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]

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.

It hasn't come up, because there is a double standard regarding doctors. Some of the ones who squeal the loudest over having a male L&D nurse(and I have met one) think nothing of the fact that their MALE gynecologist takes a good long peek up there. Makes no freakin' sense.

[Cul2]

" Don't communicate, we don't know such a problem exists."

First of all, the caregiver is the one who has the obligation

to create an atmosphere where the patient feels safe enough

to communicate. Secondly, the caregiver has the obligation

to open lines of communication. Don't deny it -- sometimes it's

just easier not to ask. That way you can just get the job done

without any, at least spoken, problem. Sometimes you may

"know" the answer from the patient's demeanor and body

language. But why ask the question if you don't really want

to hear the answer. In fairness to you, I do accept that it

would be "nice" if more patients did speak up. But as I know

you know, patients are often in vulnerable positions, and

whether they really are or not, they often feel powerless.

"There just aren't that many males applying to nursing school,

getting licenses, and applying for jobs."

Forgive me, but I recall hearing the same excuse years

ago to explain why there were so few women doctors, lawyers,

soldiers, police, etc. Measures had to be taken to attract women

to these fields. It didn't just happen. Women didn't one day just

wake up and say, "Oh, I think I'll join the marines." These were

social battles that had to be fought. Granted, to a significant

degree it's a social issue. But it is changing. Men are more accepted

as nurses than they were years ago. But laws had to be passed,

social legislation, programs, etc. I'm sure we've all heard of the

Equal Rights Amendment and the various Title 1,11, and 111

policies.

"Nursing is predominantly female. " The way I read that statement

is that this is, as they say, "As it was in the beginning, is now, and ever shall

be, world without end. (Amen)" I will agree. Women will probably always dominate

the caregiver professions. In the same way, men will probably always

dominate the military, firefighting, and other occupations where physical

risk and strength prevail. These characters may be tightly gender embedded

for most, but not for all. We can get more women in the military, especially

as war becomes more technically oriented. And we can certainly get more

men into nursing, and more women surgeons, etc. We just have to accept

that these changes will not just happen. They need, at the very least,

encouragement.

Having said all that -- the issue is now. How do we deal with this now. All it

will take is for some financial wizard to realize that there is a market out there

for same gender care. And I believe there is, and, although it's a minority,

it's a much larger minority than many people realize. Let that businessman

figure this out, and we'll see whether this is possible or not.

[advo-kate2]

here is one of my concerns...there are so many psychological reasons why someone cares about gender. too many to mention and certainly difficult to explain here. so.." i'm not a psychiatrist, so if someone is really badly off psychologically, not much we can do."...this would be an extremely bad assumption of what (most) patients are experiencing. it is really niave and sometimes dangerous to forge ahead on assumptions simply based on one's own judgements and entitlements. at a certain point, some motives become suspect.

perhaps those who insist that people have no right to tell you 'no' may do well to investigate that control issue.

can we stop calling everyone crazy and work on the issues? i would really like to go back to discussing solutions.

[rn/writer, RN]

"There just aren't that many males applying to nursing school,

getting licenses, and applying for jobs."

Forgive me, but I recall hearing the same excuse years

ago to explain why there were so few women doctors, lawyers,

soldiers, police, etc. Measures had to be taken to attract women

to these fields.

The key difference in your comparisons is that in many male-dominated fields, women weren't allowed to study for or participate in these jobs. Or if they could get a degree, they still weren't easily hired. For men in nursing, it's the exact opposite. With the exception of a very few specialties, men are exceedingly welcome.

My point is that no one is standing in the way of the men. In fact, men are being encouraged to go into nursing. So if there are not enough of them entering the field, it isn't because anyone is barring the door.

That said, I think we have two similar but distinct issues in this thread that need to be separated if we are to have a coherent discussion.

One is the idea of same-gender staff for females. The other is same-gender staff for men. Regarding the former, an obstacle is not enough female surgeons while regarding the latter, the difficulty is not enough male nurses.

This is a recruitment issue, that will not be solved quickly or easily. It's going to take time and effort to get more women established as surgeons and more men in nursing.

Until such time as the numbers become more feasible, same-gender care is going to be a challenge--not because nobody cares, but because you can't offer what you can't staff.

[canoehead, BSN, RN]

To address the concerns of the patient, obviously some discussion before surgery would help. Most docs do that as a matter of routine, and expect that the patient will be honest about their fears and preferences. We can do our best to meet their needs, but the big issue seems to be whether OR staff are acting appropriately when the patient is sedated. What if the hospital offers to videotape the surgery and allow the patient/spouse to view it during their recovery period. Then they would KNOW what happened, and it sounds like the fear of the unknown is the biggest problem (so long as basic professional behavior occurs.) Administration would have a nervous breakdown over liability, but if the tape was destroyed on discharge...would that work?

[Cul2]

"I would be 100% for a "class" for patients undergoing elective surgery.

