirements to graduate.

What in the world are patients to do? I now know to be on guard when i go into facilities like this but it bothers me that many people are really sick and have no idea what to expect and will endure crap like this needlessly. The cycle continues...................

tbrd450 · Apr 20, 2010

I really hope that skater wasn't exposed that way because it was just someone abusing their power. Who knows what was in that staff person's mind. I know one thing, though, it was cruel and inappropriate. It was not just "silly." And, honestly, I think the person that told the patient that even knows that herself on some level.

The bottom line is that it probably would not have happened that way if it were a female on the table. That's just my opinion.

advo-kate2 · Apr 21, 2010

A. Unfortunately the nurse who exposed the skater was teaching the student that there is no such thing as patient dignity and respect. Many (not all) will accept this attitude because it came from a senior staff member and continue it through their caregiving career.

B. Male patients are told to let their wishes be known about opposite gender care, but are then told that they usually can not be accomodated. Why do we then encourage them to speak up if the facility is not sensitive to the issue? Do nurses document requests and speak about the need for more male nurses to anyone in control?

C. Patients and caregivers can not fully understand each other until you take them out of a medical scenerio. Consider how often in 'real' life you would accept being exposed to a stranger of the opposite gender. That's how many times some patients want to accept it too. We carry our modesty with us WHEREVER we go.

DonMD · May 5, 2010

The bottom line is that a man without pants is as exposed, in any position, as a woman in stirrups for a pelvic exam, and should be given as much privacy as we accord a woman in that situation. All patients need to be treated as if they are the most modest person on the planet. You won't cause emotional harm if you treat the less modest person with the utmost regard for privacy. But you'll harm a lot if you treat every guy patient based on the myth that "guys don't mind" being seen naked, or "it's no big deal". And speaking of big, the elephant in the room is the issue of member size in our society. Women do look, and do compare and do talk. As a doc, I can't tell you how often I've heard nursing staff making comments. So it's hypocritical to pretend it shouldn't be a concern for the male patient.

If in doubt, reverse the gender of everyone in the room, and ask yourself if the situation still seems right.

A 30 year old patient who had traumatic brain injury and schizophrenia was brought to the ED by his 40 year old aunt, and a 38 year old woman who the family hired to help care for him during the day. Seems OK, right?

The 38 year old woman was actually the next door neighbor who grew up with the patient. The patient was disinhibited, and kept undressing and other disinhibited behaviors. The women cared for him, including assisting him shower. Still seems OK, right?

Now change the gender. Would we be OK with the 38 year old man from next door showering a 30 year old female he grew up with? How about the uncle caring for her? No difference in the situations except for the female as caregiver societal conditioning, and anti male (all males are molesters) societal conditioning we have. It's a bias we usually don't see.

Another example (true story): a man in his mid 50s with early dementia in the ED was forcibly cathed for a urine specimen. Two female RNs, a female tech, and a female social worker (all mid-20s) went into the room and held him and did it. No problem seen because they were all staff, and the girls had a "it's just us" mentality, and a "it's necessary and we're just helping" attitude. The societal conditioning that it's OK for any woman, especially who work in a hospital, to see a naked guy. They thought nothing of it.

Now imagine a 55 year old woman, and 2 male RNs and a male tech go in, and they ask the male social worker to come in and help. Seems different, doesn't it? 4 guys holding a woman down and spreading her legs. One of the men a social worker, not a tech or RN.

When I told them it wasn't right to have a female non-clinical staff member help, they responded "Well, he's demented, he doesn't mind". An unconscious female "doesn't mind" if she's fondled, but that doesn't make it OK.

Last example, also true. A 42 year old in with a kidney stone is in the emergency department at change of shift . He's been there 40 minutes. As I come in for my shift, I hear a scream from the room, so I go over, and knock, but don't say anything. A nurse says "Come in", so I do. The man is laying naked from chest down, with the gown flipped up. The nurse who said "come in" is trying to cath him. His wife is sitting in a chair, literally wringing her hand. Two other nurses are leaning on the counter by the sink watching. To make a long story short, I asked the RNs to come outside, and enlightened them on their actions. They were surprised I was upset. Truly baffled. They did not see anything wrong. The one RN wanted to get the urine sent before shift change so "nothing was left" for the oncoming RN, and the patient had just urinated before coming in, so didn't feel like he could urinate right then. That was her reason for telling the patient he needed a cath. One nurse was the oncoming rn taking over. The other was waiting for the first nurse to leave, so she could walk out with her at the end of her shift, and was "keeping her company". They were so unconcerned with his privacy that they thought nothing about saying "come in" to a knock at the door - could've been his daughter or co-workers coming to see how he's doing. And they thought an audience for the cath was OK.

