Patient modesty concerns pertaining to surgery - page 14

Want to get feedback about how we all handle pt concerns about modesty and/or being naked as part of surgery. Concerns about who sees them and for how long? Why do they need to be naked? When is the... Read More

  1. by   advo-kate2
    ".how about cases where the blanket never goes below the hip, the gown never above nipple line and no foley needed, then what? do we still have to rearrange schedules to do surgery on a wrist or an ankle??"
    good question sandracvrn.
    the quick answer would be that those people who care about who they expose themselves to ( most people i know) would be looking for a guarantee, and that's not easy. even explanations here differ as to the level of exposure for almost any proceedure, and there are varying levels of "full" disclosure posted here as well. so long story short, if you could honestly tell a wrist or ankle patient that there would be no intimate exposure then that may be enough to mitagate a circumstance of mixed gender team.
  2. by   tbrd450
    There is room for improvement across the board when it comes to modesty consideration. That is true for female patients, male patients and everything in between. However, I have clearly been harping a lot on the gender double standard aspect/component of this modesty issue. And, for what it is worth, I would like to explain that.

    As a middle aged man now, I have grown within my own skin for a lot of years, and I have analyzed the issues for some time. I am now somewhat immune to mistreatment while conscious in any medical setting. If I visit the doctor's office nobody will behave inappropriately, nobody will be leaving doors open and nobody will be requesting I expose myself unnecessarily. I will speak up and question it. I already have. Nobody will be in the room that doesn't need to be there. If I need surgery at this point in my life... same holds true. My doctor will be explaining everything to me beforehand, step by step. I will speak up. I already have. At first, I got a little backlash on this... a little antagonism, but I have always been able to shut that down quickly with some well-timed, well-placed, accurate responses that usually does the trick nicely. I am always respectful and tactful. I simply make it clear that I expect the same level of consideration for my modesty that would be extended to the most modest female patient they ever encountered. The folks at my doctor's office respect me for that, I think. I don't think I care too much if they truly don't.

    However, there was a time in my life when I was in such awe of doctors, nurses and those in authority that I was really just at the mercy of whomever I encountered on my medical visit or experience. If he/she was highly moral, ethical and considerate, then I got the treatment and respect I needed and deserved (most of my experiences). If he/she was having a bad day, in a bad mood, mad at males that day, etc... then I didn't (rare experiences). I had no voice on this, back then. I took whatever I got. My most troubling, embarrasing and hurtful experience I ever had on this occured when I was a young teenager. The details are not important. However, it is clear to me now that the experience served to shape me into the person I am today in some possibly significant ways. When I relive that medical "care" experience in my mind -- I have many times over the years --I always intuitively want to reexamine it, reevaluate it and possibly view it through a new lens. I do that, I think, because I want to find an answer for it, a rationalization. I want to explain it away. I really can't without facing the truth. It should not have happened and it did not have to happen. What I now know with utter certainty after all these years is that the opportune stage for that negative experience was in place because of, and premised on, in very large part, my gender. It happened either directly because I, as male, was assumed to not be modest; or there were more nefarious/disingenuous intentions invovled but couched within the common false society-wide understanding that males are not modest (or not entitled to such nuanced emotion about our bodies). It happened under the veil of "he's a boy and it really shouldn't matter to him." Like most boys would have probably done, I betrayed myself. I played along. I swallowed my pain and I acted like it didn't matter. It did matter.

    I don't need nurses and doctors to re-think these modesty issues on behalf of me now... I can demand and ensure that wherever I am, just so long as I'm awake!. No. This isn't about me now. This is about me, then. That is why I now post here on this topic. There are boys and male teenagers, and even many adult men, for whom actively stating and demanding this consideration is an impossibility -- because of their gender. The feelings underneath, however, are very real. Somebody once said "still waters run deep".. for many males these feelings go deep.

