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"?

[ImaWonderer]

Hi......

and to sandracvrn

This is a quick one...perhaps Ill go through and locate the skateboard incident but now from memory......

This teen was injured and was banged up from a skateboarding injury on his legs/knees. Im sure I used the word naked but he did have on a gown the thing is in looking at his injury the nurse lifted his gown to the point wear his genitals were exposed with several others standing around.

The kid was obviously embarrassed and made an effort to cover himself when the nurse made some comment that dismissed his embarrassment and the gown was lifted again by the nurse.(again with several students standing around) I used the word naked.....but even in one of those gowns if my privates are hanging out for everyone to see I consider that "naked"...........

As far as medical students needing to watch or how are they going to learn.....I'm in agreement I simply believe the patient should know in advance and not be ambushed,suprised....Also a patient who may be comfortable with ONE student observing doesnt mean they are comfortable with 4 students watching......

Things like that need to be addressed BEFORE the patient in undressed.......Thats basic respect.....

[RetRN77]

I agree with rn/writer

"I see a couple of real problems with having advocates be friends, family members, or others close to the patient.

First is a lack of objectivity. The last thing anyone--the patient included--needs is someone who is not familiar with surgical procedures having a bad reaction because they are freaked by seeing surgery on someone they care about. If complications happen, this could be a real nightmare, especially where sterile procedure can be so easily compromised. "

Before going to nursing school I was an Oral Surgery Assistant for 12 years. I cannot tell you how many family members pass out / got sick etc just watching their family get wisdom teeth removed under sedation. Nurses were the worst, it's different when it's your loved one being worked on. Nothing like having to leave your pt to take care of the "watcher"..... really can't see how it would work in the OR.

The first time my hubby suffered a near catastrophic bleed-out and required emergency surgery, I remember walking down the hallway away from the surgical unit after he went in, and I suddenly had a "flash" thinking about him undergoing surgery - imagining him intubated and the first incision, procedures I'd witnessed as scrub/circ nurse over and over again. I nearly fell down in the hallway because the very thought was more than I could bear. Not the same when it's your family, no matter how inured you are. Some in medicine can handle it but I venture to say most cannot. The general public? Sandra CVRN made excellent points.

To completely overhaul how things are done and require advocates for everything creates a lot of burden. Hard cases make bad law, as it is said. However, requiring a conversation with the patient to suss out what modesty issues they may be concerned about is not such an insurmountable problem. A handy checklist would probably help the conversation go well and address common issues. Then having a serious discussion about how they can or cannot be accommodated (and why not) based on their individual concerns is more manageable. Just letting patients know you are concerned about privacy and modesty and want to be flexible as far as possible about their concerns can go a long way in establishing trust and ameliorating their fears. Most of the time, if we just followed ordinary procedure, we would be doing what most patients hope for!

Time and again, for instance, in a local hospital, women waiting for mammos were forced to get into ill-fitting gowns open in the front and wait in the waiting room off a very busy hallway without bras in order to (reasonably) keep the procedures flowing. Not such a problem unless you are over endowed and embarrassed repeatedly by your gaping gown and drooping anatomy when the personnel keep leaving the provided curtain to the waiting area open instead of closed. Never once an attempt to use the curtain. Every maintenance man on duty would walk down that hall and gape in at the patients. So unnecessary.

[tbrd450]

Hi......

and to sandracvrn

This is a quick one...perhaps Ill go through and locate the skateboard incident but now from memory......

This teen was injured and was banged up from a skateboarding injury on his legs/knees. Im sure I used the word naked but he did have on a gown the thing is in looking at his injury the nurse lifted his gown to the point wear his genitals were exposed with several others standing around.

The kid was obviously embarrassed and made an effort to cover himself when the nurse made some comment that dismissed his embarrassment and the gown was lifted again by the nurse.(again with several students standing around) I used the word naked.....but even in one of those gowns if my privates are hanging out for everyone to see I consider that "naked"...........

