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"?

[sirI, MSN, APRN, NP]

As it applies to the OR and/or surgery (the thread topic), yes, I think further discussion is warranted.

But, just beating a horse to death stating again and again that we as nurses are burying/hiding the issue of modesty concerns is unwarranted.

Also, instead of posing the question to the nurses here on the boards to solely come up with the answer, how about come up with some possible solutions that are feasibly workable?? Again, as it applies to OR/surgery.

It is not our (most of us) goal to disrespect any caregiver and their effort toward dignified care.

Thank you.

[Cul2]

I agree with both advo-kate2 and sirI. The issue is being discussed here. But

perhaps we should be asking different questions. Assuming that we'll all

basically on the same page regarding patient autonomy and dignity (and I

realize that may be a faulty assumption for some) -- then perhaps we should

be asking what are the specific obstacles within healthcare preventing patient

gender choice. We must assume that we agree that, when possible, patient

should have gender choices when possible and approprite. What, then, makes this impossible

or less likely. And then, what steps can be take to make it possible and more

likely. And, what can no medical professionals, patients, do to help the medical

community make this happen? For those who want to see things change,

perhaps we need to stop complaining and start coming up with specific

plans of actions -- plans that involve doctors, nurses, techs and patients

working together. To some extent this is a political ad economic problem.

It may involve more financial resources and political activism. To some

extent this is a cultural/social problem. How do we get a better gender

balance in medicine without discrimination against either gender, and at

the same time getting the best people into training programs. How do we

get this issue embedded more into the training of medical professionals. I'm

not saying it isn't in the curriculum now. But like all academic programs, the

issues is always moving from classroom theory into practical application.

I have some ideas, as I'm sure many people do. Perhaps we should be

discussing practical solutions to this issue.

[sirI, MSN, APRN, NP]

And, that's exactly what I suggested in my post above.

Ones who come here and are actively advocating for patient modesty need to post some suggestions. Suggestions that are feasible........but, these suggestions must be as they apply to the OR/surgery (this thread topic).

This thread was bumped up to discuss Patient Modesty, but no one (advocates for) has posted any potential solutions.

So, I again ask, what do you, as the ones bumping this thread and asking nurses here on the site, suggest as possible solutions...............as it applies to the OR/surgery?

Our members can then take these suggestions back to their respective employers and once again..............have a very nice 1st step.

[rn/writer, RN]

One option, perhaps, is for a specific hospital or out-patient surgical facility to arrange staffing to allow for same-gender care on a trial basis to see if, a) there are enough patients for whom these issues are of paramount concern to warrant the extra effort, and b) to see if it is economically/practically feasible to make and sustain such arrangements.

It could be that the modesty issues matter this much (as has been discussed in this thread) to a specific percentage of the population and not as much to others.

A surgical unit within a hospital or an out-patient facility would need to have extra staff (either working in some other capacity/on call) to be able to accommodate every patient, and that would not be inexpensive. On the flip side, this option might have a built-in clientele in addition to those whose modesty concerns are personal. Orthodox Jews, Muslims, and others might choose such a facility and the volume could possibly offset any extra expenses.

Every unit and facility should be able to treat patients with dignity and respect, regardless of gender issues. (Many people are okay with surgical staff of mixed gender, so long as they are cared for properly.) But if same-sex caregivers are a primary concern, it seems like having a dedicated venue would be a good test market and offer an assurance to patients that would be difficult to mass produce without some kind of business and practice model to use as an example.

Rather than challenge the entire medical community to bend to wishes that are voiced by a limited segment of the population, it might be better to start small and proceed from there. If patients flock to the trial settings and the new measures could be shown to work well, it's likely that the medical community would take notice as they did when many of the birthing practices that are common today (mom being awake for their deliveries, fathers at the births, epidural anesthesia, minimal medication, nurse-midwives, to name a few) were first introduced. Initially many docs had a fit and predicted all sorts of problems. Then some hospitals tried the new ideas. In time, what was once an intrusion became an attraction and many of the changes have now become standard operating procedure.