    In general society has heaped a bunch of burdens on boys and men to close themselves in, swallow their injustices and abuses, and "man-up" to the negative experiences and embarrassments they encounter -- those that never really have to happen, but do. And, of the male population burdened the most, boys and male teenagers are particularly vulnerable to this. In many ways society says to them (and they to themselves) you must have the "man-up" responsbilities, but do so while enduring the insecurities and inadequate coping strategies inherent in childhood. I dont' believe these burdens are necessarily heaped on males by females or males in particular, but rather by society in general and the culture we live in.

    Our culture is one that has lead to a situation where boys grow up living with a much narrower scope of possible emotional response, outlet, and vocalized support. And, ultimately, they grow up with little available recourse to the subtle injustices permeating daily interactions across the gender divide. The little elemetary school girl who kicks her male classmate in the groin on the playground during recess, to get a laugh, because she saw it on America's Funniest Home videos, doesn't think there is anything seriously dangerous about that.. afterall, everybody laughed when it happened on TV!. It's not her fault. It's society's fault.

    Luckily, for girls, the past five decades of feminism has served to open the full range of outlet, expression, potential and opportunity. They are supported in their advocacy almost everywhere, including school curiculums. They are encouraged and groomed toward developing their voice, to speak up and demand respect and equality. They are taught to demand and expect modesty consideration anywhere and everywhere.

    What are boys taught? ... to respect girls. To extent them special considerations.

    Therefore, I continue to recycle this gender double standard issue here in these posts on modesty. It is there, it is real. And, it is detrimental to everyone but particularly to half the population.

    It is not enough to just conclude, for example, that patients generally warrant better and more considerate care when it comes to modesty. Instead, please conclude and state: patients, but particularly male patients, warrant better and more considerate care when it comes to modesty.

    Imagine us all climbing a hill. Girls and women are about three quarters the way up the hill. Boys and men are about one quarter way up the hill. The journey isn't over until everybody reaches the top -- respect, dignity and consideration for modesty, universally applied to all patients. True feminism isn't just about advancing women and girls, its about creating a harmonious society in which respect and dignity are extended to everyone.

    Don't wait for boys and men to find their voice. Speak up on their behalf. Don't wait for boys and men to begin cancelling their medical appointments in defiance (doing so will only help anyway if they then explain clearly why they are canceling them).

    Call the OR. Call the ER. Ask why they sent the male skater kid out without first covering him. Ask them to not make that mistake again. If they respond with "well, he didn't say anthing about it"... then reply: "I'm saying something about it now!"

    Pull the doctor aside and ask him/her why he/she imagined for one remote minute it was appropriate to allow so many unnecessary people in the room during the procedure. If he/she responds by calling you silly for bringing it up, then respond with "No, in so doing, you are being inconsiderate and unprofessional!"
  3. by   RetRN77
    Quote from tbrd450
    I think the hospital doctors and nurses are maybe just de-sensitized to the whole nudity thing. How could they not be after so many cases they worked on. And, consequently, it can sometimes seem trivial and unnecessary to ensure modesty at the standard of the still-sensitive, typical general public patient. The doc that popped in to talk about the TV show, he probably wasn't thinking anything about the naked patient. He probably wasn't looking at it from her perspective. That just means he was being careless, not abusive or anything beyond that.

    I hear and read conflicting points on this. On the one hand, I hear that staff do sometimes talk about a patient while he/she is under (breast size, penis size, etc.). Then, I also hear that everyone is always professional and strictly clinical. I suspect the truth lies somewhere in the middle
    It may seem "trivial and unnecessary" to those providing patient care, but it never should be so. Patients have a right to their modesty, and just because a nurse or doctor has no such sensitivity, he/she should never assume that the patient does not. Even worse is to assume that a patient has no defensible reason to have expectations of modesty being preserved.

    One never knows who has been sexually abused, so please do not ever trivialize a patient's need to avoid unnecessary exposure.

    It was always a strong tenet in training that lax attitudes, most especially including not discussing patients' anatomies, much less in a derogatory fashion, is the height of a lack of professionalism. Perhaps those who see it as such a negligible issue need to spend some time as patients themselves.

