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"?

[GadgetRN71, ASN, 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.

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.

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.)

Sorry, but these things are so not going to happen, nor should they. If you or a patient have trust issues that intense, elective surgery isn't what you need, maybe counseling is in order first. I have seen surgeons refuse to operate on patients that seemed to have these trust issues and baggage, and I can't say I blame them. Obviously, we're talking about elective procedures. Bringing in someone from the outside creates privacy issues all its own, also infection issues. There is no way risk management would allow it.

And the circulator's job is to be the patient advocate and we take this very seriously. We work with the patient as much as we can when it comes to quirks, hangups, phobias, but there comes a point where we have to prioritize..if someone is coding, the fact that their butt is showing really isn't an issue.

[GadgetRN71, ASN, 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.

I agree that it should be handled positively, but OR nursing is one of the few specialties where there is a true shortage of experienced nurses and at the end of the day, that's who I want in my room. Give me experience over a specific set of genitals anyday.

I run the board on my shift and we have no male nurses at all anywhere in the OR. People don't float to the OR,BTW. The knowledge base is just too specific. So, does this mean we only set out to hire male nurses into the OR for a period of time? That's a "quota" system and that's not right either. Do we hire Nurse Y over Nurse X even though Nurse Y is a doofus? Apparently, some would say yes, because Nurse Y has a member. Scary.

I think because having surgery can be frightening, some people kind of "act out" over small stuff..it's the anxiety and I understand it, honestly. The last time I had surgery, I was worried about waking up under anesthesia..but, I had to calm down and realize that the people in the room were there to take care of me. I had to realize that I was freaking myself out.

[Cul2]

"That's a "quota" system and that's not right either."

Do we hire Nurse Y over Nurse X even though Nurse

Y is a doofus? Apparently, some would say yes,

because Nurse Y has a member. Scary."

Excuse me, but I can't believe I'm reading this. You talk

as if quota systems just don't exist and never have.

Are you saying that affirmative action, the program

that made sure minorities, including women, were

able to break into male dominated occupations

was an exercise in hiring minority Y, who is basically

unqualified, over white male X who is qualified? Thus,

you're suggesting that most minorities and women

who benefited form affirmative action were really

not qualified?

You think you can't find a few men who are

really qualified for the OR? They just can't live

up to the standards? I recall that kind of reasoning

in the 1960's and 1970's when minorities, including

women, were striving for acceptance in the workplace.

We still sometimes hear it today.

Why is the nursing profession so opposed to

some kind of quota system or affirmative action

that would result in more qualified men in the profession?

This is gender equity? I'm all for doing what it takes

to get women into male dominated jobs. I'm not saying

we should take unqualified women. But to suggested that

we just can't get qualified women is as wrong as to suggest

that, with a little recruiting you can't get qualified men in

the OR.

[TDCHIM]

I agree that it should be handled positively, but OR nursing is one of the few specialties where there is a true shortage of experienced nurses and at the end of the day, that's who I want in my room. Give me experience over a specific set of genitals anyday.

I run the board on my shift and we have no male nurses at all anywhere in the OR. People don't float to the OR,BTW. The knowledge base is just too specific. So, does this mean we only set out to hire male nurses into the OR for a period of time? That's a "quota" system and that's not right either. Do we hire Nurse Y over Nurse X even though Nurse Y is a doofus? Apparently, some would say yes, because Nurse Y has a member. Scary.

I think because having surgery can be frightening, some people kind of "act out" over small stuff..it's the anxiety and I understand it, honestly. The last time I had surgery, I was worried about waking up under anesthesia..but, I had to calm down and realize that the people in the room were there to take care of me. I had to realize that I was freaking myself out.

Forgive me, but this issue is in fact about patient comfort, not just about who you as a nurse "want in [your] room." Most of us have no issues with mixed-gender teams providing treatment, but to dismiss patients who have firm personal reasons (for instance, cultural or religious concerns) for requesting or seeking single-gender care providers as individuals who are just "acting out" due to anxiety is unfair. RN/Writer is proposing testing the public's interest in such care at a few sites. If the need turned out to be more prevalent than is currently recognized, facilities that wanted to capitalize on the new market could recruit competent male nurses accordingly, just as women have been recruited to improve diversity in other professions that have traditionally been dominated by men. RN/Writer does not appear to be advocating that all facilities offer single-gender teams, which as you say would be impossible given nursing's current demographics. Single-gender treatment teams would instead become a specialized service that certain facilities would offer and that patients could seek out for elective surgeries.

