observers/students and pt rights

  1. I'm interested to hear how everybody handles all those extra people in the OR. When a pt is in any other hospital dept they meet everybody involved in their care- students, interns, job shadowers, etc. They have the chance to be upfront and say, no- I don't want students, for whatever their reasons. What about in the OR? I know this is part of our general consent, but is that good enough? I introduce pts to everyone in the room when we go in, but how often do student nurses, interns, and orientees show up mid procedure... for instance after another room is done or after a conference? How do you handle pts who may have refused? I'll admit, we have some "VIP" tendencies- staff might pick their own team of people they are comfortable with and we don't give breaks in that room to maintain a co-workers dignity. Sure, it's more significant to some people around people you know but don't our stranger-patients still deserve half that? Anybody have policies?

    Last edit by MissJoRN on Apr 24, '07 : Reason: typo
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  3. by   Marie_LPN, RN
    Student have to ask the permission of the pt., circulator, and surgeon to watch a procedure, and also to view the chart. Not allowed to come in 'mid-procedure.' That's our policy.

    And to me, i couldn't imagine NOT asking permission to observe someone's surgery. It's just common courtesy.
  4. by   MissJoRN
    Unfortunately common courtesy may be as common as commen sense. That's why we need policy committees and I'll be bringing this issue up with ours.

    Typically, out of common courtesy, we do introduce and ask, but there are times that the educators bring a student after a procedure has started.

    Marie, does your policy make any distinction between students "belonging" to the hospital (such as a ST program), the surgeon, or outside programs?

    What about orientees vs students? Same thing or not? Ideally we wouldn't even change shifts without aking a pt aware- in the awake areas of nursing, don't we hurry to tell our pts who we are, we just came on duty, and how long we'll be working today? But it's not practical to tell an OR pt that, so if I'm precepting an orientee for 3-11, do I bring her in the room with me when it's time to relieve or wait until the next case starts?
  5. by   Marie_LPN, RN
    Our dept. orientees are permitted in, since it is considered part of their training. That's the only distinction. I think our policy uses the phrase "people who are unnecessary for a procedure" or something like that.

    We had one doc who attempted to bring his 19 year old daughter in on his cases because "she wants to watch." She wasn't in school, wasn't involved in anything that needed an OR trip. And of course he thought his idea was the exception to the rules. But it wasn't, and she wasn't allowed in the OR, since she had no academic or employment related reason to be there.
  6. by   Natkat
    I did my rotation this week, and at the hospital I'm in, every patient is asked if they want to have photos or video taken or if a student or intern can observe their procedure. They ask this on the consent form. When I was getting ready to watch a case we looked in the patien'ts record to make sure they agreed to letting a student watch before I went in to watch the case.
  7. by   mcmike55
    I work at a rural, 3 OR hospital. So, many times, we must watch who is in the room, as they could be close friends or family members, which are not allowed.
    We have at times, lots of students, paramedics, RN students, scrub tech students, student physical therapists, x-ray students and even sales rep students.
    Students are worked through our education dept, the schools involved go through a process with them, then both are in contact with our supervisior, a schedule is set up, etc. We keep the number of people down in the room. One to one is ideal, and we try to stay on that ratio.
    Before any student or rep goes into the room, they have to read and sign a form that says essentially, that they understand basic sterile technique and OR operations, they take responisibility for their own actions, and that they can be asked to leave or not admitted to the room at any time at the descresion of the operating personnel.
    When I have a student with me, I normally introduce them to the pt in holding area, and if that pt has issues, the student won't go in. I rarely have had any problems, most pt's know they have to learn and we are not "practicing" on them.
    Students are also told to initially lean on a wall, and eventually, we will get them into a good position to see. I try to put them in an area that they can see everything, and ask them to watch, and see what we are doing, and why, and if they have a question....ask.
    I like students to give and take when possible. Makes them think, and us too.
    They also are told that if the "manure hit the air conditioning",,,again, put your back up against a wall, and watch!
    I rarely feel the students are an intruder, we've had a few that felt they needed to impress us with what they knew, which I dislike. Yes, they may have more knowledge than me in some things, but that's not what they are here for today. They are basicly here to watch, and learn from us.
    Hope that helps.

  8. by   MissJoRN
    thanks, mike. and if anyone else is interested, this is the ama standard. i'm off this week so i don't have an aorn standards handy- i'll look into that when i go back.

    e-8.087 medical student involvement in patient care

    (1) patients and the public benefit from the integrated care that is provided by health care teams that include medical students. patients should be informed of the identity and training status of individuals involved in their care and all health care professionals share the responsibility for properly identifying themselves. students and their supervisors should refrain from using terms that may be confusing when describing the training status of students. (2) patients are free to choose from whom they receive treatment. when medical students are involved in the care of patients, health care professionals should relate the benefits of medical student participation to patients and should ensure that they are willing to permit such participation. generally, attending physicians are best suited to fulfill this responsibility. (3) in instances where the patient will be temporarily incapacitated (eg, anesthetized) and where student involvement is anticipated, involvement should be discussed before the procedure is undertaken whenever possible. similarly, in instances where a patient may not have the capacity to make decisions, student involvement should be discussed with the surrogate decision-maker involved in the care of the patient whenever possible. (v, vii) issued june 2001 based on the report "medical student involvement in patient care," adopted december 2000 (j clin ethics. 2001; 12 :111-15).

  9. by   ewattsjt
    here, the student is considered different form the orientee. the orientee is considered a part of the or team since they are an employee of the hospital.

    observers (students) have to be in a program that is relevant to the medical field. the patient, anesthesiologist, and surgeon are asked if students are to be permitted. the rest of the room staff is mandated to accept the students as we are a teaching facility. there are exceptions to this; such as the student doing something they are not supposed to etc... in which case they are told to leave the room (ie. i had a surgical tech student to contaminate themselves and deny it. i made her leave, then i told my supervisor that i could no longer trust her because i felt she was a danger to my patients, so she was not allowed into my room again).

    students are not allowed to view the patient’s chart unless it pertains to their study (ie. a paramedic student who is learning to intubate has no business going through the patient’s chart while a nursing student needs to learn where things are located in the chart).