Spouses being asked to leave the room

[Indenial]

Hi

I'm not a nurse, but I'm hoping someone can clear something up for me.

I accompanied my husband to hospital several times over the past few weeks, and a couple of things have really puzzled and slightly annoyed me.

First off, we went to see a consultant, who had to examine my husband's abdomen. The consultant asked my husband to remove his shirt and lie on the bed, so my husband started taking his shirt off as he was walking to the bed. The consultant hurriedly ushered my husband towards the bed, and closed the curtain as if trying to protect my husband's privacy (from me - his wife?!). I found that a bit odd, especially as he only had to remove his shirt. Does he not think I've seen my husband's chest before?

Secondly, when my husband went into the same hospital for a procedure, the porter asked me to leave the room whilst they (four people including two females) transferred my husband from the trolley to the bed.

In both these situations it struck me as a little odd that a spouse would be asked to leave, and I felt a bit annoyed that the staff wanted to shield him from me, as if me being there would upset him somehow. When in fact he would feel no loss of dignity or privacy if I saw any part of his body at any time.

He is more comfortable with me seeing his body than anyone else in the world, especially female hospial staff. If he was going to suffer any loss of dignity, it would be from them seeing him, not me.

I should think that would be the case for most couples (except perhaps the odd vicar / nun combination).

Shouldn't the patient be asked?

All staff knew we were married, because he introduced me as his wife to all staff members who assisted him.

I realise I'm taking this way too personally, andpeople will think I'm getting upset over nothing. I've tried to put this out of my mind, but unfortunately it's not going anywhere, and I'm hoping someone can enlighten me as to the rationale behing asking spouses to leave in the situations described above. It might help me feel a bit better.

I don't want to ask the hospital, because they might think I'm neurotic and paranoid, which I am due to a couple of mental health conditions.

Thank you for reading; I hope someone can help.

[Altra, BSN, RN]

This is something of a pet peeve of mine:

I am caring for your family member. In order to do that, I need to be able to move freely throughout the room.

I cannot think of any instance where I would fail to give someone the physical space to do their job.

And, OP, I mean this gently, I really do: the people taking professional care of your husband need to be able to assess him and his symptoms ... not your interpretation of his symptoms. Your comment of how he was somehow unable to communicate due to having pain just doesn't fly. I've been married to my spouse for 20+ years ... trust me, not everything is a shared experience.

[One1, BSN, RN]

Altra said:

And, OP, I mean this gently, I really do: the people taking professional care of your husband need to be able to assess him and his symptoms ... not your interpretation of his symptoms. Your comment of how he was somehow unable to communicate due to having pain just doesn't fly. I've been married to my spouse for 20+ years ... trust me, not everything is a shared experience.

I agree with Altra. Sometimes spouses/family members mean too well and think that it is better to answer the questions addressed to the patient instead of the patient, maybe because they feel that the patient is too distracted by the pain. However, this is not helpful to us since we want the patient's answers to our questions, and at times we end up having to ask well-meaning family members to step out of the room while we do the assessment or take the history. If we need additional information the patient cannot give us for one reason or another, and the patient agrees, then we are happy to ask the family member for that information.

[psu_213, BSN, RN]

One1 said:

I agree with Altra. Sometimes spouses/family members mean too well and think that it is better to answer the questions addressed to the patient instead of the patient, maybe because they feel that the patient is too distracted by the pain. However, this is not helpful to us since we want the patient's answers to our questions, and at times we end up having to ask well-meaning family members to step out of the room while we do the assessment or take the history. If we need additional information the patient cannot give us for one reason or another, and the patient agrees, then we are happy to ask the family member for that information.

I have been in situations where a family member is in the room and you will ask the pt a question...say "where is you pain and what does it feel like." The family member will then chime in with "he has a stabbing pain on the right side of the chest." Back to the pt, I say "does it hurt anywhere else." Family member "I already told you where the pain is." Now, I'm not saying that you would have been that family member, but it is better to politely ask the family to leave before you start rather than get into that situation.

There are many more reasons why the person might have closed the curtain and shut you out...try not to take it personally. Pretty sure the provider was not trying to make it personal.

[psu_213, BSN, RN]

not.done.yet said:

Yeah, I had the same thought. PRoviding privacy becomes a reflex.

About a year ago I was visiting friends who just had a baby girl...the baby was in the NICU. While there, they had to change the infant's diaper. When they started, I turned and closed the curtain. They looked at me and said "Really??!" I said "sorry, just habit" (though afterward, I still thought it was appropriate to close the curtain...oh well).

(For those who are wondering, the baby is now a happy and health one year old.)

[NicuGal, MSN, RN]

I would want someone to preserve my dignity, even in front of my spouse. Yeah, we may share a lot of things, and he has seen me naked and vulnerable (think childbirth lol), but sometimes that little bit of privacy to get my hospital gown on or get on a different stretcher sans panties...well, that is okay :)

And when we ask the patient a question, to have the spouse answer isn't really okay, most of the time. We are getting a feel for the patient and we need to know how they are feeling, etc. Nothing personal :)

[Sacred eagle]

I once saw two female nursescath an unconscious malepatient in full view of anotherfemale patient. No attemptwas made to pull the curtain. It's interesting how some staff behave when the patienthas an advocate in the roomand how their behavior quicklychanges.

