Modesty Issues

[ToryAdore]

Looking for words of wisdom from those who are more experienced with prepping a pt for surgery or catheterizing adult male pts with modesty issues. It has only happened a few times in the past year but it's still something I need to be able to deal with better. I hold a pts dignity high on my list of priorities. What do you do or say prior and during the procedure to ease their anxiety...? Any advise would be greatly appreciated.

Tory

[Argo]

Squirrel I agree 100% this threads post have generally no relevance to most OR cases and have very little input from anyone that actually work in the environment. Another post that should be in a general forum for non nursing people. However, if they show up in my OR about to die and want someone without a member I will still do my job and not let them die.

[DonMD]

SquirrelRN71 :

I really appreciate that you try to maintain a person's modesty. Awareness of the problem is a big part. But often, you believe that you and your female colleagues are treating the patient well because you have a sort of cortical blindness to what really is going on. You are in your own familiar environment with your friends/coworkers, mostly other female nurses, and it's "just us". No one but us seeing the patient, so no problem. You're fully dressed. But the patient is frightened, in a very scary environment, in a room full of strangers. And with healthcare being overwhelmingly female, for a male patient, it is getting thrown in the female locker room naked. We need to be constantly cognizant of the patient's predicament AND gender issues - for EVERY patient.

Changing the gender of everyone involved, patient and staff, and then seeing if the situation still feels comfortable is a good self check.

No one needs expertise in ANY specialty to remind someone of common decency, or to point out societal myths that we function under but about which we may be unaware. As a multiply boarded physician I've learned tons of things from docs in different specialties, and from RNs, RTs, OTs, pharmacists, even techs. I've learned bunches more from my patients themselves.

As for those commenting who DON'T work in healthcare, their comments are VITAL and IMPORTANT - we must understand their worries and fears in order to alleviate them. And everyone "knows squat" about how they personally would like to be treated by medical caregivers. Yes, I know they don't understand why we do things. But their concerns about modesty and dignity are valid nonetheless. We have to see it from THEIR perspective, not ours. Here's a question: Do you understand why you do some things at work, or is it just rote, because "we've always done them this way"(such as leaving trauma patients naked or moving them through the hospital that way)? Is it medical societal ritual, or really needed and beneficial to the patient? Is it beneficial to the patient, or just convenient for the staff?

Your comment that "we do not have the staff to accomodate someone who prefers a certain gender. " is unfeeling and harsh. It is also illegal. Several Supreme Court rulings have gone very harshly against providers and hospitals who did not accommodate a patient's request for a certain gender provider.

While I do understand staffing constraints, this attitude does not fly. It just isn't a priority for anyone to be concerned enough to solve the problem. But that doesn't mean it is acceptable. That is the typical "deal with it" sneer that men as consumers of healthcare get.

Most patients DON'T care about the gender of staff, most especially if they are not being treated immodestly. But the few who have a request should be accommodated, or educated as to why that isn't possible, and then put as much at ease as possible.

As far as those who "are not in a condition to ask", that doesn't mean we have carte blanche to be casual about their privacy and dignity. But I see that ALL THE TIME with male trauma or code patients. The unconscious guy is just left lying there naked. The unconscious female is almost NEVER left naked with her legs spread and genitals fully visible.

I applaud you for being angry about trauma patients coming up naked. Where is our basic decency? But we get all hyped up in our medical rituals and get so pumped up doing things TO people, and feeling SO important, that we often forget the person who is the patient. If they can't protect their own privacy and dignity they're out of luck. Did you take the next step and call down to the ED or talk to a supervisor or make an incident report about your concern? I bet you didn't, because you didn't want to look silly. If we're going to change the system behavior, we have to make a little noise. And risk our OWN personal embarrassment.

I very much agree with you that I want someone in my room who is gentle and compassionate. But they also MUST be aware of gender issues and respectful and treat me with dignity and modesty. The Social Worker in the example in my first post is extremely gentle and compassionate. But she simply did not see she was crossing a boundary - she was a female with a hospital ID, so the RNs grabbed her to help perform an intimate procedure on a man. Because it was busy and the staff was spread thin. And she just thought she was helping, so it wasn't a big deal. No one even gave it a thought. No one even saw it. Cortical blindness. And that's the point. You must think of these things. Like it or not, inconvenient or not, or "silly" or not. And all the excuses and self exemption on OUR end does not make the action right, or more tolerable for the patient.

