Patient Modesty

[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"?

[GadgetRN71, ASN, RN]

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.

Most ORs will try to match the case to the staff who are most knowledgable or skilled in a given specialty or procedure. They do this primarily for the patient's benefit but surgeons like it too. For instance, in my specialty(orthopedics) there are nurses and techs who almost always work with the same doctor, doing the same types of cases. If you start saying "I want only males in my room" for example, you may very well get someone who is brand new or not experienced in the procedure. You've denied yourself the best staff merely because they are the "wrong" gender. That was my point.

Give me an experienced, compassionate nurse or tech for my surgery...I don't care what they have between their legs!

[elizabells, BSN, RN]

I'm not an OR nurse, but in re videostreams of surgeries:

Every surgical consent I've ever seen has a separate section to consent for cameras to be present during surgery. Patients are free to deny consent for this. Nobody is sending OR videos out over the net without the patient's specific consent.

[dutch92602]

I'm not an OR nurse, but in re videostreams of surgeries:

Every surgical consent I've ever seen has a separate section to consent for cameras to be present during surgery. Patients are free to deny consent for this. Nobody is sending OR videos out over the net without the patient's specific consent.

A commonly used consent form patients' are asked to sign consenting to a blood transfusion also states in small print:

Allow photos, videography, and others to be present and stand in

The AORN also confirms these are standard forms widely used.

The other caveat to this issue is that this form is handed to a patient while in bed in an OR holding area. The patient is without corrective lenses at this point in time and there is no adovcate or family member present to read the entire form. Therefore, the patient is signing this not knowing they are consenting to such things!!!!!

[Anxious Patient]

At the teaching hospital where I had my surgery, the general consent form was presented to me just before surgery. The form included vague paragraphs about patient photography, medical student participation, etc. Nothing specific. One signature covered everything. I asked if I could strike out the photography paragraph, but was told by the admissions clerk that the consent form could not be altered. If it was, it would be considered invalid, thus surgery couldn't be performed.

I was told that I could make a verbal request to the circulating nurse that I would meet prior to surgery, which I did. (I would have made this request directly to the surgeon, but was already anesthesized by the time I was wheeled into the OR)

My question is: Would the cir. nurse be obligated to pass on my request to the surgical team? And, if the request wasn't honored, what could/would she do about it?

[dutch92602]

At the teaching hospital where I had my surgery, the general consent form was presented to me just before surgery. The form included vague paragraphs about patient photography, medical student participation, etc. Nothing specific. One signature covered everything. I asked if I could strike out the photography paragraph, but was told by the admissions clerk that the consent form could not be altered. If it was, it would be considered invalid, thus surgery couldn't be performed.

I was told that I could make a verbal request to the circulating nurse that I would meet prior to surgery, which I did. (I would have made this request directly to the surgeon, but was already anesthesized by the time I was wheeled into the OR)

My question is: Would the cir. nurse be obligated to pass on my request to the surgical team? And, if the request wasn't honored, what could/would she do about it?

Personally speaking, I would obtain all consent forms at least 1 week in advance of a scheduled elective surgery. This would allow proper time to read everything. That way any issues could be addressed and if they could not accomodate to what a patient is willing to accept then you have the option of cancelling the procedure and going elsewhere.

[elizabells, BSN, RN]

I stand corrected. I guess my hospital is just awesome, then.

[GadgetRN71, ASN, RN]

I stand corrected. I guess my hospital is just awesome, then.

No, your hospital is pretty much standard...most elective surgeries(at least in my area of the country) are explained by the surgeon, in the office. If the patient is an outpatient, then the forms are given in advance and any paperwork not completed is finished in the pre-op area where patients are allowed to have their glasses and are allowed to have up to 2 relatives with them. When the relatives leave, they take the glasses/personal belongings and only when the patient is going to the room are they medicated.

Obviously, emergency surgeries are different.

Any filming or observers are explained to the pt. They have the option to refuse to have med students,or observers in there but they do not get to dictate the operative team.