[Scrubby]

One option, perhaps, is for a specific hospital or out-patient surgical facility to arrange staffing to allow for same-gender care on a trial basis to see if, a) there are enough patients for whom these issues are of paramount concern to warrant the extra effort, and b) to see if it is economically/practically feasible to make and sustain such arrangements.

The whole idea of same gender teams is absolutely ridiculous. We have enough trouble staffing the OR as it is with adequate nursing skill mix most days. Same gender teams is not and should not be an option for anyone at all. I'm going to sound like a mean OR nurse here but quite frankly we don't care about naked bodies at all, we see them everyday. We do our best to promote patient dignity by ensuring that the patient is covered up until it's time to prep. I'm actually kind of militant when it comes to leaving the patient covered until it's time to prep and drape.

[Laurab14]

Here is my perspective... I had a d&c and tubal ligation last summer, it was my first surgery ever. I am a RN, have been for 16 years. I have faith that modesty/dignity issues are followed 99% of the time, but I have witnessed "jokes" about patients, specifically about their body parts.

It was not necessarily for the part of being draped, or naked during the surgery. It was the fact that I don't REMEMBER any of it. I can't identify any of my surgical staff. It was a very weird experience to wake up in the recovery room and swear they hadn't even touch me yet. I guess I am more of a control-freak than I thought (most nurses are).

I consider myself a pretty modest person, 3 people have seen me naked in my adult life- my husband and 2 doctors. I don't like NOT knowing who those people were, and if I see them on the street (we live in a very rural area) are they thinking about me with naked with my legs in stirrups?

Now, here is where it gets funny... I know professionally they are not, just as I do not when I see former patients. But, as a patient, it makes me feel uncomfortable. If I was awake, and met these people and I had some control over the situation it might make a difference. It is the UNKNOWN that is always worse.

Not sure what we can do about it as nurses, but thanks for giving it a second thought, I hardly did until I became the patient.

[TDCHIM]

The whole idea of same gender teams is absolutely ridiculous. We have enough trouble staffing the OR as it is with adequate nursing skill mix most days. Same gender teams is not and should not be an option for anyone at all. I'm going to sound like a mean OR nurse here but quite frankly we don't care about naked bodies at all, we see them everyday. We do our best to promote patient dignity by ensuring that the patient is covered up until it's time to prep. I'm actually kind of militant when it comes to leaving the patient covered until it's time to prep and drape.

I definitely understand your concerns about staffing, and I'm not entirely sure about the whole same-gender team option idea. It sounds like it would be tough and costly to maintain.

However, I have to take issue with the whole "we don't care about naked bodies at all" statement. There are many instances already noted on this thread alone where medical professionals were less than considerate of patient modesty issues. In addition, isn't the patient's comfort level more important than yours? I mean, as a patient I'd be perfectly content being covered up as you describe, but there are cultural issues in many populations that make same-gender treatment an important option to offer.

Those are just my somewhat muddled thoughts....

[Cul2]

"The whole idea of same gender teams is absolutely ridiculous."

I wouldn't use the word "ridiculous." That's a value judgment based

as much on emotion as anything else. We might say it's unworkable

in most situations as staffing exists currently. People's feelings are

people's feelings. You can't quantify "ridiculous." What's "ridiculous"

to you may be quite serious to someone else, and both of you can'

be quite sane and normal.

Having said that -- I think the "control" factor mentioned above is

significant. I recall having surgery recently, and the anesthesiologist

just knocked me out without giving me a warning our countdown.

That bothered me. I felt tricked. My point? Good communication.

Don't assume too much about the patient. Ask preferences. Frankly,

I think it's important for many patients to know precisely who will

be in the OR and who will be doing what. Best practice is to make

sure the patient has been introduced to everyone, even briefly.

The patient may want assurance that these people, and only

people will be in the OR during the operation -- that, unless specific

permission has been given, no non essential observers will be there, esp.

non medical professionals, like medical hardware salespeople. Talk the

patient through everything, if that's what they want. No real surprises

if the patient wants to know things. Give a countdown before putting

them out. Explain specific prep and positioning if they want to know.

But you've got to ask if they want to know. They may not tell you. Some

may just want to be knocked out and not remember anything. But not

everyone.