Some good suggestions coming out of this discussion. As I've said

before, the foundational key to all of this, IMO, is good, open, honest

communication. Hospitals are not very up front about what exactly

goes on in the OR. It's shrouded in mystery. I suppose the assumption

is that if the patient really wants to know, he or she will ask -- a faulty

assumption, I believe. First time patients, or those with little experience,

don't even know how to frame the questions, what words to use. To ask

meaningful questions, you need some basic knowledge of what's going on,

which they don't have.

So -- a short session about what goes on in the OR, who does what,

basic concerns -- with time for the patient to ask questions. Now, if this

is done in a group, you may or may not get the real serious concerns

like modesty. Unless one person breaks the ice, or the instructor brings

it up, it may not come up. Also, a tour of an open OR, and the recovery

area might help.

It's also a trust issue -- and if the patient see that these normally

unspoke issues are actually being brought up, that may help to develop

more trust. I've always had essentially good experiences with the OR as a patient.

I've noticed significant communication issues that I had wished were

better, but overall, I'm not complaining. I think the OR staff assumes

too much about what patients want/need to know about what will

happen. I have no basic trust issues -- but some people do. The class

and the tour may help with that. I've never had an OR nurse or anyone

as me before the surgery, "How do feel about what's going to happen

this morning? Do you have any questions, any questions at all about

what will happen while you're asleep?" That may help with some people.

I'm hoping that we can reduce the number of people, small as it may be,

who will actually require same gender OR situations. I really believe that

if they are approached properly, they may feel more comfortable and safe.

Some will never change, especially those who have had bad experiences

where the trust has been lost.

[tbrd450]

I just think that striving for same-gender team environment options is fundamentally futile. There are way too many dynamics involved, not the least of which are: competence, training, scheduling, availability, discrimination, hiring practices, etc.

The correctional community is struggling with something like this now. For example, the courts have ruled that female inmates are entitled to having only female correctional officers viewing them during strip searches, during showers, during bathroom use, unless it is an emergency situation. Male inmates, as ruled by the courts, have no such rights. Female correctional officers view them during strip searches (I think they can actually conduct them on males), during showers, during bathroom use. This makes hiring a little tricky for the prisons and jails. It also makes for some angry and embarrased male inmates, but who really cares about them. Correctional facilities have to ensure a certain percentage of female officers on staff to meet the court mandates. Female correctional officers are hired in higher proportions than is the proportion of female inmates to male inmates, for this reason. Female correctional officers are deemed universal and interchangeable-- they can work with male inmates and female inmates. Not so for male correctional officers.

Generally, society just doesn't like the idea of extending or accommodating any sort of male modesty consideration in any environment, on any level, in any place, for anybody male. We are "silly" for even asking. Such consideration is entirely discretionary and up to the care provider one (male) happens to encounter.

Yes, the vast majority of nurses are female. That continues to be the case. However, much more could be done to reach out to, cultivate, and encourage more males to pursue the field. Nothing special here, no special treatment, just the very same outreach that serves to this day as the basis for affirmative action efforts in bringing a more "balanced" work enviroment to other professions. Note: Most of affirmative action does not involve setting and implementing actual quotas. Arguments are always being made and presented about how more females in the military, in corrections, on the police force, in technical fields like engineering, and in medical schools serves to bring fresh perspective, a calming vibe and well,... more "balance" to those environments. On that basis, they are pursued for that work.

It seems like, however, when people extend that same logical argument for bringing balance to female fields (nursing, elementary education, social work, etc.), then everybody says whooaaa... hold your horses Batman!.. preferential treatment!?!...not on my watch!

Re: patient modesty and same gender teams - The reality of the matter is that when same-gender teams are accommodated these days within the medical setting, it is done almost exclusively on behalf of female patients requesting it. Some times they get it, in some places they get it and sometimes they don't.

Most men and boys don't even know, or field comfortable about, asking for such equal treatment. To do so would be emasculating. Certainly, nobody is asking them if they would prefer an all male team. But please don't make the mistake of interpreting that to mean they don't want it, or wouldn't choose it if they could without feeling emasculated and silly.

In the end, if ever such gender team accommodations are extended to patients, it will be done so universally for female patients. For males that is just wishful thinking at best.

Now...back to my main gender double standard modesty concern.... please just treat your male patients with some remote consideration for their potential modesty concerns. Cover them up when they don't need to be uncovered. Pull the curtains closed as you do for your female patients. Ask your sister from Bufalo to sit outside until you are done getting the foley inserted. Close the darn door in the doctor's office...the administrative assistant and the technician are not entitled to view the hunky male patient with his pants down.. Ok? It is not okay to ask your nurse friends to check out the hunky kid's large membere in room 423.

Come on folks, just imagine that is your father, husband, or brother, ok?

[tbrd450]

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.

"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."

However, many medical areas are established and maintained on an inherent understanding of female preference for female care -- OB GYN It is just assumed women will want women taking care of them in certain situations, it is assumed that without anybody having to explicitly state it.