And since you read the prior few threads, I'm surprised you said "some people just lose it over the silliest things". Being upset at being the only naked one in the room is not silly. Not to the patient. It's not silly to be embarrassed. Labeling something as "silly" is an intent to dismiss it in a derisive fashion. Perhaps you are personally not very body modest or shy, but most in our culture are. It is not "silly" to them. It's not "silly" if a man does not want to be exposed in front of a female stranger who is fully dressed, no matter what initials after her name. It's understandable, or should be. It's our job to minimize the patient's shame, exposure and discomfort. It's not their job to adjust their "silly" attitude to my work needs.

Would you think it silly for a woman to be uncomfortable and ashamed and humiliated at being naked in front of an all male staff, or maybe getting a catheter in front of such a group? Probably not.

I bet you would be humiliated walking through your OR suites naked. But since the staff is mostly female, and the male staff have all "seen it before", wouldn't that be "silly" for you to feel that way?

I hope these posts would at least get you to look at the situation in a new way. Really try to see it from the male patient's perspective, not just yours as a harried female RN. And if you DO see it, try not to dismiss it. :)

[DonMD]

Argo, it's all about the patient, not the nurse. About treating them with privacy, modesty, dignity, and respect. And about respecting their wishes and needs as much as possible. Think of it like a cultural issue, and we're all about "cultural competence" these days. The culture we're woefully uneducated about is patient dignity and privacy in healthcare.

I'm not offended when a woman doesn't want a male doc. It happens a few times a month. Often, after talking with her, she's at ease and the exam proceeds.

The dying and really sick/injured have NEVER made a gender request. Doesn't stop me from recognizing that shame/humiliation may be adding insult to injury, and trying to alleviate that as much as possible. I never leave them lying naked. Not even the traumas. And there's not a trail of bodies because I covered someone up.

It's a false dichotomy to give the patient the option of being treated disrespectfully and without dignity, or dying.

Family members are sometimes in the room when we do cardiac arrests. You bet the patient is treated respectfully and modestly and with dignity. That doesn't stop our best efforts to save them.

When you're sick, what matters for the caregivers is what's between their ears, not what's between their legs. But even if our patients KNOW that, it doesn't stop them from FEELING differently. And we need to be aware of that. BTW THEY'RE the customer, not grist for our mill.

So I'm not calling for gender-identical care. I'm calling for awareness of unseen biases and gender-aware care. And I'm asking for respect for privacy and modesty. Keeping doors closed, curtains pulled, extraneous staff and observers out, cameras off unless explicitly permitted, and treating people with basic decency. That's not so hard, really.

[Cul2]

i don't have too much to add to what donmd has said. he's said it well. but to respond to squirrelrn71's comment:

"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 "

that attitude is a big part of the problem. let me tell you something that doctors, nurses and other medical professionals don't understand: they don't understand what it means to be a patient...a patient without all their specialized knowledge. they may have been a patient, but they have the knowledge not only of the medicine, but also of the strange, hospital culture with it's gender neutral atittudes and other mores that don't jive with the culture outside. knowledge is power. and when you're dealing with naked, vulnerable people who are unfamiliar with your culture and your knowledge, you will never understand what it's like to be in their shoes. so, although non medical professionals as patients don'w know what it's like to be in your shoes, neither do you know what it's like to be a patient totally unfamiliar with what you know and the strange culture within which you live. you're knowledge of what it means to be a patient is very limited.

[Rose_Queen, BSN, MSN, RN]

Let me tell you something that doctors, nurses and other medical professionals don't understand: They don't understand what it means to be a patient...a patient without all their specialized knowledge. They may have been a patient, but they have the knowledge not only of the medicine, but also of the strange, hospital culture with it's gender neutral atittudes and other mores that don't jive with the culture outside. Knowledge is power. And when you're dealing with naked, vulnerable people who are unfamiliar with your culture and your knowledge, you will never understand what it's like to be in their shoes. So, although non medical professionals as patients don'w know what it's like to be in your shoes, neither do you know what it's like to be a patient totally unfamiliar with what you know and the strange culture within which you live. You're knowledge of what it means to be a patient is very limited.

You don't think people in the medical field were patients before they gained knowledge in their field? I was a patient at 12 (ear surgery), 14 (dental surgery), 18 (rule out a stroke), and 19 (food poisoning/electrolyte imbalance/dehydration) all before I even considered nursing school. (And those are just the ones I remember- I've also spent time in the hospital as a very yound child and don't have memories of it) I'd also been through several hospitalizations for family members. For some of us, that is why we chose the health field, and we have truly seen both sides of the coin without the benefit of inside info.

