Patient Modesty

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"?

An AORN representative stated that to me in an email. Practicality of it?... that is another issue if it is a long case. Most I assume are not. But, that is what the AORN states as a patient right prior to surgery.

I can't find any reference in the AORN standards and recommended practices (although admittedly my manual is several years old). Just because someone told you does not make it AORN policy. A representative emailing you also does not make it an AORN statement. Like I stated it would be tremendously unworkable.

David Carpenter, PA-C

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I can't find any reference in the AORN standards and recommended practices (although admittedly my manual is several years old). Just because someone told you does not make it AORN policy. A representative emailing you also does not make it an AORN statement. Like I stated it would be tremendously unworkable.

David Carpenter, PA-C

Whatever!

Bonnie Denholm, RN MS CNOR

Perioperative Nursing Specialist

Center for Nursing Practice

AORN

It is and should be any patients right if they want to exercise it.

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Quoted from Maurice Bernstein, MD:

"Without the patient, the surgeon could do nothing more but trim is own toenails. It is the patient who brings to the doctor the critical information in the form of a history. It is the patient who brings the pathology and allows the physician to examine his or her body to find that pathology. It is the patient who provides the legally required and ethical informed consent for further testing and treatment. And, isn't it the patient through one way or another that provides the means for the doctor to get paid for his or her services. Without the patient the doctor has nothing. Doctors have to keep in mind that as important a player in the final act is the doctor, without the patient the play would never get there."

Nursing and other ancillary healthcare personnel should keep this in mind as well. :up:

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Specializes in Operating Room.
Quoted from Maurice Bernstein, MD:

"Without the patient, the surgeon could do nothing more but trim is own toenails. It is the patient who brings to the doctor the critical information in the form of a history. It is the patient who brings the pathology and allows the physician to examine his or her body to find that pathology. It is the patient who provides the legally required and ethical informed consent for further testing and treatment. And, isn't it the patient through one way or another that provides the means for the doctor to get paid for his or her services. Without the patient the doctor has nothing. Doctors have to keep in mind that as important a player in the final act is the doctor, without the patient the play would never get there."

Nursing and other ancillary healthcare personnel should keep this in mind as well. :up:

Quoted from Witchy RN:

"Without the surgeons, anesthesia, nurses and techs, the patient could do nothing more than bleed out or stay riddled with cancer. It is the healthcare team that brings the gift of survival and health to the patient in the form of their skills. It is the healthcare team that brings their education, knowledge, and compassion to the patient even when the patient is noncompliant, a criminal or just not a nice person. It is the healthcare team that is always at the ready to save your life in a trauma and emergency and still manages to see the scared person under all the blood, and broken bones. Finally, it is the healthcare team in the OR that will save your life, and restore function to your body even though you may not have insurance. Without the healthcare team, the critically injured patient is dead. Family members and those who don't work in the OR and have no clue what it entails should keep this in mind as well";)

Yeah, I know I said I was done, but we had a couple of traumas back to back in the OR and I've never been prouder of the people I work with and all the OR staff out there.

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If I ever had surgery I would like the staff to introduce themselves, be professional, kind, and protect my modesty the best they could. I can't see myself wanting to interview everyone involved. I'm modest and I might share that. I would also ask them to keep me alive because I'm petrified of surgery. lol I would of course spend ample time with the surgeon and adequate time with the Anesthesiologist. I realize that the level of privacy would depend on the surgery required.

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Question: How many people are usually in the room while the patient is being cleaned and draped?! Do other medical staff come in and out once the surgery starts or does it remain private barring an emergency?! Are the windows to the OR covered?! I think I read somewhere here about a very kind nurse putting up blankets and I wondered if that was based on patient request. I thought they would automatically be covered.

Edit-I'm a nursing student and this field interests me. TY.

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Specializes in Operating Room.

Our door to the hallway for all the rooms has a shade that we pull down...the blanket thing was in an OR where there weren't shades. I will also not allow instrument/equipment reps into the room until the patient is draped. I've thrown out orderlies that I thought were immature/nonprofessional. We do try in the OR to protect the patient as much as possible but sometimes, a body part needs to be exposed. The requesting of a particular team that is a certain gender is not often doable either. Trust me, you want the most skilled/talented people in your room..it shouldn't go by what reproductive organs you happen to have.

