Patient modesty concerns pertaining to surgery

Specialties Operating Room

Published

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"?

What I saw when I did an OR observation in nursing school really made me hope I never have to have any type of surgery that requires general anesthesia.

There were a few things, but the one that bothered me the most was a middle-aged woman in for a lap chole. She did meet the "F's" criteria, and she was slightly overweight. No where near obese, just a bit soft in the middle.

When she was out the surgeon start signing some song he made up about how fat and jiggly her belly was, and he was demonstrating by poking it and making it jiggle while the nurses and techs in the room tittered and giggled behind their masks.

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Specializes in Health Information Management.

Okay, I have to stop reading this thread or I'll never have another surgery again....

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Specializes in L&D; GI; Fam Med; Home H; Case mgmt.

Sorry in advance for TMI, but for precisely the reasons being mentioned in this thread, I have avoided having much-needed hemorrhoid surgery. After having my 2nd son, who was 10.5 lbs, I developed horrific external hemorrhoids. Then my 3rd son was 24" long and 10 lbs and they became even worse. Add 1 more son to the mix (the first was also a boy - 4 boys total) and let's just say my bottom is a bit of a mess. I would love so much to be able to go in and have this fixed, but I am mortified by the whole thing. I know without a doubt I will be the butt (har har) of jokes in that OR. :(

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Specializes in Post Anesthesia.

And my friends wonder why I am living with a GB full of stones. I'm not shy-naked isn't my worry, but I'm not a fan of a few of the O.R. staff and thier attitude toward patients. I'm going to try to avoid fried food for as long as I can.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

When I had knee surgery five years ago, they told me to bring "shorts with no metal on them" to the hospital. When it was time to get prepped, they had me put on a gown for the top and my shorts for the bottom. Considering that I was basically spread-eagle in the stirrups the whole time with my gown pushed up around my waist, I was glad to have the extra coverage, particularly since I was fully conscious for the whole thing.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.
Sorry in advance for TMI, but for precisely the reasons being mentioned in this thread, I have avoided having much-needed hemorrhoid surgery. After having my 2nd son, who was 10.5 lbs, I developed horrific external hemorrhoids. Then my 3rd son was 24" long and 10 lbs and they became even worse. Add 1 more son to the mix (the first was also a boy - 4 boys total) and let's just say my bottom is a bit of a mess. I would love so much to be able to go in and have this fixed, but I am mortified by the whole thing. I know without a doubt I will be the butt (har har) of jokes in that OR. :(

Do you need to be in the OR for external hemorrhoid removal?

When I was 9 mos pregnant, I got a really nasty GI virus -- one of those where you have to sit on the toilet and hold a bucket in your lap at the same time, if you KWIM. (It was so bad that I ended up going to the hospital for a day for IV fluids.) I ended up with two HUGE external hemorrhoids. A week or so later, one of them thrombosed. My general practitioner's office wouldn't make an appt for me when they realized I was preggers, so I had to see my midwife. I'm lying on the exam table and I "assume the position" and she takes one look and says "Ay Carumba!" She said they were the biggest hemorrhoids she has ever seen in her life -- it looked like I had testicles! She consulted with an OB in the office, and then made me an appt that same day with a general surgeon.

I went over to the surgeon's office, and after all the paperwork and what-not, I was gowned up and escorted to a procedure room. I assumed a hands-and-knees position on the table, he injected the local (MAN does that ever sting!), lopped off the thrombosed "testicle" (wish he'd done them both while I was there, but he chose not to), they shoved a bunch of gauze in my butt crack (no stitches or anything), gave me a pad for my undies, and sent me home.

The day before I was being induced, the second "testicle" thrombosed, so I just waited to deal with that until later. I ended up with a c-section, and a couple days later I had the surgeon come up to my hospital room and lop off my remaining testicle. Basically did the same as what we did before, only he did it on my hospital bed: local, slash, stuff, and done.

I obviously don't know what your specific situation is like, but you may be able to take care of the whole thing while fully conscious in an office or out-patient setting.

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Specializes in L&D; GI; Fam Med; Home H; Case mgmt.

First, I truly appreciate your candor. Really - it's a breath of fresh air to just lay it all out and not worry with offending sensibilities. We're nurses after all, haha. Second - well heck, I didn't know that. I had a scope done last year due to blood in the stool (guess where THAT was coming from? yeah). The guy who did it said it was definitely coming from the hemorrhoids and if I wanted to have them surgically removed he would be happy to do it. It would be same-day surgery, but definitely in the OR. Maybe I could see if he would be willing to do it in-office? And by the way - OUCHHHHH! Thrombosed hemorrhoids! JEEEEEZZZZ. I can't think of anything more painful. After boy #2 was born, I had to sit on one of those inflatable donuts because the pain was excruciating. The vajayjay was lacerated to kingdom come due to his hugeness but compared to the pain of the hemorrhoids, I couldn't have cared less.

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Specializes in Cardio-Pulmonary; Med-Surg; Private Duty.

Definitely check to see... and check with more than one doctor, if you strike out with this one.