Now, some of you will say, we do that already. No, you don't. Not all

the time. This needs to be protocol. This needs to be part of the

checklist that's now being used in some OR's. Has the patient been

asked about what they want to know? Has the patient met members

of the OR team? Etc.

I realize we're talking about same gender OR teams, but my contention

is that most people, they feel safe, if they feel respected, if they feel that

they have at least some control, if they feel their dignity is being observed --

most people may go along with mixed gender teams. Granted, some may

never want it. But I don't think they are in the majority. And I'm not saying

we shouldn't try to accommodate them if possible. But in my mind this

modesty issue is more about good, open, honest, communication than

it is really about modesty -- for most people.

[Intern67]

"The whole idea of same gender teams is absolutely ridiculous."

I wouldn't use the word "ridiculous." That's a value judgment based

as much on emotion as anything else.

If the shoe fits...

It could be a value judgement based on reason and evidence more than it is on emotion.

[Cul2]

"If the shoe fits...It could be a value judgement based on reason and evidence more than it is on emotion."

Okay -- then use reason and evidence to back up your statement? Let's hear your case.

It's easy to say something is ridiculous. Anybody can do that. It's more difficult to

quantify that statement. All we have to do is look around the world to see various

customs and beliefs so different from ours. We can say some of them may not

recognize human rights or the dignity of the human being. We could base that on

the philosophic foundations upon which our Declaration of Independence and

Constitution rest. But to say these customs and traditions are "ridiculous" without

using our brains to reason it out, that's obtuse arrogance.

So, go for it. Reason out why your position is a valid and those of posters who

think people's right to preserve their modesty as they see fit is unreasonable.

[SandraCVRN]

>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.

That is NOT AT ALL what I am saying, I am saying that exposure that is not MEDICALLY NECESSARY is 'not right'. I do NOT care about how 'respectful' those '10 others' in the room are, when there is NO REASON for them to see the patient 'unclothed' other than CONVENIENCE.

I have seen multiple unconscious patients have EVERYTHING removed and THEN it is noticed that 'oh, we need to go and get something from another room. Yep, they are working on 'draping the patient' ... the fact that it took 10 minutes from the time the patient was totally unconvered to the time anyone even STARTED draping ANYTHING ... apparently no big deal.

Now I say this as a hardware technician that was 'in the room' for a technical issue with a piece of electronics. I was there because it was a convenient time between 'actual surgery in progress' to get the phone system working correctly. I was more than once the ONLY person in the room with a naked unconscious patient ... sure it was only moments while others were in and out ... but GEEZ how is this okay???

I didn't know these patients, and I had NO BUSINESS seeing them. Was I respectful? Sure. Was I shocked and horrified at the treatment of these patients? YES!!! Did I say anything? Once I asked one of the busy people if they shouldn't 'cover that poor lady up' and she actually said 'it's okay, she's out' (like the fact that the patient was unconscious meant that it was OK to leave her lying there naked). I also told my supervisor about it, and he said 'happens all the time, you'll get used to it'.

So when you say 'like when they're being draped' ... I read this as 'like whenever it is convenient for the staff'. (Is this because I am hostile or think every nurse/doctor/tech is evil or even inconsiderate?!? Hell no, it is because I KNOW it happens ... I've SEEN it happen. Others have SEEN it happen. And yet, if a patient asks about such issues happening, they are spoken to as if all of these occurances are just figments of sordid imaginations.

We've got 'linearthinker' stating '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. ;-) '

And it appears that everyone is just OK with the FACT that this happened (because it is so COMMONPLACE).

So now I ask, why would ANYONE in their right mind trust that everyone in that room is doing what was best for the patient??? Sure, you tell me that you are respectful of seeing patients unclothed. Well, what about a tech that makes comments to his buddies later? Am I okay with the fact that this person saw me, and was outwardly respectful but has gotten an eyeful of things he had NO REASON to see? Are you okay with that being your well-endowed 15 year old daughter on the table?

So what I am asking is when you say

'>modesty matters . . . to a point. '

What point are you speaking of?

The point at which it inconveniences the medical personnel?

Cause I would agree that my 'point' is that it MATTERS unless there is a damned good reason why it shouldn't. Is it an emergency? Maybe, but modesty STILL matters even then. If I am having an asthma attack, it's likely an emergency. Does anyone then have a legitimate reason to yank off all my clothes? Hell NO!