The OR is a great place...glad to hear you're interested!:up:

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Question: How many people are usually in the room while the patient is being cleaned and draped?! Do other medical staff come in and out once the surgery starts or does it remain private barring an emergency?! Are the windows to the OR covered?! I think I read somewhere here about a very kind nurse putting up blankets and I wondered if that was based on patient request. I thought they would automatically be covered.

Edit-I'm a nursing student and this field interests me. TY.

Most ORs are set up with an outer unsterile hall and an inner sterile core. Think of a donut with the hall around the donut, the donut itself the rooms and the donut hold the core. Sterile and clean items and instruments are stored in the core and the patients are brought in through the unsterile part. Only personnel wearing scrubs and overgear are allowed in the core. This prevents accidental contamination of sterile and clean items.

As far as windows there is usually a window in the door and some rooms have other windows into either the hall or core. Usually they either already covered or not. Non door windows are usually indicative of older ORs. It would be unwise to cover the windows in the door since that is how people know that a case is going and they cannot enter the room unless necessary (in most ORs there are only a few entrances between the hall and core and its common to cut through ORs if they are not in use).

As far as who is in the room, there are always four people in a regular OR case a cirulator, a scrub, anesthesia and the surgeon. Other people who may be present are anesthesia techs, perfusionists, first assists and additional nursing personnel as required. A busy case such as open heart surgery may have as many as 10-12 people in the room. In an academic institution there also may be residents or other trainees. Generally once the case is started you try to limit the amount of traffic as that is one of the principles of aseptic technique. Depending on how long and how complex the case is you may need to bring in more instruments, blood products or medications all of which necessitate people coming in and out. If the case takes time then everyone but the surgeon may have relief for lunch or other breaks.

As far as covering the patient, hypothermia is a problem in the OR so you try to keep them as covered as possible. You usually only uncover what you need to prep or what anesthesia needs access to. Once you drape its often hard to tell there is a patient under all the drapes. In a big case anesthesia will first need to get access before draping. Usually there is a minimum of people in the room but in a big case the patient may be asleep for more than an hour before the case actually starts.

Hope this helps

David Carpenter, PA-C

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Our door to the hallway for all the rooms has a shade that we pull down...the blanket thing was in an OR where there weren't shades. I will also not allow instrument/equipment reps into the room until the patient is draped. I've thrown out orderlies that I thought were immature/nonprofessional. We do try in the OR to protect the patient as much as possible but sometimes, a body part needs to be exposed. The requesting of a particular team that is a certain gender is not often doable either. Trust me, you want the most skilled/talented people in your room..it shouldn't go by what reproductive organs you happen to have.

The OR is a great place...glad to hear you're interested!:up:

This "trust me you want the most skilled/talented people in your room."

..How is a patient to know if they have the best or worst team? They don't ...it is pot-luck for a patient.

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Here is another issue about dignity and privacy and modesty in the OR.

Go to: http://creston.com/downloads/pdf/featured_articles/business/or_live_university_hospital_uab.pdf

Go to: http://www.or-tv.net

Go to: http://ucihealth.com/news_releases.asp?filename=or1.htm

(between the word featured and articles there is the hyphen on the bottom of the line and between "or" , live, university and hospital)

For about 7 yrs now this ORTV stuff has been going on. The thing that is not disclosed is that non-medical geek techs can dial into an OR. The cameras are not turned off, so a patient when fully exposed will be visible to anyone dialed into the OR from anywhere in the world. These video streams can be captured on the receiving computer. Comments, albeit inappropropriate comments, from healthcare professionals is nothing compared to this technology. This is voyeurism beyond words! The techs that support this AV computer system that enable remote functions to physicians and others all over the world also have the same remote access to the entire system.:bugeyes:

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Specializes in critical care and LTC.

I had a simple D&E done after a miscarriage, I had never had surgery where I was put under general anesthesia before and was nervous. As a nursing student observing in the OR I heard some pretty bizzare things being said. So in my room before surgery I told the Nurse anesthesist to tell everyone not to make fun of me or say bad things about me while I was "out". She told me awe sweety you are beautiful, they won't have anything to say about you. Thanks for the compliment but mean while in surgery in the lithotomy postion, wonder if anything was said. I was just uncomfortable knowing that things are said and how I was postioned while have a proceedure. I can simpothize.

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Specializes in US Army.

dutch92602, can you please post the hyperlink to that site. The only thing I can find is a virtual operating room tour... Give us the link that you are talking about.

You seem set and determined to find something negative or controversial about the operating room, what's up with all the hostility???

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