    As one who has suffered her share of indignities, as well as her share of truly thoughtful, heartily appreciated treatment, I find this a real hot button issue, so I'm sorry to come off so indignant. However, that I am!

    And, bravo, to the poster above! Well said, and much food for thought.
    Last edit by RetRN77 on Jun 16, '10
  4. by   RetRN77
    Quote from TDCHIM
    Okay, a few years ago when I had my son, I had to have a cesarean. (And NO, before anyone yells at me, I did not "decide" to have one - my spine is such a mess that I had a high-risk OB, a top-shelf neurologist, and the anesthesiologist on my case all look at me individually and turn pale when I brought up the possibility of natural birth. Even I knew an epidural was out of the question from the start.)

    So I went back for prepping and was kept there longer than expected because my OB/GYN had some sort of emergency - which I didn't mind at all. I was shaved, and the nurse explained why; as a multiple surgery veteran, I knew that was going to happen and why. She also offered to wait on the cath until I was out, which I really appreciated.

    But then they took me out to the OR and another nurse yanked off my gown without so much as a word to me, let alone telling me why it had to go off then or how long I might have to lay there freezing and exposed to the world, without even so much as a drape over my nether regions. Then the same OR nurse put me in restraints and left me there - again without a word to me! I didn't even KNOW I had to have them - no one had ever said a word to me about that sort of thing! And the doctor was still busy with his emergency case, so I lay there for the nine longest minutes of my life (I got to watch the clock), no one talking to me and only one or two people around until the last second before I was knocked out! I was terrified, hurting (because I was having to lay totally flat, which is incredibly painful for me due to my disability), and I'd never felt so alone in all my life. When my doctor came in and saw the look on my face, he was furious.

    So unless someone can tell me why it's necessary to treat a patient like that, I'd like to register that style of treatment as officially traumatic for the patient.
    Ridiculous! No excuse! Something is seriously wrong here - no need to leave a patient exposed like this, especially as the "nurse" removed coverings you already had. Just the fact that you unavoidably became chilled for no reason whatsoever, beyond the abusive exposure and uncomfortable position given that she should have informed herself regarding your case, shows a stunning lack of concern for your well-being. Personally, I think that person should have been reported.

    There really is no reason to leave a patient naked and restrained before a c-section - especially one which is not an emergency. The patient's temp needs to be preserved not only for her sake, but for the baby's as well. Post delivery, the patient is generally hypothermic as it is. During the section, the patient needs to be draped and covered - I could see if she *might* have taken off your gown in advance and then provided you with warm blankets during your wait, but what was done was unnecessary and inexcusable. There is no reason to leave a patient completely naked. At the most, prepping the actual surgical area and leaving it exposed would be all that is necessary beforehand, and then only a few minutes before the procedure - and it seems she did not actually prep you at all, except for the restraints.