As far as medical students needing to watch or how are they going to learn.....I'm in agreement I simply believe the patient should know in advance and not be ambushed,suprised....Also a patient who may be comfortable with ONE student observing doesnt mean they are comfortable with 4 students watching......

Things like that need to be addressed BEFORE the patient in undressed.......Thats basic respect.....

Okay, now having been refreshed on this story, I realize it is worse than I had originally thought. Let's deconstruct this a bit:

1) Male patient, and

2) teenager (not an adult), and

3) gown lifted, apparently, beyond where it needed to be lifted, exposing genitals, and

4) main female nurse teaching more than one female student nurse present, and

5) Student nurses likely closer to embarrassed patient's age, and

Then, after it happened once:

6) The male teenager expressed clear discomfort and embarrassment as recognized by one or more of the attending student nurses, and

7) Attempts to cover himself, and

8) main nurse trivializes his feelings, and

9) main nurse proceeds to humiliate him again

Okay.... this is registering on the creepy meter. I can't think of a more prime example of the double standard. Imagine if you will, the gender of everyone involved was reversed. Could you imagine such a scenario?

Honestly, wouldn't the main mail nurse (in the hypothetical reverse scenario) be marched off the job quicker than a rabbit on a dog track.

Advo-Kate... when I hear stories like this, I seem to understand your point a little better. This kid's experience wasn't explainable by simply something like a care giver's calouse, desensitized mistake in the moment. This wasn't just a nurse failing to close a door, or pull a curtain shut. This smells of something worse ... dare I say intentional infliction of humiliation ?? Does this hint at underlying sadism ??

She knew this embarrassed the kid -- AND SHE DID IT AGAIN! ... yikes.

I'm sure, on some level, she later rationalized that it was okay because, ... well.. he's a boy and boys aren't that concerned about that kind of stuff... Or, maybe not... maybe she did this precisely because he was a boy..! eek!...

ImaW,

I'm curious about something, she wasn't a nurse soon to ship out to Abu Ghraib was she?

[Rose_Queen, BSN, MSN, RN]

Okay, I'm probably going to get flamed for this, but I've gotta say it.

While I agree that the situation with the skateboarder was completely inappropriate and never should have happened, it has nothing to do with the topic of this thread, which is patient modesty concerns pertaining to surgery. If you would like to discuss modesty concerns in general, please start a thread or do a search in the general nursing forum.

[tbrd450]

Okay, I'm probably going to get flamed for this, but I've gotta say it.

While I agree that the situation with the skateboarder was completely inappropriate and never should have happened, it has nothing to do with the topic of this thread, which is patient modesty concerns pertaining to surgery. If you would like to discuss modesty concerns in general, please start a thread or do a search in the general nursing forum.

Please don't take this the wrong way, but patient modesty concerns pertaining to surgery, or patient modesty concerns pertaining to operating rooms, or patient modesty concerns pertaining to emergency rooms, or patient modesty concerns pertaining to snack bars, all pertain directly to examining the root causes of why anybody, in any medical setting, on any medical floor, compromises patient modesty concerns.

When it does happen, I don't think that it happens on the 7th floor for different reasons than it happens on the 3rd floor. To really examine it and come up with possible solutions, we have to dig past the surface. Why does it happen? From a patient's perspective, it is alll related and intricately connected; and attempting to porifice it out, and attempting to compartmentalize an issue as complex and over-arching like "patient modesty," is not only futile, but also somewhat deflective -- deflecting from real, authenic analysis.

Why keep it at the surface? What does that accomplish?

[SandraCVRN]

Okay, I'm probably going to get flamed for this, but I've gotta say it.

While I agree that the situation with the skateboarder was completely inappropriate and never should have happened, it has nothing to do with the topic of this thread, which is patient modesty concerns pertaining to surgery. If you would like to discuss modesty concerns in general, please start a thread or do a search in the general nursing forum.