[ImaWonderer]

Awesome posts !!!!! DONmd ....such a relief to see someone in the medical community that gets it. Lord Knows its rare. I just wanted to say my thoughts were the same when i read the comment about the patient being brought up from the OR naked. There was no reason for it so why is this CONTINUING to happen? SquirrelRN71 said "several patients" okay so this sounds like a pretty regular practice that is happening but not just at this facility but I'm willing to bet this is pretty common. Then in the same post "someone could have gotton them a gown?' uh...gee you think. This is a facility with doctors,nurses,techs,assistants and noone has the skills or the "training" or decency to hand a naked person a gown that doesnt need to be naked?

As a person again who has no medical training what bothers me is that it seems that this human being is being treated simply as a slab of meat. If you saw that nude person as your mother,father,sister,your son or daughter that person would have been covered with a gown within 2 seconds!!!!Much less paraded around in their birthday suit in front of God Knows who.

Im writng this as a person who has been that slab of meat sourronded by medical professionals who were too occupied with their God Complex to think that gee perhaps this person doesnt want 12 eyeballs gawking at her lady parts while in stirrups.....but less me guess that's just me being "silly."

I do not work as a nurse and I dont care to so i realize I will be percieved as not knowing "squat" . Please educate me what are the steps that are taken when people are brought up naked that Do not need to be and their is no reason for it? Whats the explanation? Other than being upset and angry is their any displinary action taken? Any complaints filed? Any type of action taken at all.

Thing is this is not just happening in Er type situations this type of treatment seems pretty common in medical facilities. Staff just walking in the room,not closing curtains,unneccessary exposure etc........I was reading another post(I thinkon this board) about a patient in surgury where the doctor was jiggling the patients fat and singing a silly song. I'm sure this patient was surrounded by an audience just laughing the whole time. Where is this patients advocate?You should not be able to use your postion as a healthcare worker to grab and handle a persons body in this way? Yet i'm sure everyone around thought it was hilarious? Again if it was your son,daughter,father that was that patient then how would you feel? Would you still be laughing............but being under anesthia is a whole different can of worms. The things medical professionals do while your looking at them dead in the eye is scary i dont want to know half the things that go on when your knocked out.

[Cul2]

"You don't think people in the medical field were patients before they gained knowledge in their field?" Let's talk about Mark Twain, poetnyouknowit. Here's what I mean: In "Life on the Mississippi, Mark Twain says that once he became a river boat captain, he could never look at the river the same way he had looked at it as a child. The vision we get of the river in "Tom Sawyer" and "Huckleberry Finn" was gone. The innocence was gone. There was beauty, but it was a different kind of beauty. As a river boat captain, he was looking for snags and deadheads, and learned to "read" the river in a different way. This principle applies to many professions. Becoming a profession means you learn to "see" in a different way. You also learn not to see certain things. I'm suggesting that your claim that medical professionals can see the whole picture and patients can only see part of it -- that reasoning is flawed. You can't see the whole picture, any more than a patient with no medical knowledge can. As Thomas Wolfe said: "You Can't Go Home Again." You can never get rid of your current knowledge, never go back to being ignorant of what you now know. Never really understand how it feels. You may "remember" how you thought it felt at the time. And that memory may or may not be accurate. That's also why putting doctors and nurses on medical boards to represent "patients," is also a flawed. We were and are patients, they say, so we can represent the patient perspective. Nonsense. You need no medically trained people to represent patients. Of course, that may give you feedback that you don't want to hear, and the response can always be that they don't know what they're talking about. But they do. They know what it means to be a patient with no professional medical knowledge.

[Cul2]

You need no medically trained people to represent patients. That sentence should read: "You need some non medically trained people to represent patients."

Another point. When this modesty issue comes up, we always end up in the ER. We get comments like "if they show up in my OR about to die and want someone without a member I will still do my job and not let them die." So, it's either dignity or death? Consider all the other non emergency situations where nakedness and nudity are ignored by medical professionals. Group exams, especially for men or boys, where they're paraded around in their shorts and then told to drop those shorts with little or no consideration for who may be watching or modesty. Consider the whole issue of chaperones -- how often do female doctors use female chaperones when they have a male patient? Do male doctors every use a male nurse when they do an intimate exam on a female patient? Exams like dermatology exams where a "note taker" is in the room with the doctor. Is that note taker ever a male medical assistant or a male nurse during the exam of a female? It's most often a female medical assistant when a male is being examined. A man who needs a foley cath in prep for the OR is may not be dying. If he asks for a male to do it, what's the response? Is there even a male available to do it? How about a female in the same situation asking for a female nurse to do the cath? Would there ever by a problem with that request? So...it's not either dignity or death. Most reasonable people accept that in emergencies they may need to be exposed to save their lives. They just don't want doctor and nurses to be so used to the routine of nakedness that they ignore protecting their patients. And, frankly, I accept that most doctors and nurse do try to protect their patients. But I also know that too often, when they see other doctors and nurses disrespecting patient dignity in these situations -- they don't speak up. They don't advocate for the patient. Sometimes it's a question of who has the power and how doesn't, and who's career may be hurt by standing up for what's right. That's also part of the hospital culture, the ugly part.