[Scrubby]

Sorry double post see below

[Scrubby]

I notice that no one has yet to come up with any kind of solution to the problem with specialised surgeons for these gender teams. It's easier to train a nurse but a surgeon training is far more extensive. As the nurses who work in the OR on this thread have said before most surgeons are male. I've yet to meet a female orthopaedic, hepatobiliary, urology, plastics, vascular surgeon and I work in the largest hospital in my state. I'm not saying they don't exist but they seem to be

few and far between.

The only surgical clinic where you'll get an all gender based surgical team is with the breast endocrine clinic who routinely do mastectomies, thyroidectomies and the odd gallbladder, appendix. because we have quite a few female surgeons in this area.

Now for smaller procedures involving less specialised surgical background where patients have to be awake i.e pap smears, breast exams etc there would be a definate market for gender based teams and believe it would be feasable. But the big stuff like joint replacements, liver resections, no way.

As for positive discrimination, I'm not a huge fan. I don't believe anyone should be hired based on gender, race or sexual orientation. You should be hired on your credentiasls and attitude.

[Laurab14]

Sorry, but these things are so not going to happen, nor should they. If you or a patient have trust issues that intense, elective surgery isn't what you need, maybe counseling is in order first. I have seen surgeons refuse to operate on patients that seemed to have these trust issues and baggage, and I can't say I blame them. Obviously, we're talking about elective procedures. Bringing in someone from the outside creates privacy issues all its own, also infection issues. There is no way risk management would allow it.

And the circulator's job is to be the patient advocate and we take this very seriously. We work with the patient as much as we can when it comes to quirks, hangups, phobias, but there comes a point where we have to prioritize..if someone is coding, the fact that their butt is showing really isn't an issue.

First of all, to suggest that someone "like me" who would like assurance that I am not being made fun of during surgery is needing counseling certainly is uncalled for. I was simply trying to offer a suggestion less costly and more feesible than an "all gender" team. I have witnessed crude remarks by other nurses in my 16 years of nursing and I would rather it not happen while I am unconsious and unable to defend myself. Perhaps where you work, this isn't a problem, but where I was working it did.

I notice you work in surgery, and have a better knowledge of what specifically goes on during the surgery. This proves my point... I never met my circulating nurse, I never had any of this explained to me. I never had ANYONE make me feel comfortable enough to think I would be their priority during my procedure. This may be offensive speak to surgical nurses, but to the rest of us surgery is a big mystery. Why does this have to big such a big secret???

I am not sucispious by nature, and have good mental health, I was under the impression that this group was for bouncing off ideas, not making personal attacks.

[advo-kate2]

i do actually have a suggestion:

find out now how your facility reacts to patients who are appointing/hiring advocates. it does exist now, but it is being refined as to required education levels.

it is available and coming to a facility near you.

i would imagine caregivers would want to know ahead of time how their facility is going to handle them. will they deny entry and fight the patients right to advocacy care? would they welcome them because quality care centers have nothing to hide? or do we have a suitable middle ground.

not agreeing with a trend does not stop it from happening. i suggest we be prepared.

as to:"we work with the patient as much as we can when it comes to quirks, hangups, phobias."

some people care in life who touches and exposes them, some people don't. not a quirk or phobia, just a preference. we are not here to make everyone's morals and ethics the same. we are here to garner respect for everyone regardless of whether we agree or not.

i would hazzard a guess that i could site several examples of circumstances where people here would be very upset being exposed to the opposite gendered employee. who might actually feel that the degree of exposure would either warrant the option or have the same gender employee in the first place. quirk or preference? public decency or phobia? who's to say? you feel how you feel.

[Cul2]

"As for positive discrimination, I'm not a huge fan. I don't believe anyone should be hired based on gender, race or sexual orientation. You should be hired on your credentiasls and attitude."

Scrubby -- You may not be a huge fan, and neither am I -- but that's what it took to break the back of systems that excluded minorities and women. And that's what it may take to get more men into

fields like nursing and elementary education -- two occupations that have very few men. Right now the stats regarding women in the American military are between 14 and 17 percent. Maybe we'll get to 25 percent. It's not about abilities, but some studies indicate that men and women have different preferences that are reflected in both their gender strengths and what they feel they do well. I don't think we'll ever get 50/50 gender balance in all fields, and I'm not advocating that. But certainly in nursing and elementary school teaching we can do better. Don't we need role models for children of both genders?

The poster who brought up the lack of women surgeons has a good point. That does pose a problem. The question is posed -- Why do some women allow male doctor's access to their bodies and not male nurses? Maybe we're not really talking about gender OR teams of "all" one gender. Perhaps there both men and women who would go with the doctor being either male or female with those assisting being one gender. Now, I realize that will bother those assisting. But this isn't sexist discrimination. If patients chose this for comfort reasons -- NOT because they believe one gender of the other is incompetent -- this isn't sexism. I would argue that nearly all patients who would not want a particular gender for a sensitive procedure, would be willing to let that gender work with them in less sensitive areas.