[Wrench Party]

Pulling the curtain is automatic; it's drilled into us in nursing school. There

have also been times when I have had to ask a family member to leave

the room, quite bluntly, because of comments concerning the patient's condition-

now how can your loved one accept the change to her body (an ostomy)

when you are saying how you can't look at it? As if she's not obviously aware of it

herself?

[Susie2310]

I am an RN; my husband has been hospitalized several times for serious conditions, and sees multiple doctors. I have been present with him day and night through his hospital stays, either on a cot in his room, or sleeping in a hospital lounge, and attend some of his medical appointments with him. I fully understand HIPAA, and the responsibilities of the nurse. For the most part the staff have been reasonable in accommodating my wish and that of my husband's, for me to be with him. I have stepped outside when asked by the nurses to have time to settle him; I have waited outside the curtains after the nurse respectfully explained the need to do an assessment. For the most part, everyone was considerate of everyone else. I do recognize the need to tread carefully on the part of the family member, and I do tread carefully, although I will certainly speak up if I observe substandard care, as I am sure all nurses would expect.

I do think that the application of HIPAA needs to be done with intelligence and sensitivity. The intention of HIPAA is to protect the patient's privacy, not the nurse's or other providers convenience. I think it is not really ethical to try to prevent a family member from being with the patient, using the pretext of HIPAA, just because you think they might complain about your nursing care, or because you perceive them as being difficult. If you are afraid they might complain about the care you give, give good care, document properly, and treat the family member with consideration and respect. If you perceive the family member as difficult, try to understand what is prompting their behaviors and find a way of working with them. If a nurse had asked my husband whether he wanted me to be present with him when he had been medicated with morphine or dilaudid, he may have given a different answer to the one he would have given when he was not influenced by a mind altering medication. Would you as a nurse take that into account? What would I need to do, having supported my husband through major illnesses, to convince you that I know he would want me to be present? Do you think a POA is not enough to demonstrate my husband's intentions and trust in me, even though it only applies when he can no longer make decisions for himself (which could potentially apply at many points during his care, depending on the circumstances)? Would I have to resort to an attorney? Very often family members, however suspiciously one may perceive them, are the major caregivers and support system for the patient. I want to be with my husband when he is hospitalized 24/7 because I love him and want to support him through his illness, and I know he wants me there. Also, I will be caring for him when he is discharged.

I do of course recognize that not all patients want their spouse/family members to be present at certain times or any of the time they are receiving medical care, and that legally and ethically the patient's wishes must be respected. The nurse's responsibility is to use HIPAA intelligently, respectfully, and considerately, for the sake of the patient and also their spouse and family members. I understand that studies show that patients with a strong support system have better medical outcomes than those that don't. I think that as nurses we should be facilitating that support system whenever possible, while respecting the patient's wishes.

[applewhitern, BSN, RN]

I always ask people to leave the room. Otherwise, I would never get anything done. If I want to ask the patient a question, I want to know what the patient has to say, not the wife, girlfriend, sister, etc. It amazes me when I try to talk to an alert, oriented patient, and the wife (usually the wife!) wants to do all the talking! I try to stare directly at the patient's eyes when I talk, to assess them, but if there is a family member in the room, you can bet that person will jump right in and try to answer every single question, as if the patient wasn't able to talk. We always ask everyone to exit the room when we are transferring a patient; there is no reason for anyone else to be there. Once the patient is settled, they can come back in. I want to allow my patient to feel like they are part of their own healthcare, and give them the opportunity to tell me stuff they might not say if other's are in the room. I have had patients who did not want their spouse to know they took viagra, and once I had a 21 year old woman who didn't want her mother to know she was pregnant. What about the female who couldn't tell me her husband hit her, because he was in the room?

[Dulce29]

Well i believe its a space issue since sometimes rooms are smaller .

But as far as your husband undressing and you being asked to leave , well next time have him say MY WIFE can stay.

I hope you feel better ;]

[JBudd, MSN]

We very nearly had a major med interaction (often fatal) because the husband didn't want to admit in front of his wife about his viagra use. They had both asked if the MI treatment was compatible with everything else he was on, and both the MD and I had reviewed his list and reassured them.

Just as I was mixing a rather expensive kit of meds he asked one more time. I turned around and said "unless you are on Viagra this is safe". He then said "well I am" and his wife was totally shocked.

I have had to tell people "I really need for (the pt) to tell me what is going on so I can assess where he is" (mentally as well).

[rn/writer, RN]

All of the above.

Some have mentioned this part, but I would like to elaborate. I work postpartum. Normally a happy place. But sometimes you just get a vibe that all is not right.

I will ask for visitors to step out--including spouse/partner--so that I can ask if the patient feels safe or has been hit or intimidated. Many times, abusers do not want to leave a patient alone, so that's a red flag. I have had several incidents where the only privacy I could get with the patient without raising a stink was to go with her into the bathroom.

Think about it. Someone who is being mistreated probably will not tell you anything about it with the partner in the room. And they may be very good at putting up a good front.

The couple of minutes away from family members may be the only window of opportunity for the patient to express her needs and for the nurse to tell her that help is available.

Not saying that this applies to the OP, but we're taught to do certain things habitually so that everyone gets screened, not just those who come in with a black eye or a swollen lip.