Like most threads this did morph into something more than JUST surgery, but for some reason a couple days ago the thread was moved to this board with no notice or notification.

I also agree that the skateboarder incedent should not have happened.

[Cul2]

I think I've had all I have to say on this subject. It's a good

discussion. I hope it stays civil. I want to thank allnurses for allowing

so many no mediical people to have thier say here. I think it's in everybody's

best interest.

[advo-kate2]

Maybe we just need to get back to how simple the problem is. Perhaps it will inspire simpler solutions.

Almost all human beings do not want and/or will refuse to expose themselves in public to the opposite gender unless it is thier choice. Simple.

Yes it gets complicated when we speak of entitlements, expectations, the right to perform a job, whether a medical proceedure is beyond all expectations of the normal personal rights we have (and why), and well, unending possible explanations.

Let's just be clear. We are all just human. We all have our own modesty,religious, moral, ethical values to contend with. These beliefs follow us wherever we go, and even if a person assess exceptions to thier own body it is hopefully and entirely their own choice.

Fairly simple. I hope we can work together for resolutions.

[ImaWonderer]

http://www.nytimes.com/2005/08/16/health/16dignity.html?_r=1&th=&emc=th&pagewanted=all

Okay so I found a very intersting article along the lines of where this discussion is going.

I'm not particularly a fan of the NY Times but this article actually does seem to have some real meat to it and its nice to see this topic addressed. Some parts are more intersting than others but stick with it.

What i find interesting is that it talks about a the patients experience. (I believe one of the patients is actually a nurse)

There are some interesting things here....I'm going to do more research on this Plantree organization and its work. Also patient care representatives and what EXACTLYthey do and if they deal with modesty issues.

The article also makes reference to ENVIORNMENTAL PSYCOLOGISTS.....(this is the first time Ive even heard of that) but it talks about the psycology of what happens to people entering medical care and how patients are effected by everything from design to noise to the infamous gown.....The most interesting thing is all the things we have been talking about (EXCEPT GENDER...yes I noticed) this article talks about.....complaints about people just walking in,coming and going, and many times not even SPEAKING to the patient or introducing themselves.

I find it interesting that MANY "educated people" in the medical field seem to be shockingly ignorant at how having an univited group of observers just walking in ...... How not knocking or introducing themselves, opening doors carelessly,dismissing modesty issues...etc....effects care.

We have along way to go...when the people "caring"for us considers all these issues hangups, and phobias but the good news is that their is NO doubt in my mind that these changes Are coming!!!!!

[CaDad]

Hi Again:

There is an excellent article in this monthly nurses magazine and it hit it on the head on several areas. What I found amazing is that several of the behavioral characteristics discussed apply to other industries lol. Like the one characteristic of becoming mechanical , treating th pt like an object, etc. Great and telling article.

I also want to clarify the advocate role, perhaps they might be attached to HR, where the patient is talked to during and after the stay, like just routine visits-not staying in the room during sensitive tasks, specifically making sure their modesty needs were respected or accommodated without any repercussions from the staff. Even providing training or refresher courses on new research or polls, etc. I know, what? more training? But I think that this kind of training is sadly lacking. Maybe we even have cyclical evaluations to detect burnout so maybe a rotation can be utuilized into anothr department. This advocate can even be the person where anonymous personnel can discuss the actions of another employees without reprecussion or disclosure so than any incident can be looked at and perhaps addressed, not in an adversarial way, but in a caring diplomatic fashion so everyone wins. We do not need a hospital cop lol. But someone who would have the power to initiate change where necessary.

My brother recently went in to have his prostrate examined because of the higher readings on the test he as given and he requested , yup, a male crew, well guess what, there was an all female staff ready to help lol-he declined the test and gave his doctor you know what and his Doctor told him more and more men are requesting this, so I guess it worked and information is getting out to more and more men. I have to say I am sincerely grateful to the female nurses on this discussion, it is gratifying to hear you understand, comment, and address the issue. I know this blog was about the OR room , but it is more than that, I sincerely believe that most of the damage is done prior to the operation, it everything that happens up to that dreaded moment and afterward that is the worst.