    Perhaps in an emergency, if blankets were wet and soiled, someone might remove them and leave a patient while seeking fresh ones, but even then, it is unnecessary. The practice is to leave the blankets on until you have the clean ones in hand. Really, this was beyond bad practice. I hope your physician reported her for her ridiculous abuse of you.
    Last edit by RetRN77 on Jun 16, '10
  5. by   RetRN77
    Quote from brokenvessel
    Three stories to share...yes, three... after the vaginal delivery of my second baby (not a nurse at the time) the Dr told the nurse to "put her under". No explanation given, just "put her under". I worriedly turned to my husband to ask him to pray for me, because I was SCARED, and one nurse grabbed my left hand, restrained it, as the other nurse restrained my right one, and a mask was forced over my face to administer anesthesia!! The Dr then Shoved his Large Male sized Hand into my uterus and RIPPED the placenta from the wall of my uterus!!! I know, I know, you're thinking, she just delivered a Baby,how much of a Stretch (pardon the pun) is that anyway? He then proceeded to sew me up. I never went "under" and I remember the whole thing vividly. (20 something years later). Being a mild mannered person that I am (really, I normally AM) as soon as they took the mask off my face I gave the Dr a piece of my mind, (which I'm sure meant nothing to him, but it made me feel better).
    Wow, dear, you've had some awful experiences! This one was most likely unavoidable. There was an emergency situation which required fast action and no time for explanations. You were probably in danger of severe hemorrhage, and he knew his "Large Male sized Hand," needed for compression, would be painful, so everyone proceeded to prepare for your anesthesia. Under the circumstances, it sounds as though there just wasn't sufficient time for the induction of anesthesia, which is whey you were never "under." Or, given your other experience, you are difficult to put "under." Probably a little of both.
  6. by   RetRN77
    When draping a patient, how hard is it to leave the gown on until the drape is already there??? I've seen it done. There was one nurse who was also a nun ... she was the model for what I would want in any caregiver. She would roll up the folded drape starting at the patients feet, and then as she got to the area of the gown (which was still in place) she would roll the drape over the gown 1 fold(about 6-8 inches), and the pull the gown out from under the drape and fold it up. I don't think she ever saw anything of a patient other than head, arms & legs.
    This is the actual proper way to deal with such things, and variations of it even during bed baths - only one appendage exposed at a time, etc. During emergencies, sometimes things do indeed get slung around in haste out of necessity, but it shouldn't be the daily norm.
  7. by   Scrubby
    You can't actually leave the gown on right up until draping, you have to apply skin preparation first then drape. There's no avoiding it.
  8. by   Rose_Queen
    Quote from Scrubby
    You can't actually leave the gown on right up until draping, you have to apply skin preparation first then drape. There's no avoiding it.
    Not to mention that some manufacturers of forced air warming blankets state that the blanket must be directly against skin in order to be effective and to avoid burns from overheated gowns (metal snaps or the fabric itself) or blankets.
  9. by   RetRN77
    I actually was momentarily forgetting the OP mentioned draping and was thinking about changing gowns and bathing, etc. :duh:

    Last edit by RetRN77 on Jun 17, '10
  10. by   ImaWonderer
    I too am LARGELY in favor of an advocate for the patient (seperate from the medical staff). Thing is I constantly hear medical professionals talk about how they are the advocate for the patient. The problem is the issue of the Fox guarding the hen house.

    This is simple... read some of the posts on here. Post where a nurse talks about patients routinely being brought up from the ER naked for no reason. The post about the gyn calling a crowd over to look at a girls vagina only to talk about the way she shaves.(while she was under). A post about a doctor jiggling the body fat of a patient and singing a song about it while the nurses/techs all laughed.I also recall a post about a high school student watching a patient have a surgery as part of a program used to encourage students to enter the healthcare field . Thing is I'm CERTAIN the patient had no idea she was some kids "homework."

    Someone made reference and called modesty concerns patient had "hangups,phobias and quirks." This type of attitude is EXACTLY WHY there is a need for advocates for the patient.

    If an advocate was in that room what are the odds that the doctor would have kept his stupid song to himself. Much less grabbing the patient they way he did. Much less have a room filled with "healthcare providers" laughing.
    This is simply one example but the list goes on and on and on.

    When one poster brought up the issue of a patient advocate someone responded how it would be a problem because of additional "traffic" The problem is without an advocate patients OFTEN end up with more people walking in who "wanna look" and crowd around.The patient can often feel embarrassed ,humiliated,intimidated,shy lets face it. Their was a poster i believe under another thread say the reason he wouldnt ask if his prescene in the room was okay (i believe it had to do w a woman giving birth) is because he knew she would say no. So he would just enter and unless the patient said anything then it was "okay' wink wink.....

    The arguement:Consent forms would have to be changed stating that a medically unneccasary person would be in the room. THIS IS ALREADY HAPPENING!!!! Id rather have one person on my side to ensure 5 medically unnecassary people werent in the room gawking at me.Again I'm making reference to conscience patients as well as those under and knocked out.

