Patient modesty concerns pertaining to surgery

[creinkent]

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 gown removed, etc? How much do you tell them? How do you handle pt that is concerned about students practicing pelvic exams on them without concent? How to handle the situation when after the surgery they realize they had been "exposed"?

[Rose_Queen, BSN, MSN, RN]

reading these additonal posts- here are two solutions that i would be happy with (as a patient).

1. a same gender advocate/ liason, perhaps a social worker. really someone that would fight to make sure i was treated properly, and would tell me if there was anything wrong. this person would "police" each or room, hired by an outside source. yes, i know that we are professionals, but each profession needs checks and balance to keep you on the straight and narrow..

this could cause problems, and not just for the staff. if this person is "policing" all the ors, that means more doors being opened and more traffic in the room, which has been tied to and could lead to a higher infection rate. consents would have to be changed to inform patients that this additional (and medically unnecessary) person will be in and out of their or. as far as staff, i for one would resent someone watching over my shoulder. also, would this person truly just stand and watch, or would they be getting in my way? how much education would this person need? you'd be surprised by how many non-or personnel (nursing students, medical students, nurses from the floor observing surgeries they would care for on the floor) have no concept of sterile technique. it's never personally happened to me, but i've heard stories of the nursing student who, not scrubbed, reached into the sterile field and touched the bowel.

2. some sort of video monitoring of the staff, again so you could be certain nothing bad was going on, and would keep staff from taking short cuts. i know they are doing this in the icu where i live. they are video monitoring the patient room and techs in another city are "watching" to make sure the patient isn't trying to get oob, staff washes their hands etc... i originally hated this idea(still do really) i guess i have no trust that these videos will remain confidential. a central station would be watching every surgery to ensure patients rights were maintained.

here again, you would have staff resenting the person watching over their shoulder. my hospital already installed cameras in each or that are not recorded so that the person in charge can see how a case is progressing (will they be done in time for shift change or does that room need relief/did that lap chole turn open, etc). also, any kind of a recording can be dragged into court during a lawsuit. we record trauma surgeries "for educational purposes" and are specifically told not to document that such a recording exists. also brings up more confidentiality issues for the patient- now have they not only been exposed to the staff caring for them, but it has now been recorded/viewed by how many other people as well. there are also no guarantees that the people viewing distantly will act professionally either.

i think most people would agree that the quality of healthcare has declined over the years. i wish i could trust our profession to be 100% caring and appropriate, but it doesn't hurt to make sure it remains so. (and yes, i would be offended if these interventions took place where i work, but it is about the patients comfort level not about me.)

i disagree that "it is about the patient's comfort level not about me." employees have rights as well. i for one would feel that a hospital using these techniques does not trust its employees to act professionally, and would not work there. i'm sure there would be a lot of nurses talking with their feet should this practice be widespread. i'd find somewhere else to go or even another profession.

[rn/writer, RN]

My take on this is that there is a small number of people for whom same-gender care is of great importance and a great number of people for whom it matters little, if at all. That is why I suggested in an earlier post that this issue be approached on a market-driven basis rather than mandated by yet another set of onerous regulations and (if the last few posts are any indication) Big Brother surveillance techniques.

To require same-sex staff everywhere (as opposed to offering it in specific facilities or free-standing out-patient surgical clinics) is as impractical and unwieldy as ordering all restaurants and grocery stores to keep kosher on the grounds that a tiny percentage of the general population deems dietary laws important.

I am sympathetic to the needs of those for whom religious or personal constraints require specific foods and preparation techniques, but I also believe that the people who practice these laws are very much in the minority. I can support these people and their beliefs at the same time as I can acknowledge the difficulty of making everyone adhere to these challenging tenets.

Back to the surgical realm, by making same-sex staff available on a limited basis, the needs of the few could be met without becoming an unnecessary imposition on the many. There might be enough patients to allow for a small number of units to accommodate same-sex surgical teams, and this might be a draw to the population to whom this matters, thus benefiting everyone.

Those with modesty concerns would find practitioners willing to provide a team of their gender. Such hospitals or clinics would likely become quite popular among those who desire its services. General health care staff would be spared an immense scheduling burden and a plethora of new hoops to jump through (not to mention the stress of trying to function with cameras looking over their shoulders). And we all would be spared the tremendous pressure and expense of instituting a difficult protocol which would tax the majority to serve the minority.

Here's a side question--if off-site video monitoring were ever instituted, would there not be an additional need to watch the watchers to insure that they were the same gender as the patient? Besides being impractical and intrusive (regarding staff), the expense of this measure strikes me as way, way over the top.

