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.

[Susie2310]

To Altra,

Altra said:

As a nurse, I ask the patient questions for which I am interested in his/her answer. And observing the patient's ability to answer questions gives me important information about the patient's mental status. If I have any doubt that I have complete information, I will then seek out additional sources of information, including family members present.

Perhaps ambgirl2nurse's post above will encourage you to reconsider your self-righteous statement.

[deftonez188]

I have spouses/etc. leave unless the patient requests they stay. They have their right to privacy as well, and maybe they don't want their significant other knowing some pertinent details regarding their stay. Case in point, what about the man who came in with a 'bowel obstruction' self-imposed that the little old lady wasn't to catch wind of?

[ClearBlueOctoberSky]

I don't think Altra was being self-righteous, and I understand the need to assess the patient completely for yourself, and not rely on the family members completely.

I also understand the need to get family members out of your way. I have done it on more than one occasion.

I guess my point was that sometimes, it is beneficial to have a family member therem or at least do a secondary interview to get their view of what the problem might be.

[Altra, BSN, RN]

ambgirl2nurse said:

I don't think Altra was being self-righteous, and I understand the need to assess the patient completely for yourself, and not rely on the family members completely.

I also understand the need to get family members out of your way. I have done it on more than one occasion.

I guess my point was that sometimes, it is beneficial to have a family member therem or at least do a secondary interview to get their view of what the problem might be.

I agree with this completely.

It can be helpful to remember, also, the amount of objective data that is going to be obtained through labs, diagnostics, etc. A patient and 15 family members can all attest that the patient is/is not taking Coumadin, using sliding scale insulin as prescribed, etc. ... but the PT/INR and the HgbA1C will tell the story without the complications of family dynamics.

[Susie2310]

Altra said:

As a nurse, I ask the patient questions for which I am interested in his/her answer. And observing the patient's ability to answer questions gives me important information about the patient's mental status. If I have any doubt that I have complete information, I will then seek out additional sources of information, including family members present.

Edited to add: Patient assessment and filling out an admission database is not simply filling out a form and checking off boxes. During a conversation with a patient, I am assessing not only his/her basic history and current symptoms, but mental status, emotional state, his/her understanding of primary disease process and co-morbidities, and getting a feel for the individual's perceptions and attitude toward treatment.

I hope this better explains why it's important to speak with the patient.

Altra, I'm afraid your explanation doesn't address a situation such as mine and my husband's, although it does address a textbook situation. I hope both my husband and myself continue to encounter nurses who have some compassion, flexibility and common sense in dealing with life and death.

[Altra, BSN, RN]

The textbook situation would be filling out the form/checking off all the boxes.

But of course, you & your husband's situation is different.

[jadelpn, LPN, EMT-B]

I have literally have a husband tell me that he did NOT "fall down stairs" but that his wife needed help, as she was abusing him. That would not have been said if the wife was in the room. I have had husbands disclose meds that they were on that the wife was unaware of. I have had wives who were on meds that the husband was not aware of. This goes deeper than "modesty" and the "overuse" of HIPAA to attempt to be convenient or hide some sort of substandard care. This has everything to do with needing to get an accurate history, assessment.....even had a husband once say he took ED drug (that wife did not know about) and was having an angina attack.....nitro is of course, contraindicated. I have also had patients say that their spouse knew ALL about their meds and history, therefore, after the physical assessment, and the releases are signed, I do include a spouse. But patients have rights, married or not, involved family or not.

[Meriwhen, ASN, BSN, MSN, RN]

I work in psych. No way in hell would I conduct a patient assessment with the patient's family in the room. The reason being is that in my experience, the patient and the family often have very different takes on what's going on. In addition, the presence of the family may make the patient reluctant to share information, or they may try to minimize/distort/outright lie about it. But most often what I encounter is that the FAMILY MEMBER is the one who's answering most of the questions.

Or family members get angry when things aren't going the way they think it should--I had one mother upset because her son was released from a 5150. It's not our fault there was no justification to continue the hold, but she was expecting that he'd be held for several days, so she unleashed her outrage at us. I can't even count how many times "caring" family members have been verbally abusive to me because they and the patient/patient's doctor don't see eye-to-eye on something. It's like family members think that psych patients have no rights so whatever the family wants should take precedence over what the patient wants.

This doesn't mean the family's input is important--it most certainly is important. I will definitely talk to the family either before or after seeing the patient. The extent of that conversation would be based on whether the patient signed a release and how involved they want the family to be. However, that assessment would also be conducted in private without the patient present for the same reasons given above.

My job is not to referee or take sides or judge. My job is to gather as much information as I possibly can, so I can give the patient the best possible care as I can.

So it's not personal if I ask you to leave.

[wooh, BSN, RN]

Everyone thinks that their situation is different. "Well of course *I* don't abuse my spouse. *I* know all the drugs my mother is on." It's not personal. It's like standard precautions.

You can tell me all you want that YOU don't have HIV or Hep C. I'm still wearing the gloves because there's absolutely no way to tell the difference looking at you whether you have HIV/HepC or don't. It's not personal, it's standard.

You can tell me all you want that YOU aren't someone that needs to be kicked out of the room. But the person that's throwing dad down the stairs? That's kicking their pregnant wife in the stomach? That doesn't know their husband is taking Viagra? THEY are saying the same thing. There's absolutely no way to tell the difference looking at you.

[One1, BSN, RN]

ambgirl2nurse said:

I have to say this. I am primary caretaker for my mother, who is alert and oriented and quite capable of taking care of herself, though that is a whole different topic. Maybe some mild confusion, but I am mostly in denial about that at the moment. I am her MDPOA. I go into her appointments and into the ER with her and I stay. I guess the point I am trying to make is, while she is more than capable of stating her history and for the most part taking care of herself (she primarily has mobility issues), sometimes, she isn't entirely truthful either.

In cases like yours I found that family members often approach me outside the room, or ask to speak to me privately. I appreciate the additional information/insight, but if the pt is AAO then I want to hear "their version" of what is going on. If the pt is not truthful about meds/history then that tells me something in and of itself that is important for my assessment. I prefer the differences in information to be discussed separately though rather than watching a family discussion evolve. If such differences in information exist, then that warrants a closer look into what and why is causing these differences in perception.

[Nurse SMS, MSN, RN]

One1 said:

In cases like yours I found that family members often approach me outside the room, or ask to speak to me privately. I appreciate the additional information/insight, but if the pt is AAO then I want to hear "their version" of what is going on. If the pt is not truthful about meds/history then that tells me something in and of itself that is important for my assessment. I prefer the differences in information to be discussed separately though rather than watching a family discussion evolve. If such differences in information exist, then that warrants a closer look into what and why is causing these differences in perception.

Exactly.

[Altra, BSN, RN]

wooh said:

Everyone thinks that their situation is different.

This.