[CaDad]

I find discussions like these, on boards like this ,furthers the education of everyone who participates. DonMD hit the nail on the head in so many areas I don't know what I want to comment on :-] None the less, I was also reading another topic " What I learned in Er, or something like that" It is no wonder that the medical staff gets so calloused in their every day work when they see the stupidity they encounter every day. Like the various objects they find inserted in every orifice a person has.... It can be daunting, disturbing, disgusting, and disconcerting to see humanity on so many levels and at their very worst. If the general public really knew what you see and do every day they would be humbled that you even go to work every day!!!! I for one, in spite of the observations I have vented here, have nothing but the highest respect for the Doctors and Nurses and medical staff that work to help people.

But, there is always a but, the first step in any problem solving situation is recognizing that there may be a problem. There are countless studies that will tell you that PT recovery is significantly accelerated when the PT is emotionally supported in a caring, supportive environment. The cavalier treatment of males in general does not help in the recovery and mental well being. Everyone has some reponsability in helping making change and perfecting our trade, that is why our system is the best in the world, we have the ability to make change happen when it is a benefit. I know it is difficult, that you may be snickered at or though of as a nut, but being an advocate in what ever small capacity you may have, is the highest compliment you can receive. All of the Medical personnel I have met love their jobs and genuinely care for the PT, it is just that this issue of miodesty is somehow lost in all of the work and trauma of the day, but it is so vitally important!!!! How would you feel if you knew your son, Uncle, Grandfather, Husband or brother refused to go to the Doctor, Hospital because of this small insignificant issue of modesty? But I can tell you , in fact, it is a real reality, more than you can even imagine. How senseless and tragic. And it starts early in our upbringing. This is not the correct forem to go into all the details here, but DonMd stated it pretty clearly, the general notion that somehow modesty for males, at any age, is nonsense, silly, and males should not be modest or have modesty issues is an old wives tale. I sincerely hope that these discussions at least get some of the readers pause ,to reconsider their positions and help move the culture to making change on a topic that is at best, unpopular with the medical arena. When we forget about the modesty of our charges, we loose a little bit of our humanity every time it takes place. When others observe your diligence in protecting the PT, we give them pause to consider how they do their jobs . Ignoring the culture and offenses perpetuates the abuse. I hope I mad some sense here. At the end of the day, I know everyone here only wants what is the best for our PT's, and an analysis on what we do and how we react to our environment is a huge step in the right direction.

[ImaWonderer]

Great Post CaDad

I have to say that I agree that yes Doctors/nurses etc see people at their best and worst. Yet so do police officers and they should not be able to use their authority to abuse people. Social Workers see and know the best and worst but they can not use the information they have and blab it to everyone in their neighborhood. Pastors hear peoples confessions,regrets,mistakes and also know the best and worst in people but shouldnt be able to use that information to belittle another human being. Since you mentioned the example of seeing objects in God Knows what orifice...yes okay I got you. When it crosses the line for me is when pictures get taken with the cell phone, x rays get passed around just for laughs, a whole gang gets brought in to "assist" wink wink. Just curious as to why this is allowed to happen.I can think anything is hilarious,disgusting,unimaginble,bizarre and just right out stupid and thats fine but that person is still a human being..... if those things throw you then perhaps you should work in a flower shop.

the golden Rule would save patients a lot of embarrassment and anger...again recognize gender at least as a valid issue,close curtains,knock on doors before entering,realize that just because you are a "shadow" the patient can still see you. Just think if you were the person with your back out in the gown and told to remove your underwear in a room filled with fully clothed staff asking you everything from the number of sexual partners to when your last period and/or bowel movement was your perspective is different.

Just saying from the patients point of view this can be embarrassing,humiliating and traumatic.Medical people see this all the time so its no big deal. To the patient its often a different story.

[PetiteOpRN]

I work in a surgery center where the vast majority of our procedures are done under conscious sedation, so my patients are awake when I prep them. The key for me is patient comfort.

