Patient Modesty

ewattsjt · Dec 26, 2006

Maybe my previous post was taken wrong. We do not do intra operative pelvic exams and do not have med students here so I can not comment on that part of the post.

We do give the patient the up most respect for their privacy and decency. Nothing is ever exposed that should not be and is only exposed after induction if a general is given. Everything is explained as prior to it happening. I am a male, so I have a female in the room place electrodes on female pts. when possible.

The other side of the coin is where I am coming from. As I said before I am a male, so when a female patient accuses me of possibly exposing them, so the accusations could snowball into something totally different. So yes I am very defensive.

The patients, who do complain, do so afterwards. It is something that can not be changed. It can only be voiced with concern of why it was done.

If a diagnostic laparoscopic procedure for possible endometrial adhesions is performed, it is AORN standard that the prep is from thigh to nipples and side to side. So nipples have to be exposed and so does the lady parts for placement of the humi or other uterine manipulation device. The patient does not understand why her nipples were exposed when the trocar placements were in the peri-umbilical region. The patient awakens to find some missed scrub by her nipple and wants to know what it is; then refuses to understand and accuses that the staff exposes her unnecessarily. No matter how it is explained afterward, she insists that it should have been told prior to instead of calling it a standard procedure or practice.

As I said in my previous post, it would take a day to tell the patient of everything that will happen and why. That is why it is listed as a standard. I am for the patient receiving as much information as possible but I am also realistic as well.

cvrnfa · Jan 11, 2008

As professionals in the operating room, we as nurses should make every attempt to preserve patient dignity and modesty. At our hospital, we keep the patient covered until it is time for the surgical prep. Although our patients accept the fact that complete modesty is not possible, they put their trust in us to see that it is taken care of for them in a professional manner.

ewattsjt · Jan 12, 2008

Actually, I have had several procedures done and it is also the reason for me coming to surgery (it was all before becoming involved in health care). I trusted that the people doing my procedure would be professional. Being in the health care setting; I see that they are when it comes to things like modesty. So I still stand by what I had written.

I do think if something is specifically asked for, it should be granted or explained why it can not be (ie. where I work, when a woman asks for an all female team ,they get it. When a male asks for an all male team, they do not get it. It is told to them that there are not enough men employed to do so). If they are still uncomfortable with the staffing issue, they can cancel the surgery.

Modesty is to be respected to the up most but there is a necessary exposure level to ensure the surgery goes well without complications. To be covered as much as possible is not too much to ask but aren’t all patients covered in this manner? If not, you violated them.

GadgetRN71, ASN, RN · Jan 12, 2008

I try to maintain the patient's modesty as much as possible. That said, I have had quite a few patients come up for major procedures with their underwear on and then they are shocked that the undies have to be removed(foley catheter). Or the middle aged woman who came in for a cysto and was horrified that she was going to be in stirrups and the surgeon was going in through her urethra. This woman had no clue of what the surgery entailed.

We simply don't have the people on my shift(evenings) to accomodate preferences for staff of a specific gender. I don't think that particular practice should be encouraged anyway-just makes it that much harder to run the schedule when there is a shortage of OR nurses(at least in my area) to begin with. I think most reasonable people kind of know that when you have surgery, people may see your private parts. Like I said, I protect the patients privacy as much as I can, but sometimes, the staff may see you naked. (especially for laminectomies. the gown is completely removed so that the patient can be flipped onto the wilson frame) Oh, and I have had several major abdominal/GI surgeries and one cysto, so many of my coworkers have seen my naked fanny as well as my vajayjay...I have no modesty left, but personally, I find that kind of freeing. I also have no problem with patients being educated about their procedures, but the surgeon needs to do that. I don't have the time to be explaining every single step of the prep and obtaining permission to do my job from someone who's "shy" . If the surgeon explains what is going to happen before the surgery, anyone who is uncomfortable with being seen by the staff can cancel.

Just so you guys know, I have been known to tape blankets up over every last window in the OR suite to protect my patient. We've gotten teenagers that needed to have their underwear removed to do the surgery but before taking the child to PACU, I will put the underwear back on so they don't freak out...I believe that we must value the patients dignity. My problem is only with carrying it too far..as the poster above said, we need to be realistic also. I have worked with male RNs and techs that I would choose hands down to do my procedure(even a GYN one) because they are good at what they do, and compassionate. I also know fellow female RNs that I would not allow within 10 feet of me. I know those not in healthcare don't believe it, but when we are doing a procedure, we really couldn't care less how a patient looks naked. In my day, I did lots of Cysto cases. I saw more memberes than probably most hookers. When you have a procedure, you need to be able to trust the people taking care of you. IMO, if a patient can't do that maybe they need to postpone or cancel their surgery.

Scrubby · Jan 12, 2008

I take protecting my patients dignity seriously no matter what their religious considerations. There is no need to expose a patient before applying the prep solution so i make sure they are covered (also to help prevent hypothermia) until i need to paint so that the time they are exposed is shorter.

dutch92602 · Jan 20, 2008

I dont know how much this will help, but here's an interesting blog
Bioethics Discussion Blog: Patient Modesty: A More Significant Issue?

This site is more than interesting. It really shows how much people are offended with being handled by the opposite sex with regard to intimate and personal procedures. Nurses, in my humble opinion, are very wrong to assume that just because a nurse does things of this nature routinely as a part of the job, does not make it acceptable to the patient. It is NOT okay with many people. Silence does not mean or equate to acceptance. People feel very intimidated and don't feel they can speak up. They feel paralyzed in a place that "controls" them. If more patients insist on having things done their way, the healthcare delivered will change. There is a double standard for men and there should not be. Men are not necessarily any more comfortable with having the opposite sex do genital procedures than women would be. Men deserve the same respect, dignity, and decency and choice.