If you are ever wondering ... is it OK to uncover this part of the patient?

The question literally should be if 'I keep it covered will it cause some medical problem'? If the answer is no, then the answer is NO!

When draping a patient, how hard is it to leave the gown on until the drape is already there??? I've seen it done. There was one nurse who was also a nun ... she was the model for what I would want in any caregiver. She would roll up the folded drape starting at the patients feet, and then as she got to the area of the gown (which was still in place) she would roll the drape over the gown 1 fold(about 6-8 inches), and the pull the gown out from under the drape and fold it up. I don't think she ever saw anything of a patient other than head, arms & legs. So how come she can manage this but others can't? Sure, some might say that it takes more time ... but I'd happily fork out another $500-1000 or even more for greater consideration in these matters.

Anyway, why would I accept any less consideration for my modesty when I KNOW that it CAN be done right?

I have NEVER been anywere that a pt was left in the OR unattended. PERIOD

Draping and prepping are 2 different things. You can't change a gown for a drape and still have a sterile field. If I am prepping an abdomen for a Lap Chole for instance. The gown is pulled up to the nipple line and the blanket down to right across the groin. The abd is then prepped and covered with the sterile drapes. You HAVE to prep out a little farther than the actual opening in the drape. There are landmarks the surgeon must be able to see.

[Scrubby]

"If the shoe fits...It could be a value judgement based on reason and evidence more than it is on emotion."

Okay -- then use reason and evidence to back up your statement? Let's hear your case.

It's easy to say something is ridiculous. Anybody can do that. It's more difficult to

quantify that statement. All we have to do is look around the world to see various

customs and beliefs so different from ours. We can say some of them may not

recognize human rights or the dignity of the human being. We could base that on

the philosophic foundations upon which our Declaration of Independence and

Constitution rest. But to say these customs and traditions are "ridiculous" without

using our brains to reason it out, that's obtuse arrogance.

So, go for it. Reason out why your position is a valid and those of posters who

think people's right to preserve their modesty as they see fit is unreasonable.

I find it ridiculous because you cannot staff according to gender in a nursing speciality that is struggling to provide adequate skill mix as it is. For example someone who is requesting for an male team had better go to another hospital considering we have a shortage of male RN's in my workplace.

Anyone undergoing an orthopaedic procedure who wants an all female surgical team better travel to another state because we don't have female orthopaedic consultants in my hospital. And it's the same with our hepatobiliary surgeons-all of them are male so if you require a liver resection then you simply have no option but to have a male surgeon unless you want to travel or interstate. Unless you want the only female registrar in the clinic who takes 4 hours just to do a lap chole doing the operating all by themselves in which your putting yourself at HUGE risk of bleeding and probably death.

So the fact is the ratio's don't add up. More female nurses than male nurses, more male surgeons to female surgeons.

And quite frankly it's a PUBLIC hospital which means that the government is subsidising everything-this is Australia not the US so I don't know how it works over there. Patients in the public system don't even have a choice of surgeon, let alone the operating room team. If some patients get to dictate who they get it's not fair on all the other patients. If it's a private patient then they do get a certain level of choice for their surgeon but it still comes down to skill mix and staffing.

As for modesty I never said that people don't have the right to modesty, they just need to understand that their ideas will not work. Modesty is of paramount importance to all of us who work in the operating room, we have ACORN standards that address this very issue and we strive very hard to maintain patient dignity. If a patient tells me they are embarrassed etc then I discreetly let everyone in the team know so we're all aware of the issue. Modesty is something I take very seriously. I just don't believe that the idea of having all gender teams is viable at all and yes even ridiculous given our staffing issues. IF we had equal ratio's of male-female staff then it could possibly be arranged but this isn't going to happen anytime soon.

And what about the rights of nurses and medical professionals not to be discriminated against in their workplace? I believe there are laws against this. If someone doesn't want me as their scrub nurse or circulating nurse I'd feel like I was being treated unfairly.

I ask the people who want this ridiculous option who would you prefer? The top person in the field who happens to be of opposite gender? Or the same gender who isn't as good as their male colleague?