I meet my patients when they come in for their initial visit. They have a chance to meet me, and discuss the surgical procedure. I encourage them to ask questions and try to give them all of the information they'll need for surgery.

Before taking the patient into the surgical suite, I warm my prep. If the patient is cold, everything seems worse: the prep seems longer, and the patient feels more exposed.

When the patient comes into the surgical suite, I let them take a look around and get comfortable before asking them to disrobe. I keep them as covered as possible. As others have said, keep the patient informed: tell them what's going on before and during the prep.

I think it is helpful to talk to the patient to distract them. It takes 3 minutes for chloraprep to dry, but it feels like forever. Asking simple questions like, "how was your drive this morning?" seems to help the patient relax and the time to pass more quickly.

[tbrd450]

DonMD: I want to sincerely thank you for participating here. You articulated the issues around the modesty double standard so well. Please don't discount or minimize your potential impact here, or in other forums, when you speak up. When someone like you summarizes so well the very real double standard that we all know exists, and you additionally provide real life examples, and you do so with the "MD" on your business card, you provide legitamacy and credence to the issue. You were dead-on accurate in your post -- on all points! You probably don't realize this, but for me, your words reflecting that laser-like analysis illuminating the very real double standard in the medical setting, and society in general, have been therapeutic for me to read and digest. You have validated my feelings. I didn't respond right away, despite wanting to, because I wanted to see how others responded. As a conscientious male medical doctor, you have unapologetically provided legitamacy and validation for the very real feelings that come to us on the losing end of that double standard. Whether we as males having directly experienced the negative impact of a double standard, or our sisters who are tuned in enough to have recognized it when it happened, you have delivered us a powerfully accurate message. What I have learned from the great agents of change in the past -- the pioneering feminists and the civil rights leaders -- is that change often has to come one complaint at a time, one voice at a time. Many true feminists have long ago acknowledged that female privilege exists in a patriarchal society. It is damaging to both men and women. Just as men have had to struggle with relinguishing their male "rights" and privleges to better jobs, higher salaries, and reserved seats at the table, so too will women have to begin to struggle with relinguising the myriad of daily privleges that simply come with being female. All this, on our journey toward true equality, respect and dignity for everyone. As men begin to apply the very same feminist approaches to voicing male concerns, injustices and everything in between, the platforms of social interaction between males and females will necessarily have to change. I'm quite sure male modesty consideration and equality was not on the minds of the pioneering feminist activists and authors decades ago, however, they laid the foundation for it later becoming a legitimate issue worthy of dialogue. Many of the equality standards that young women now enjoy and take for granted, were initially deemed trivial and "silly" by society years ago.

I did not know that about the Abu Ghraib strategy -- I did not know that the Pentagon (or whomever) authorized the sexual humiliation of males (men and BOYS) because it would be "tolerable," whereas the same done to females would clearly be viewed otherwise. This is about as perfect an example of the double standard as could possibly exist. the fact that it is recognized and exploited by the leaders of the free world leave little doubt that it exists. And, then you explained that it was not only deemed "tolerable" but also the very strategy/approach that was identified and recognized as the ideal way to break men and boys. What does that really say about society's value placed on males? I fear what that really means about our societal value of male worth, universally.

DonMD: In your eloquent post, you illuminated various real life medical environment examples of the double standard at work. However, nobody subsequently posted anything addressing that (the double standard) -- everything was about me not being qualified to have an opinion, and the recognition that all patient modesty is a concern, and the inability/impracticality of providing same gender care providers when requested by males, etc. Nothing, specifically, about the double standard. There are many things that could happen far short of providing a team of all males care providers. Nothing about the double standard working against male patients when it comes to everything short of accommodating a male provider team -- things like the lack of concern for covering male patients prior to, during, or after surgery (as compared to the consideration afforded female patients); the lack of consideration and concern for covering male patients during transport (as compared to the consideration and concern afforded female patients); the lack of concern and consideration for ensuring the social worker that is pulled off the hospital floor simply because she has a hosp ID to help with a male cath is, in fact, a nurse (as would clearly be the case were the patient female). All the respondents thus far have been focused, it sadly appears, on redirecting away from that double standard topic... why? Why do you think that is happening?

DonMD, again, thank you. I am very interested in hearing more from you. Please continue to articulate these issues and concerns regarding the double standard. Please continue to provide a voice for the men and boys out there that have been socialized to remain silent on these issues. I am curious, what do your female MD colleages have to say about this? Do they generally agree? Any out there reading this, .. please chime in. I am very interested in hearing what, if anything, they do in their practices to address the male modesty consideration double standard.