The patient did what most men in the patient role do. Assumed this was how it is, and if he objected he'd be a bad patient. So he did one of the two options men have. Either "man up" and tough it out and maintain control, or freak out and be aggressive and loud and be seen as an ass. He stayed quiet.

Imagine the emotional trauma to this man, who was on his way to work, and then was exposed and humiliated in front of a bunch of women a short time later.

What if a three male nurses did that to a woman?

For the actions of workers in a health care setting, the bottom line is this: Knock before entering a room, and WAIT for a response before barging in. Keep people covered. Keep curtains and doors closed. Warn before uncovering. Ask permission for others to be in the room, such as chaperones or students. Keep onlookers out unless absolutely essential. Treat everyone as you'd like your loved one treated. Be gentle, and respectful. Put yourself in the patient's shoes, and empathize with their embarrassment and shame and humiliation. Be aware of those societal biases that we have been conditioned to as to not even see.

Remember that the patient is the only naked one in the room, and that is extremely humiliating. (Just imagine your embarrassment if you wore a bathing suit to work when everyone else was dressed - then multiply that by a hundred) The patient is incredibly vulnerable. And every patient is a PERSON, not a thing. It's our job to protect their modesty, dignity, and privacy. It's that simple.

tbrd450 · May 9, 2010

DonMD: YES! YES! YES! THANK YOU!

Thank you for stating the obvious. It's obvious but if we mention it, well... we are being silly and unmanly. As a male, I know exactly what you are talking about with regard to the double standard. What hurts me the most, I think, is that it is often women -- the very ones that would themselves expect much more respect for their own modesty in a given situation --- that seem to disregard the potential feelings of the male. Some men are not modest, or, at least, they act that way. Some men are very shy and modest, but they likely act otherwise. It is not safe for a man to be "unmanly." I know, without ever having met him, that the gentleman you described was at a minimum very uncomfortable with having to endure that in front of three women -- at least one of whom didn't even have to be there !... OMG!... what are people thinking?

But just about every woman I ever met recognizes her own expectations when it comes to being treated with dignity, respect and basic consideration on the modesty issues. It hurts because I have considered myself a feminist for so long -- advocating for the elimination of double standards against females in our society.

One of the double standards that negatively impacts males is around our bodies -- we aren't expected to demand consideration (that would be unmanly, childish, "silly," and frivolous). It hurts me that the feminists whom I supported on so many fronts don't seem to have anything to say about the double standards that hurt the men in their lives. They had very little to say (write about) following the realization, for example, that have the soldiers involved in the disgusting abuse and humiliation of Iraqi detainees turned out to be female -- the person in charge was female. Half of the pryamid builders were female.

Yes, I know the nurses and med techs probably do talk about the guys' membere size. But, let them hear a doctor make a comment about a nurse's breasts and, well, take cover.

I do think we, as a society of men and women, are evolving. We men are beginning to expect to have as much right as our sisters to get on the lifeboat when the ship is sinking. We are, as a society, beginning to recognize that the epidemic proportions of male rape behind bars is probably not a good thing -- the jokes are starting to wane. We are expecting to be treated with dignity and consideration when we go for health care. Our sons are starting to ask if it really is necessary for the female gym teacher to be in his locker room.

I recently heard a study that said men know more about breast cancer than they do about prostated cancer!!. There was a recent article in a feminist magazine (the main one), and the argument was that women should do more for understanding prostate cancer and encouraging the men in their lives to seek help. Why? not because it is best for them, but rather because they are in their lives... it is ultimately best for the women.

We are beginning to expect some consideration when we have to disrobe in the hospital in front of the nurse, her sister from Buffalo, the Census worker that happens to be taking a count that day, the female medical supply rep in a business suit who is there to sell something, etc. .. well you get my point.

We need you -- male doctors -- to take the lead. We need you -- male doctors -- to point these things out when you encounter them, as you did. While I used to think it would be the female population, or at least the female feminists, that would likely end up carrying this equality flag for us, I've come to realize we probably will have to rely on ourselves in that regard. Overly dramatic, for a post on modesty? Maybe. But, it is all related. And, I don't care. The doc inspired me to tell it like it is.

Thanks,

advo-kate2 · May 11, 2010

Two excellant posts! Quite frankly as a woman (equalist not feminist) female caregivers seem to be my hardest sell. I often wonder what motive they would have for not showing respect for the modesty of our husbands, brothers, sons, and fathers when they would do the least for their mothers, daughters, and friends. Our conversations often turn away from my goal of respect to their goal of entitlement.

Maybe some will read the posts and realize that men are saying no to any care at all if it means facing a fight of their body verses someone's job entitlements. Isn't that why most women we talk to say they entered healthcare? There is certainly no "care" displayed in forcing 'our care or no care' on men. If women here truely care, then realize that men are NOT choosing wellness over modesty, and something needs to be done. That is....if we really care.

DonMD · May 12, 2010

tbrd450. EXCELLENT post. You brought up many, many points, all well and succinctly said.