Some smart cookie is going to figure out that offering same-gender surgery options would be highly attractive to this small but dedicated portion of the population and find the prospects attractive enough to proceed in this direction. I hope, for all our sakes, this happens soon.

[sharkdiver]

. ........we record trauma surgeries "for educational purposes" and are specifically told not to document that such a recording exists......

you're joking, right? there are so many ethical and legal problems with this i wouldn't know where to start.......

[Rose_Queen, BSN, MSN, RN]

You're joking, right? There are so many ethical and legal problems with this I wouldn't know where to start.......

Not joking. Wish I was. Believe me, there was quite a vocal outcry when this was started. And I certainly don't make it a priority. If I get to it, I get to it. If the patient's coding, I'm dealing with that first and the h*** with the recording. Supposedly, only the trauma surgeons/coordinator see it.

[island40]

I just had my 4th open abdominal surgery related to Ulcerative Colitis in May. I had nothing on under my gown going in and with an expected 5 hours in the same position I didn't want to have a bow tie under my neck. I did have a blanket over my top and legs while they worked on my middles and when I woke up all was covered and clean and the PACU nurse was right there to hand my my beloved button!

[Cul2]

I think it's interesting that so many are assuming that there's a small, very

small percentage of people who would opt for same gender OR. I do think

they are a minority, but I think it's a significant minority that, as one poster

has contended, would make it a marketable option. But it is interesting

that there are so few studies about patient gender choice, and the few I

have found do not place gender choice into the context of the kind of exam

or procedure being done. They just ask whether people prefer one gender

or the other. From a marketing perspective, a few studies might actually

identify a market. Now -- I realize that some people are just plain philosophically

or ethically opposed to patients having the right to chose the gender of

their caregivers. Some countries with socialized medicine, forbid patients

from choosing. Also, to compare one's sense of bodily boundaries to kosher

diet choices, I think, is an inadequate analogy.

[rn/writer, RN]

Also, to compare one's sense of bodily boundaries to kosher

diet choices, I think, is an inadequate analogy.

I thought there were some important similarities. In both situations (wanting same-gender medical/surgical staff and keeping kosher), some are bound by religious laws while others choose to follow non-mainstream options out of personal preference. Both represent a minority within the general population. Both can find it difficult to find providers. Both can be on the receiving end of ridicule or pressure to conform. Neither is readily understood by people who do not share their convictions. Neither has easy solutions to the goal of greater availability. Neither has much in the way of options because that would involve compromising something they view as important and valuable in their lives.

Why do you see the analogy as inadequate?

[Cul2]

rn/writer -- You're analogy is quite close, I do agree. It's just that there are few comparisons to how we feel about out bodies -- especially the symbolic significance of certain body parts. Consider all the varous evocations of women's breasts, male and female genatles and butts, etc. We can see it in art and statuary throughout the ages, and it embedds itself into other aspects of a culture. But, you're right, food is another critical cultural element. But for some people more than others, the genatles have signficant symboic power -- and thier exposure can have seirous psycholgical side effects to various degrees. I do believe that this overshadows the importance of food customs, as important as they are. And when I talk about cultures, I'm not talking about what we in the West might consider exotic cultures, but the sub cultures within ours that are connected to child rearing customs that can be good, bad, functional, disfunctional, etc.

[advo-kate2]

Valid points by both rn/writer and Cul2. I have to emphasize though that this "small" portion of population is not that small at all. What we are seeing in data is the proportion of people it matters to vs the proportion of people that think anything can or will be done about it.

The medical field is just about the only one that provides intimate services with no expected choices of gender. If this happened in other public intimate/personal situations there would be huge public outcry. It really is just a matter of generational conditioning to accept it. Once you do not accept it, things can change. The OR should be no exception, just harder to change policies.

[SandraCVRN]

I still want to know where the staff will come from. We have no male RN's right now. No female anesthesia providers MD or CRNA, no female ortho, uro, or cv docs. We have 4 males CST's and 2 male RN's in PACU. No males in SDS or holding.

[rn/writer, RN]

One way to find out the size of the group we're speaking of would be to do what amounts to a test marketing in select areas. If the response is great and the schedules max out, offering same-gender medical care could very well become a higher priority than it is now. If the response is adequate but not booming, the test marketing sites might prove sufficient to meet the needs. That's a win-win in my book.

I would like to see this handled in a positive manner rather than turned into a battle.

[SandraCVRN]

Also, no female gen surgeons. The only female surgeons are neuro and gyn.....