Patient modesty concerns pertaining to surgery

netglow, ASN, RN · May 16, 2010

OMG!!!! CrazierThanYou! :eek:

**canoehead, BSN, RN** · May 16, 2010

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.

If someone asks me specific questions I will not lie, but not many know what questions to ask. Actually, I've never had anyone ask much more than why they have to take underwear off. I just say that is part of the protocol for the OR, and it's easier to clean them up after the surgery if the underwear isn't on. True...but I left out the incontinence bit, or the fact that there may be 10 people in the room as the cleaning process occurs.

carolinapooh, BSN, RN · May 17, 2010

Is it totally wrong that I'm enjoying the TMI tales, or should I hide it all under the guise of "learning experience" since I'm not an OR RN? :eek: :eek::uhoh21:

(Or is it more confirmation that I've led a sheltered life??)

carolinapooh, BSN, RN · May 17, 2010

OMG!!!! CrazierThanYou!

OMG OMG OMG OMG !!!!!!

TDCHIM · May 17, 2010

Holy jumping cats, CrazierThanYou! If I'd fallen into a bunch of metal equipment and in doing so unintentionally exposed my nether regions to the entire staff of my OB/GYN's office, I might have become the first person on record to actually expire from embarrassment! If you ever went back there again, you're a much tougher cookie than I'll ever be....

CrazierThanYou · May 17, 2010

Holy jumping cats, CrazierThanYou! If I'd fallen into a bunch of metal equipment and in doing so unintentionally exposed my nether regions to the entire staff of my OB/GYN's office, I might have become the first person on record to actually expire from embarrassment! If you ever went back there again, you're a much tougher cookie than I'll ever be....

Actually, I didn't go back. The doctor moved to another city. But, he has returned to the general area and I think I'm going to go to him for my tubal. But, I don't think anyone will remember me! :lol2:

TDCHIM · May 17, 2010

Actually, I didn't go back. The doctor moved to another city. But, he has returned to the general area and I think I'm going to go to him for my tubal. But, I don't think anyone will remember me!

Oh jeez, I'd probably go in wearing a Mission: Impossible-esque disguise! I embarrass fairly easily when it comes to my own errors, klutziness, or nudity, though. Go to it, tough gal!

Cul2 · May 17, 2010

but I left out the incontinence bit, or the fact that there may be 10 people in the room as the cleaning process occurs."

canoehead -- Please, give me a good reason, a good medical reason why 10 people need to be in the room while this is happening. Please describe the specific role each of the 10 people have in the specific surgery and why they are essential and need to be in the room. Thanks.

slineb · May 17, 2010

I'd love to hear a good reason for NOT having patients wear incontinence pads/briefs. Many patients are told they can't wear their own clothing due to 'sterile' issues ... but this is total BS.

How can having a patient lying in their own excrement NOT be a problem with infection control/sterile field?? I just can't seem to get a valid explanation from anyone on this.

If it is something nearly EVERYONE complains about (being naked) and there is NO valid reason for it (which we have established) ... then WHY keep doing it this way???

Another thing I haven't managed to get a doctor to give a good explanation of is surgical prep/shaving. This was once thought to be also about cleanliness & infection control, but many studies have been done that show not only does NOT shaving have no detrimental effect ... but shaving DOES have a detrimental effect by causing microabrasions of the skin that harbor bacteria/germs & weaken our natural skin barrier to such things.

I have found that if a patient is well-versed in this research AND they confront the surgeon about it -- they have a chance of keeping most of the hair in the area. I think this is a BIG deal for many procedures. I know some local providers were irritated when I started telling male patients that they did NOT need to be shaved for various things involving their private areas. Certainly the actual exact incision site may need hair removed so that the surgeon can work in the area without having hair in the way, but it ends up being a MUCH smaller area and often the hair only needs to be really trimmed (not shaved or totally removed). This is a BIG deal. I think any doctor that requires someone to shave their privates for surgery should be required to have it done to them.

How stupid is it to cause itching & irritation exactly in and around the area that needs to heal?!?

It seems yet another case of 'that's they way we do things, and who are YOU to ask us why'

morte, LPN, LVN · May 17, 2010

but I left out the incontinence bit, or the fact that there may be 10 people in the room as the cleaning process occurs."
canoehead -- Please, give me a good reason, a good medical reason why 10 people need to be in the room while this is happening. Please describe the specific role each of the 10 people have in the specific surgery and why they are essential and need to be in the room. Thanks.

that isnt the way i took this post. I think the point was that those persons would be in the room, doing whatever, not that they would be involved with the clean up, BUT would be within "seeing" range.

**canoehead, BSN, RN** · May 17, 2010

that isnt the way i took this post. I think the point was that those persons would be in the room, doing whatever, not that they would be involved with the clean up, BUT would be within "seeing" range.

Yes, that's what I meant, but the minimum of personnel in the OR is five. Scrub nurse, circulating nurse, anesthesia, surgeon, surgeon's assistant...so more than five is definitely possible, especially if they are turning and cleaning and getting lifting help.

rn/writer, RN · May 17, 2010

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.
depending on the surgery, that could mean you'd be lying in feces/urine for many hours. that isn't good from an infection control standpoint. it also isn't good for your skin. not to mention the odor for the surgical team to have to contend with.
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.
one reason is that urinary output is a way to gauge hydration and other dynamics. you can't measure the volume of that output or assess for character of the urine in a brief. other reasons are infection control and protecting the skin integrity of the patient.
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.
and yet you are trusting these same people to cut you open and manipulate your organs.
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?
serioiusly? this is a sterile procedure. it takes time to learn to do it correctly. i have a relative who straight caths himself but he has almost no feeling below the waist. even with lots of practice and great attention to cleanliness, he has utis.
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.
you might be willing to cath yourself, but i don't think that would be the usual reaction.
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.
i'm sure there are occasional exceptions, but speaking as someone who has 16 years of nursing experience and 17 years experience as an emt, heath care professionals, as a rule, respect their patients and don't view their vulnerability in an exploitative fashion. it would appear that you see any exposure that isn't precipitated by a dire emergency as "not right." i've been on both sides of this equation and i understand that there are ways to be respectful even while seeing the patient temporarily unclothed (like when they're being draped). and i understand that modesty matters . . . to a point.
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.
seems like that was a good decision.

some of your suggestions might give you comfort, but they also have the potential to cause other problems. as in most matters, the trick is to find a good balance.