[tbrd450]

Wonderful article. I really like that it gets quickly to the irony of the issue:

"At the hospital where Ms. Duffy was a patient and at many others the small courtesies that help lubricate and dignify civil society are neglected precisely when they are needed most, when people are feeling acutely cut off from others and betrayed by their own bodies."

While little (relatively) has really been proven about just how powerful mental health really is to the recovery process, we all know it is. It is sort of a no-brainer. How Ms. Duffy internalizes the indignity of the situation is probably as important to her recovery as whether or not she actually passed gas. Whatever happened to "hello Ms. Duffy, how are you feeling today?" The nimrod in the story just enters the room, with a crew of 20somethings in tow, ignores the patient, circles her bed, then asks her: "Have you passed gas yet?" I don't care, sometimes a nimrod just has to be called a nimrod. We just have to make some noise sometimes. Granted, I would refrain from calling the biker dude such a derogotory name as he sits at the stop light one lane over having just cut you off in traffic a few miles back. But this guy... yea, ... nimrod!

No, the article does not address the double standard. Frankly, it isn't a popular facet of the issue to address, and it often gets sidelined. Let's face it, if someone wants to make a point about a topic such as patient care, patient modesty, patient dignity, patient well-being, cross-gender strip searching, equal employment rights, discrimination, etc., it is always best to put your message out there with a female in the victim role. Society is just more sympathetic to female victims. You will always have a much better chance of getting support for your cause.

Many of the rights and quality of life improvements boys and men enjoy these days came only well after the cases were made and won on behalf of girls and women. Example, a short man is allowed to be a police officer today because women demanded the right to become police officers, decades ago. Because it was deemed appropriate that women should be allowed to serve as police officers, the height standard had to be lowered. As an after thought, short men benefited from the fall-out.

Imagine the story in the article slightly different. Imagine the physician is female and the patient is Mr. Duffy. Does that drive the message of the article home quite as well as if the patient is Ms. Duffy and the physican is male (as it is)? Do you see my point?

In much the same way the Pentagon recognized that public knowledge of systematic, standardized, sexual humiliation, degradation, forced nudity and abuse on detained females would never be tolerated by society, it rationalized that such things done to detained boys and men would likely be tolerated, albeit mildly troublesome for the PR folks to deal with. To this day you can still surf the talk shows, the radio programs and the roundtable discussions and still find a significant number of people that think what happened to those boys and men in Abu Ghraib was fine...because... well... we are at war!. I think Rush Limbaugh once said that it was just like "fraternity hazing."

Advocacy for things like patient modesty are best done in the context of, or on behalf of, female victims.

The problem with the double standard is that it sets up false perception, and false premise. We begin to actually think Mr. Duffy, in the same situation, isn't really hurt by the indignant treatment. Why? Because the stories, the articles, the outrages, the newscasts, the soundbytes, the abuses are always seen in the context of female victims. We eventually begin to even think it only ever happens to females.

The male teenage skater stories become unworthy.

I think the article, however, clearly presents the issue from a patient perspective. And, that is wonderful. But is seeing through the patients' eyes really enough? I suspect that is not really all that will be needed to trigger true change.

[CaDad]

I agree , the article did not address the huge difference between male and female modesty issues but did point to some of the reasons and observations on how some in the profession behave in a very stressful environment. It was not condoning but exploratory and it did cause me to pause .None the less, at the end of the day, it was drawing upon the conclusion, based on lots of research, that a Patient/Caregiver relationship needs to be developed and maintained for the benefit of both and when the modesty of the PT is trivialized it demeans the relationship, extends the recovery and both parties suffer. You cannot take the the relationship out of the care process like many do. ort wish they could do. It is against the very nature of what Nursing is all about.