GadgetRN71, ASN, RN · Jan 20, 2008

This site is more than interesting. It really shows how much people are offended with being handled by the opposite sex with regard to intimate and personal procedures. Nurses, in my humble opinion, are very wrong to assume that just because a nurse does things of this nature routinely as a part of the job, does not make it acceptable to the patient. It is NOT okay with many people. Silence does not mean or equate to acceptance. People feel very intimidated and don't feel they can speak up. They feel paralyzed in a place that "controls" them. If more patients insist on having things done their way, the healthcare delivered will change. There is a double standard for men and there should not be. Men are not necessarily any more comfortable with having the opposite sex do genital procedures than women would be. Men deserve the same respect, dignity, and decency and choice.

With all due respect, it is very easy to say that patients should insist on having things done "their way" when you are not a nurse. IMO, that is one of the huge problems in nursing today, the "customer service" mentality. Patients need to realize that the majority of nurses care about their patients, act professionally and are trying to do their jobs under increasingly difficult conditions. There are not all that many male nurses(something like 95% of nurses are female) so finding a male nurse to prep an overly modest male(or a male with an insecure wife) is going to be difficult. I do agree with you that there should not be a double standard. Both genders need to realize that the OR staff tries to keep you as comfortable and safe as we can, but we cannot accomodate every little whim/hangup/phobia that a particular patient may have. Done here with this topic, because I'm sick and tired of having the implication made that we OR nurses are somehow inaapropriate or unprofessional for doing our jobs.:angryfire

DutchgirlRN, ASN, RN · Jan 20, 2008

I've never seen a "naked" person in surgery. Partially uncovered and then draped, yes "naked" No.

I have heard of patients requesting an all female crew and they do comply. I am personally not that modest. I don't have anything anyone hasn't seen before and I know that I will be treated respectfully while I'm in the OR even though I am anesthetized. I've had breast surgery and gynecological surgery in the hospital where I work.

When it comes down to it I know I can trust these people to take the best possible care of me. If I go to another hospital I wouldn't have a clue as to quality of their staff.

When I went to the surgeon (a doc I worked with on the floor) prior to my breast biopsy, it was so funny. He came into the exam room. He was unusually quiet and seemed to be uncomfortable about examining my breast but was doing his very best to be totally professional. He was looking me straight in the eyes and asking me "so how do you like working on the floor, what do you think of this, what do you think of that". I said "Dr. Smith I think you're uncomfortable but please don't be, it's a boob, just a boob, we all have them, it's not bothering me at all". Then he laughed and was able to be totally relaxed. When it came time to have the stitches taken out, the day prior to my appt I saw him on the floor and asked him if my friend could go ahead and take my stitches out at work. He said "oh yes please, that would be great". We both laughed.

aquarius1 · Jan 20, 2008

I don't take the patient's cover/gown until the surgeons are ready to prep...it's the least i can do in keeping the patient modest once inside theatre.....:nuke:

ayla2004, ASN, RN · Jan 20, 2008

Would you consider my request too demanding?

having spent some weeks in the Theater(OR) as a student i think you request is valid, i would certainly expect to be cvered and kept warm once the area to be operated on was isolated. and staff should be disreet in their converstaions

dutch92602 · Jan 20, 2008

With all due respect, it is very easy to say that patients should insist on having things done "their way" when you are not a nurse. IMO, that is one of the huge problems in nursing today, the "customer service" mentality. Patients need to realize that the majority of nurses care about their patients, act professionally and are trying to do their jobs under increasingly difficult conditions. There are not all that many male nurses(something like 95% of nurses are female) so finding a male nurse to prep an overly modest male(or a male with an insecure wife) is going to be difficult. I do agree with you that there should not be a double standard. Both genders need to realize that the OR staff tries to keep you as comfortable and safe as we can, but we cannot accomodate every little whim/hangup/phobia that a particular patient may have. Done here with this topic, because I'm sick and tired of having the implication made that we OR nurses are somehow inaapropriate or unprofessional for doing our jobs.:angryfire

It is not every whim or fancy. It is a patients' right not to be handled by the opposite sex. OR's should discuss this ahead of time with a patient and if it is elective surgery then a patient has the option of going elsewhere.

core0 · Jan 22, 2008

It is not every whim or fancy. It is a patients' right not to be handled by the opposite sex. OR's should discuss this ahead of time with a patient and if it is elective surgery then a patient has the option of going elsewhere.

Its not a right to make unreasonable demands which is what that is. The assumption seems to be that nakedness is the equivalent of a sexual display. In medicine that is almost never the case. Nakedness is part of what we do and it isn't something that we pay attention to.

In our rooms we wouldn't even consider a request to dictate the operative team. Asking that would probably be a huge red flag that you are not a surgical candidate. And yes you have the option of seeking other providers. To be charitable most of our patients have been in the medical system long enough that modesty is no longer a consideration.

Surgery is a team effort and you want your A team. Trying to dictate the team composition of something you know nothing about is almost certainly going to guarantee that your team is not composed of the optimal members in terms of experience or technical ability.

I've read some of your other posts. I understand that you feel that something wrong has been done. What you need to understand in medicine (and surgery especially) is that Nakedness is not the same as sex.

David Carpenter, PA-C