[Rose_Queen, BSN, MSN, RN]

Here's why hiring more men just isn't feasible:

1. Nursing is predominantly female. There just aren't that many males applying to nursing school, getting licenses, and applying for jobs.

2. Due to the economy, hospitals just aren't hiring. We've lost maybe 4-5 nurses in the last 6 months, and we are not replacing them. Hiring more men just for the sake of having more men on the floor is not fiscally responsible.

3. Also due to the economy, more nurses who weren't full time are now working full time or at least more hours. Again, no positions available to be filled.

With (in my experience) little to no demand for an all male OR team, positions aren't going to be created just to bring more men on board. And to bring more men on board would mean men would have to apply. Of all the applications we've received for our unit recently, zero came from men. Continuing the status quo? Yes. Ignoring patients' wishes? Not that we know of because no one has communicated such a desire, and nurses are not mind readers. Don't communicate, we don't know such a problem exists.

[GadgetRN71, ASN, RN]

First of all, to suggest that someone "like me" who would like assurance that I am not being made fun of during surgery is needing counseling certainly is uncalled for. I was simply trying to offer a suggestion less costly and more feesible than an "all gender" team. I have witnessed crude remarks by other nurses in my 16 years of nursing and I would rather it not happen while I am unconsious and unable to defend myself. Perhaps where you work, this isn't a problem, but where I was working it did.

I notice you work in surgery, and have a better knowledge of what specifically goes on during the surgery. This proves my point... I never met my circulating nurse, I never had any of this explained to me. I never had ANYONE make me feel comfortable enough to think I would be their priority during my procedure. This may be offensive speak to surgical nurses, but to the rest of us surgery is a big mystery. Why does this have to big such a big secret???

I am not sucispious by nature, and have good mental health, I was under the impression that this group was for bouncing off ideas, not making personal attacks.

It wasn't a personal attack. I just feel that if someone is that concerned that the OR team is out to "get" them(making comments etc) that there may be something else going on there. For someone with no issues, surgery can be scary, for someone with a trust issue, it may be overwhelming.While I address my patient's emotional state as well, I'm not a psychiatrist, so if someone is really badly off psychologically, not much we can do. Many surgical specialties such as bariatrics require counseling beforehand.

I would be 100% for a "class" for patients undergoing elective surgery..this way patients unfamiliar with the OR setting learn the various roles of staff, why we often require people to remove jewelry and underpants, the whole NPO issue. Anyone with a problem, or who has special requests can address them then. I would go so far as to make this a requirement before you even do a final booking for your surgery. I think this would help the OR staff too although we still will have issues with inpatients coming down with jewelry, clothing etc. That's the fault of the floor nurses though,not the patient.

Again, not attacking you..just stating that the ideas in your post, while well intentioned, are not practical.

[GadgetRN71, ASN, RN]

Forgive me, but this issue is in fact about patient comfort, not just about who you as a nurse "want in [your] room." Most of us have no issues with mixed-gender teams providing treatment, but to dismiss patients who have firm personal reasons (for instance, cultural or religious concerns) for requesting or seeking single-gender care providers as individuals who are just "acting out" due to anxiety is unfair. RN/Writer is proposing testing the public's interest in such care at a few sites. If the need turned out to be more prevalent than is currently recognized, facilities that wanted to capitalize on the new market could recruit competent male nurses accordingly, just as women have been recruited to improve diversity in other professions that have traditionally been dominated by men. RN/Writer does not appear to be advocating that all facilities offer single-gender teams, which as you say would be impossible given nursing's current demographics. Single-gender treatment teams would instead become a specialized service that certain facilities would offer and that patients could seek out for elective surgeries.

Obviously, you didn't understand my post:rolleyes:..I was stating that as a patient(and I've been an OR patient several times), it matters more to me that the staff in the room knows what the hell they're doing than if they have a member or a lady parts. Staff can make or break a case, it's not just the surgeon.

What this says to me is that there is an unhealthy fixation by some(not pointing fingers) on gender over experience. I'm sorry, but in my opinion, this is foolish. Patients should be worried more about successful outcomes and infection rates, not whether someone will be ogling their goods. You are entitled to your opinion, and you are entitled to make the decision to proceed with your surgery or not. What you are NOT entitled to do is to dictate my nursing practice or the practices of anyone else here.Sounds harsh, but that's how I feel, and obviously, I'm not alone.