Men and boys don't even know they can ask. If they knew they could ask, they would have to do so knowing they risk ridicule and emasculation for being unmanly and ...unboyly...is that a word? ... let's just say for a male to show modesty concern, he has to risk a lot. No such burden is inherently resting within female patients. However, one would have to be extremely naive and unaware to assume that a male patient's silence means he necessarily has no such concern, or wish. If it were safe for men and boys to request all male teams, and there was some remote possibility that such a request would/could be accommodated, I wouldn't at all be surprised if the number of same-gender requests by men and boys far eclipsed that of girls and women.

't mean, however, he doesn't want it every bit as much as the girls and women want it.

[Cul2]

"With the exception of a very few specialties, men are exceedingly welcome."

Interesting observation. What would those specialties be? And why would

men not be welcome, and more importantly, why would that be allowed?

Part of the answer

as to why they wouldn't be welcome would be patient preference. So...

if patient preference is an embedded acceptable factor with female patients, why not

assume it should be just accepted as a factor for males, esp. for exams and procedures

involving the genitals.

Could we change the quote above to this -- ""With the exception of a

very few specialties, women are exceedingly welcome."

What would be the medical specialties where women wouldn't be accepted

and would that be allowed in today's political culture?

I think when any gender dominates a profession, you get group think. Thus,

it seems natural to me that with nursing made up mostly of women, those

women will focus more on female modesty, they will naturally empathize with

their own gender. Now, please. This is not meant to be an insult. The same

is true for occupations dominated by men. Look at the problem women have

had and are having being accepted in some areas of the military -- they just

got authorized to serve on submarines. Tell me that's going to be an easy

assignment for a lone woman. It doesn't surprise me that the nursing

profession has certain assumptions about men and their modesty. Tell me

men in professions dominated by them don't have gender specific assumptions

about women within the context of the duties they perform. Example,

you'll find a study quoted in the book The Trouble With Boys by Peg Tyre

that found a committee of elementary school teachers, made up mostly

of women, reviewing applicants for elementary teaching jobs, were not even

seriously considering the male applicants. The men didn't even make it to

the interview stage. What made this interesting in the experiment is that

the HR director had select a group of already working outstanding male

elementary school teachers to fill out applications for that committee. None

of them even got to the interview stage. It wasn't a question of overt

sexism. It had to do with the kinds of answers these men put on the

applications and how gender differences made certain work and leadership

styles more acceptable to the different genders.

Now, I'm not being sexist here. A group of men would do the same in many

contexts -- have done the same -- it's called the glass ceiling women have to break through.

We need balance in all professions, at least enough to get out of the

gender group think rut.

Having said all that, I do accept that a certain percentage of men

are homophobic and, though embarrassed with a female nurse, would not

let a male touch them. But that's not all or even most men. But there

are few good studies about gender preference among patients, and, as

I've stated before, among those few studies, it's rare to even find a few

that ask the right questions -- questions narrowing down the context

of the kinds of procedures and exams we're talking about here. My point

is that the medical profession hasn't seem much interested in this issue

in the past, although with more of an emphasis on cultural issues and

gender, I would hope more studies would be done.

[SandraCVRN]

cul2 "having said all that, i do accept that a certain percentage of men

are homophobic and, though embarrassed with a female nurse, would not

let a male touch them. but that's not all or even most men."

i was just going to say my husband would rather a female than male place his foley. he is not homophobic in the least, just older and if someone is "going to play with his junk, he would rather it be a woman" he's a pig, what can i say???

[advo-kate2]

"I was just going to say my husband would rather a female than male place his foley. He is not homophobic in the least, just older and if someone is "going to play with his junk, he would rather it be a woman" He's a pig, what can I say??? "

Play with his junk.....

Where are all of the female caregivers here who keep telling patients that intimate proceedures are not sexual? That a@@es are the same as elbows? That we are professionals? No red flags here?

It seems convienient to tell one group of men that they should not have a preference if it is not you, and willing take part in telling men it is allright only if that preference is you.

Are we finally hitting on the "convienient truths" of nursing? If not, why not explain to men that you are not playing with their junk...you are performing a proceedure. Female or MALE, your junk shouldn't matter....right?

I think advocates may be approaching this backwards!! We need to tell female patients to step into this century and admit...."if fingers need to be inside us wouldn't we rather them be a male"? Right? Then we might get more male nurses....but for really the wrong reasons. Hmmmm

[SandraCVRN]

Play with his junk, his words not mine. What we think and our SO's think are not the same. It's not like if he were in the ER he would stop a male from placing a foley but if I were there he would want me to do it...

A friends spouse had a procedure last week, and my hubby was all...so everyone saw his package..... we could give a rats a$$....I've done foleys on co-workers...still see them every day.

FYI, I never said someone couldn't have a preference just that we don't currently have any male RN's or female anesthesia providers. The ONLY female surgeons we have are neuro and gyn.