When I was talking to my midwife, she was telling me about her own husband's experience with hemorrhoid removal. His were internal, and (as she put it) "with him being a typical heterosexual male" he was so "clenched up" that the speculum shot right out and landed halfway across the room! The doc had to have the nurse come and hold the speculum in place so he could use both hands to do the job he was there to do! :D

You mention a scope... was it a GI specialist that told you it would be an OR procedure? You might have better luck with a general surgeon (like I had). Definitely worth making a few phone calls to some other places to see if you can get it taken care of!

Feel free to PM me, too... I have no problem sharing all kinds of TMI info! ;)

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"There are lots things that are not mentioned when patients go for surgery. Imagine if every nurse took it upon themselves to list off about five to every patient in the name of "informed consent." You know that once a couple surgeries got cancelled the hammer would come down to keep your

shut or lose your job. There wouldn't be any thought that gee...the patients should have been told, or practice should change. I work in reality, not legal utopia."

If a person asks what exactly is going to happen to their body, there should be no dishonesty and it should be left to the person if they can accept it. A few surgeries may indeed get cancelled, but a person has a right to know and choose what will happen to their naked body. We should expect honesty about our bodies in every situation in life, whether inside or outside of a medical building. So many people do not trust the medical system anymore....why not try to make it better? We need more trust, not less.

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Ok ... so if the entire valid reasoning we can come up with for being totally naked during surgery is due to incontinence issues & the need to possibly remove due to emergency - why can't the patient be offered the ability to wear some incontinence briefs?

Personally I would much prefer the coverage & there would be NO reason for anyone to touch these unless an emergency occurred. I would be perfectly happy to be left in 'soiled' status until I am fully awake & can change myself.

Most full incontinence briefs have 'quick release' tabs on the sides like diapers that would allow easy access if a cath or emergency need would occur.

Also for catheters, I just do not understand why most are so quick to place these.

I had major dental surgery to remove wisdom teeth impacted in the bone - they had to go through my cheek. It took nearly 3 hours, and it was under general with an anesthesiologist ... and I wore my street clothes. I had a stretchy cotton 'sleep bra' on that I easily moved to the side (with NO exposure) for EKG leads to be placed. I had a loose fitting Tshirt, I actually wore a depends pad in my undies 'just in case' (my idea - rather than have any embarassing issues) ... and shorts. This worked just fine. My clothes were exactly the way I had put them on, nothing suspiciously on backwards or anything. I also had my husband

sit in through the entire thing as well.

So this negates the while idea that it is necessary for general anesthetic or that a surgery longer than 30 minutes requires it. It seems that it really is just 'that's how we do it' and no thought is really given about WHY??!

Some on this site and others say that patients should 'trust their nurses or doctors' and I say, 'why would I?' I don't know you, and you don't know me ... there are good & bad people everywhere, there are considerate people & those who are just trying to get through the day. Why should I just blindly trust that I got all 'good ones' on my team that day? It seems to me that it makes a LOT more sense to hope for the best ... but to PREPARE for the WORST.

Also, I have mentioned before to many friends who are nurses (I was a CNA while attending college, but chose to go into the computer field) Why exactly can many of these patients not place the cath. themselves? There are plenty of people with continence issues that do this all the time with no problem, we learn to do it in a very short time, so why not show them how to do it themselves?

If I were going in for surgery, I would happily place my own before allowing anyone else to do it. I just don't see what the need is to touch people in private areas unless ABSOLUTELY necessary. Certainly if they are seriously injured or such, but then all effort should be made to provide for their modesty.

I got out of that work specifically because I couldn't get over seeing people treated in ways that were not right. Just because a man or woman is unconscious doesn't mean that they don't care who touches them or sees them. In fact, I think for many it matters MORE when you are helpless (to me as well).

And for those of us that did make any noise about it, we just got a lot of problems heaped upon us and nothing was done to stop the behavior.

It all comes down to what is best for patient. It should not be about what is easiest or fastest for the OR staff or ER staff or any staff. Why is it that some nurses can place EKG leads in mere seconds perfectly without ever exposing me at all, and others ***** & complain like it's totally impossible to do without showing everything to everyone.

Once I know it CAN be done the right way, why would I allow someone to do it otherwise?

Anyway, that's why I am a former CNA who prays daily to never have to have emergency intervention of any kind.

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Kinda related.... Several years ago I was at my gynecologist's office having a pelvic exam. I was on the table, with my feet in the stirrups. The doctor had an emergency phone call and stepped out. After lying there for a couple of minutes, the door was blasted open and a little girl around 6 or 7 came flying in and crouched down at the end of the table, under the stirrups... and my legs. I had no idea what was happening. A couple of seconds later, a woman walks into the room and grabs the little girl by the arm and hauls her out.

Turns out, the little girl was one of the doctor's twins and the woman was his wife...:rolleyes:

Another fun story... I was at a different gynos office a few years later, having a pap smear. When he was finished, the doctor said I could dress and left the room. When I stood up, I suddenly felt weak and fell, of course crashing into all the metal equipment in the room. What seemed to be the entire staff of the office came rushing in to see what happened. Keep in mind, I hadn't gotten dressed YET.:eek:

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Specializes in FNP.

I had surgery at my hosp a few years ago and received merciless teasing about my tattoo from coworkers who should not have been in position to see it or know about it. ;-)

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