[GadgetRN71, ASN, RN]

Personally speaking, I would obtain all consent forms at least 1 week in advance of a scheduled elective surgery. This would allow proper time to read everything. That way any issues could be addressed and if they could not accomodate to what a patient is willing to accept then you have the option of cancelling the procedure and going elsewhere.

This is the first thing we can agree on! :up:I think this is an awesome idea. Although, before I had my surgeries, my surgeons already did this...I had my testing and filling out of paperwork a good 2 weeks before.

[GadgetRN71, ASN, RN]

At the teaching hospital where I had my surgery, the general consent form was presented to me just before surgery. The form included vague paragraphs about patient photography, medical student participation, etc. Nothing specific. One signature covered everything. I asked if I could strike out the photography paragraph, but was told by the admissions clerk that the consent form could not be altered. If it was, it would be considered invalid, thus surgery couldn't be performed.

I was told that I could make a verbal request to the circulating nurse that I would meet prior to surgery, which I did. (I would have made this request directly to the surgeon, but was already anesthesized by the time I was wheeled into the OR)

My question is: Would the cir. nurse be obligated to pass on my request to the surgical team? And, if the request wasn't honored, what could/would she do about it?

A question: was this elective or emergency surgery? It would depend what the request was...if it's for a team of all the same gender, and it's emergency surgery, you're pretty much SOOL. Heck, for elective surgery, it is tough to accomodate specific gender requests because of staffing.There is really not so much photography/video going on anyway...the most I've seen is when we're doing reattachment of fingers(dang snowblowers!) or limbs and they are doing extensive reconstruction, then they photograph, but it is just the hand, arm or leg. No faces are shown. I do believe even then, they ask permission. For general surgery(ie appendectomies, or gallbladder removal) they rarely, if ever, take pictures. Ditto for GYN or Cysto.

Just as an FYI, it's common practice to sedate patients when wheeling them into the room...it's a kindness for the patients, IMO, most of whom are nervous. They don't actually anesthetize you until you're in the room.

[elizabells, BSN, RN]

Oh, and I've watched many of those video streams - they don't start until the surgery is well underway, and the pt has been entirely draped except for the field. I've never seen the prep process or any of a patient's bits.

[Anxious Patient]

A question: was this elective or emergency surgery? It would depend what the request was...if it's for a team of all the same gender, and it's emergency surgery, you're pretty much SOOL. Heck, for elective surgery, it is tough to accomodate specific gender requests because of staffing.

This was elective surgery - an abdominal hysterectomy due to cancer. The hospital was a 950 bed tertiary facility. I only met the surgeon once (referred by my gyn) a week before surgery. The place was so big and busy, I felt about as small (and important) as an ant. This was the first time I was ever in a hospital and I was totally overwhelmed. On the day of surgery, when I discovered the photography reference and tried to cross it out on the consent form and was denied permission to do so, the admissions clerk suggested I make the request verbally to the circulating nurse. So, that's what I did. But I have no idea what happened after that. Of course, I never saw that nurse again.

So, my original question to any of the nurses on this board is:

If a patient has no choice to make their pre-surgery wishes known except through the cir. nurse.,(i.e. no photography or no med. students practicing pelvic exams) would the nurse be obligated to pass on those wishes to the surgeon? Whether the request would be honored, I suspect would be out of her hands. But, wouldn't she at least let the surgeon know what the patient asked for? Isn't the cir. nurse the patient's advocate in the O.R.?

[Batman24]

Anxious Patient:

Have you called/written the hospital to let them know that you were told that you couldn't alter the document and were advised to let them know verbally instead?! Patients are being asked permission about the video, pics, etc. and it is customary for people to say no according to those I checked with. This is standard practice. I don't think this is an issue you should let go before getting some answers. You might save the next patient a lot of the stress you are now going through. They need to get this straightened out and at once. I would also let the surgeon know of your concerns on a follow up appointment. It's important for them to know as well.

In checking I found out from a friend that the nurse would pass on your request to the surgeon and chances are good they would honor your wishes. As Witchy has stated earlier pics are rare, and my friend reiterated that same thing to me when asked.