    The arguement:you asked would the person stand and watch or get in your way. Well so a chaperone,medical students and the pizza delivery guy can stand and watch with no problem. But an advocate that is there on my behalf is all of a sudden knocking over supplies and filling the latex gloves with water for fun.

    You also asked how much "education"will the person have . Great Question!!!! However I suggest we start with its innappropriate to grab a patients fat and jigglie it while singing a song and work from there.

    A comment was made about the staff resenting being "watched."Well try this resent being watched, get naked and place your feet in stirrups and now invite in 5 more people. This is what patients are made to feel like when they are brought up from an ER naked with no reason, when doors are carelessly left open, when they are having a doctor talk about the way you shave your pubic hair in front of a group of people.

    Medical professionals certainly have rights ....yes we all agree...but again the fox is guarding the hen house here.
    This change IS coming to the healthcare industry.People are pushing for it and are demanding it and organizing.The argument:a hospital that uses these techniques (advocates/cameras)shows it doesnt trust its employees. LET me be clear MANY PaTIENTS DO NOT TRUST THE EMPLOYEES . Just read some of the posts on this board!!!!! Why in the world would they???????
  11. by   rn/writer
    Are you saying this should be a part of every surgery? Who will supply the advocates? What kind of training/education will they have? Who will pay for the advocates?
  12. by   advo-kate2
    Advocates can come from many places: volunteers such as family and/or friends all the way to paid advocates. The real problem right now is that education seems to be in the eye of the (advocate) beholder. Almost anyone can call themselves that with no real background training, and yes..get paid for it.
    I'm working with educators to come up with an actual level of training, but unregulated this is slow work. So in the meantime, a Berkely class in all things HIPPA, Medicare/Medicaid, and small crisis training gets you a certificate.
    My version is a little bit more complicated, but I believe an advocate whether volunteer or paid should be somewhat skilled and comfortable in a medical environment. But in the end, the patient is choosing this person, so their comfort and trust level is the goal.
  13. by   Cul2
    Advocates in the OR? Okay. But I think the profession should start examining why some people perceive this need for advocates and try to make this perceived need unnecessary
    in the eyes of most patients.
    I recall years ago working with a large company that didn't have a union. And every
    time a union tried to get in it failed. I studied why. The company examined all the
    contracts this union had initiated with other companies and made sure their employees
    not only got the same benefits, but better benefits. The union had no chance there
    because the employees realized they probably wouldn't get a better deal with the union.
    Smart business decision, huh?
    Perhaps the medical profession should start examining the reasons why some
    people feel the way they do about modesty, exams, surgery, etc ., and putting in
    place specific polices that mitigate this perceived need. I've said it before and I'll say
    it again -- it's more about open, honest, sincere, authentic communication than it is
    about modesty. It's about trust. Bring up these issues with patients. Ask if these
    are issues they want to discuss, or if they would feel more comfortable not discussing
    them. Find out why patients feel uncomfortable, unsafe, embarrassed. Just bringing
    up the topic, facing it, will help patients realize that you're in touch with their
    feelings and care. Try it.
    I've suggested and I'll suggest again, a good place to start is with websites. Dedicate a page to this whole issue of modesty, embarrassment, gender choice. Face the issue. Discuss it. Don't lock it up in the closet. The argument I get against actions like this from medical professionals is twofold: 1. By bringing it up we'll bring up something that isn't an issue but
    that will then become an issue. This argument is only valid if you actually belief this isn't an issue. Face the facts. It is an issue for a significant number of patients. Is it possible that by
    bringing it up it may become an issue for some for whom it wasn't an issue before? I suppose that's possible. But honesty is always best. 2. The other argument, a more practical one, is that why bring it up, offer choice, if we can't accommodate. That is a practical matter, I agree. But this argument still hands behind the issue rather than facing it. If it's an latent need, an
    accommodation that will benefit your patients -- face the music and make it happen. It can be made to happen. And my guess is that, if you make it know that you do accommodate, that
    information alone will be enough for some patients to make them feel more respected. Try it.