And you're right. A male patient who demands privacy and dignity is labelled as "difficult" or an ass. And he is ridiculed as being "silly" or childish. Meaning his demand for decent treatment has inconvenienced and irritated the caregiver. Which further emasculates and embarrasses him. We infantilize patients. Which leads to another observation.

We know that girls in our society grow up being taught it's OK if they bathe the baby boy or babysit. We have no problem with a 5th or 6th grade girl helping bathe a 4 year old boy or change a 3 year old's diaper. But would we feel that comfortable with a 5th or 6th grade boy helping bathe the 4 year old girl? We tend to protect the female toddler, but let any little girl see the baby boy.

And we all see male statues with clearly defined genitals. David leaps to mind. Ever seen a statue, in public, that shows a woman's labia and lady parts clearly? Nope. So girls are taught from a young age that anyone can see naked guys, it's no big deal. And guys are taught they have no privacy, the girls can see. But a woman's genital's must be kept private. Fully visible male genitalia in movie? It's an "R". Fully visible female genitalia - almost always an "X" if the labia are seen or especially the lady parts.

So when the man is exposed in the ED or OR or anywhere, EVERYONE, male and female, is conditioned that it's no big deal. Unless you're the patient, who's the only naked one in the room. THEN it's a big deal to you. (OR unless the patient's in control of the exposure, then he's a flasher or a pervert, and all these professionals who tell him he's silly for being modest will act offended! And demand modesty!)

The Abu Ghraib incident is one that has numerous similarities to what happens to guys in a hospital, but speaks to societal conditioning and anti-male bias. It starts with kids growing up being shown that some guy getting kicked in the scrotum is hilarious. It desensitizes us to men's pain.

The Pentagon brass put out a memo, literally, that the sexual humiliation was to ONLY be done to men. They knew society would not tolerate it happening to women, but they'd get by with it happening to men. Brutality to men is accepted and condoned. Even sexual degradation.

Imagine a photo of a male GI pointing at a woman's labia with her legs spread and snickering while holding the "thumbs up" sign. The firestorm over that would make what happened to those involved in the real incident look like an afternoon at the park. But it's somehow not quite as bad when it happens to the guy, because we've been conditioned that way.

The other thing about Abu Ghraib is this: the Pentagon KNEW that being stripped naked in front of a bunch of fully dressed women would BREAK these men! That's why it was done. What does that say about our usual treatment of male patients, and in particular male trauma patients, who often lie naked, for no reason, for 30 minutes to over an hour?

The point we need to educate EVERYONE on is that most males DO mind, very much, even if they don't say. Especially with the "size" baggage and the focus on it in our society. Men are often very private, as modest and private as women, and are just as damaged when humiliated. But the guys aren't allowed to show it. So they do what I call "male camouflage" - they either get stoic and quiet, or get angry and do a lot of huffing, puffing, cursing and bellowing. The only two societally acceptable masculine emotions. They may be crushed, ashamed, crying and humiliated on the inside, but to show it only adds to the degradation, loss of control, and perceived loss of masculinity. So you "man up". You maintain control. (Similarly, as a male caregiver, you don't intervene when it happens to some other guy. Because you'll be seen as unmanly, and people will wonder what's the matter with you!)

advo-kate2 Incredible post. Truly outstanding. Two powerful paragraphs. I've often wondered the same.

GadgetRN71, ASN, RN · May 12, 2010

DonMD, I don't think anyone here is disputing the fact that we should maintain modesty as best we can for patients..I myself have had several trauma pts come up from the ED naked and this made me angry..these pts weren't as bad off as some(didn't come off the trauma elevator) so really, someone could have gotten them a gown. I'm all about the blankets too, if we arent working on an area, then I cover it.

My issue with several of the posts here was that you had several people who have no clue about the OR environment telling OR nurses how to do their job. This sounds harsh, but in my hospital, we do not have the staff to accomodate someone who prefers a certain gender. We are a major trauma center, and we are the only one for miles around-we get trauma pts from 3 states. I work an off shift too, and frequently have to mandate and beg for people to stay to run a schedule. I mentioned this and mentioned that many patients come up in bad shape and are not in the condition to ask for a particular gender. Someone said I don't listen to these patients. Hello? Pretty hard to hold a conversation with them when they're tanking, and intubated to boot. :eek:

Ultimately these posts don't bother me, because they come from people who aren't nurses, for the most part. They may mean well, but unless you do this job, you don't know squat. I know that my coworkers and myself treat our patients very well, under horrendous circumstances sometimes. I know that having surgery is anxiety provoking and also can bring out the less rational aspects of a persons personality..some people just lose it over the silliest things. Personally, I would rather have staff in my room that was knowledgeable and compassionate. I don't give a rat's ass about what genitalia they happen to have. Just my :twocents: