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"?

Specializes in Operating Room.

Anxious patient...I can almost guarantee you 100% that there were no pictures taken of you during your hysterectomy. I have never seen a med student doing a practice pelvic exam on a sleeping patient either. My last hospital, I would make the med student introduce his/herself and have them ask if it was ok if they were there for the procedure. If the patient said no-then they didn't go in...and I had a few say no.Med students are pretty much there to observe...if they're lucky, they may get to scrub in, but are under the eagle eyes of the doc and the circulating nurse. We do advocate for the patient and I've made known any little requests that the patient has too-like one lady who wanted the OR staff to say a quick prayer before putting her to sleep. We complied. We have your back!:up:

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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.

I will post a couple of video websites where this is NOT the case! Stay tuned.

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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.

This was NOT the case with a personal experience. The form was handed to the patient prior to when the nurses contacted the family member to join the patient in the OR holding area. Corrective lenses had already been removed. The family member was not aware that a form had been presented to the patient. There was no mention of the additional consent form when all other general consent forms and insurance forms were signed in the waiting area downstairs. None of the forms were given to the patient in advance. Two minutes before surgery! By the way, what do you think of a surgeon that puts together a two page H & P, incorporates it in a medical file, and NONE of it was done. All fraudulent. The surgeon also states he explained everything...etc. etc. Did none of it. PACU nurses chart all kinds of things that were not done. Is this medicine today?

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I will post a couple of video websites where this is NOT the case! Stay tuned.

If you think this video stuff is ALL so inocent then go to the following:

[This is just a sampling]

http://www.or-live/hartfordhospital/1353.com

http://www.or-live.com

Revolutionary techniques in penile implant surgery March 26, 2007

Watch the full video

Shows no faces but shows ALL except for the hair removal. That has already been done in both videos. Would you want yourself or your husband displayed like this? For OR nurses..Is this how a genital prep is done on a male?

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Shows no faces but shows ALL except for the hair removal. That has already been done in both videos. Would you want yourself or your husband displayed like this? For OR nurses..Is this how a genital prep is done on a male?

If the patients consented to pics and video being taken during a personal procedure then I see no problem with it whatsoever. Some patients aren't shy or modest about their bits and pieces being seen by others. Their faces aren't shown so that does afford them a degree of privacy. It might not be a choice all of us would make but some don't mind being used for teaching, etc. It's a personal choice.

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If you think this video stuff is ALL so inocent then go to the following:

[This is just a sampling]

http://www.or-live/hartfordhospital/1353

http://www.or-live

Revolutionary techniques in penile implant surgery March 26, 2007

Watch the full video

Shows no faces but shows ALL except for the hair removal. That has already been done in both videos. Would you want yourself or your husband displayed like this? For OR nurses..Is this how a genital prep is done on a male?

This is standard CME video (continuing medical education). Neither of your links work as listed. If you add .com after the or-live part they do work (hint use the preview post button and check your links before posting).

Obviously you would not want your husband displayed like this but someone didn't mind. In cases of CME broadcast there will be extensive waivers signed not only by the surgeon and hospital but also by the video production company. These are usually underwritten by the equipment company but are also put on by hospitals to garner referrals for advance techniques. While the cynic in me does not consider this completely innocent from a sales standpoint, as far as any other reason, yes it is innocent.

David Carpenter, PA-C

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This is standard CME video (continuing medical education). Neither of your links work as listed. If you add .com after the or-live part they do work (hint use the preview post button and check your links before posting).

Obviously you would not want your husband displayed like this but someone didn't mind. In cases of CME broadcast there will be extensive waivers signed not only by the surgeon and hospital but also by the video production company. These are usually underwritten by the equipment company but are also put on by hospitals to garner referrals for advance techniques. While the cynic in me does not consider this completely innocent from a sales standpoint, as far as any other reason, yes it is innocent.

David Carpenter, PA-C

My point was that "elizabells" stated nothing was shown and the patient was fully draped. This is NOT so. Yes, there are many people in this world like Brittany Spears that don't care what they show and to whom. There are many, many more people that don't agree with that and find this over the top. CEU's yes, but all persons can view this that are not in need of CEU's. Did these patients really understand to what extent they would be displayed and handled to be viewed by the world? I wonder.

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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.?

Its hard to know what happened without being there. One of the things that you have to realize is that there are usually two consents that you sign in a hospital. One is a consent to treatment. This is basically saying that you allow the the hospital to bill for whatever care you are getting (also known as assignment of benefits). The second is the actual consent for the surgery. I will not say that it never happens but I cannot see any circumstances where the admissions clerk would have you sign it. It violates pretty much every consent of informed consent.

There is a lot of discussion about the ethics of having someone sign consent on the day of the surgery. Outside of emergency surgery the consent should at least be discussed prior to the surgery. This should be documented. At my institution the transplant patients have informed consent done at least four times prior to surgery and then the form is signed prior to surgery. They have ample opportunities to ask questions and weigh the risks and benefits of the surgery. On non transplant cases the patient has the risks and benefits explained before the surgery. They meet again with one of us for a pre op H&P several days before where the risks and benefits are again explained and then the consent is signed. The surgeon meets the patient again in pre-op for any final questions. At my institution only the physician or their designated representative can sign the consent. They have to be directly answerable to the physician so nursing for example cannot sign the consent (they can witness).

As far as photos it is a check box that you can initial either yes or no. As far as medical students practicing that is a pretty much a thing of the past (pretty much all schools use medical models to practice on). On the other had prohibiting medical students depends on the institution. At private hospitals with residents, some will allow you to ask for a non-teaching service (where you have no contact with residents). At academic institutions all patients are on the teaching service so you don't have this choice. However, as another poster stated, circulators have a lot of practice keeping an eye on medical students.

Bottom line we are blessed with patients that put their trust in us.

David Carpenter, PA-C

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My point was that "elizabells" stated nothing was shown and the patient was fully draped. This is NOT so. Yes, there are many people in this world like Brittany Spears that don't care what they show and to whom. There are many, many more people that don't agree with that and find this over the top. CEU's yes, but all persons can view this that are not in need of CEU's. Did these patients really understand to what extent they would be displayed and handled to be viewed by the world? I wonder.

You can wonder all you want but without proof to the contrary thats all you are doing. Most patients when presented with the question: "Can we film this for an educational medical film? You will in no way be identifiable." Would say yes. Having been in a couple of these productions I can tell you that the patients are carefully selected for the principle of not minding. It is similar to the people who volunteer to demonstrate lady partsl or testicular exams to medical students (or PA students). Some might do it for money, but most do it because they realize the importance of the medical student learning how to do it in a non-pressure environment with someone who is good at communicating in a non-judgmental manner. While I personally would find this awkward, I have tremendous respect for those who do this. I don't judge their motives, I was appreciative of the opportunity.

We are who we are not who people make us.

David Carpenter, PA-C

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Specializes in NICU.
My point was that "elizabells" stated nothing was shown and the patient was fully draped. This is NOT so.

Actually "dutch", what I stated was that in the videos I HAVE PERSONALLY SEEN nothing was shown. Therefore you have no right to question my veracity. None of us are able to speak to anything outside our own experience.

You know what? This isn't a debate. This is a personal crusade. No amount of logic and reason is going to make a whit of difference here, because one person's feelings of being wronged (which are very real, and unfortunate) have led said person to believe that all OR staff are perverted voyeurs out to take advantage of their patients. I'm out.

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Specializes in Operating Room.
Actually "dutch", what I stated was that in the videos I HAVE PERSONALLY SEEN nothing was shown. Therefore you have no right to question my veracity. None of us are able to speak to anything outside our own experience.

You know what? This isn't a debate. This is a personal crusade. No amount of logic and reason is going to make a whit of difference here, because one person's feelings of being wronged (which are very real, and unfortunate) have led said person to believe that all OR staff are perverted voyeurs out to take advantage of their patients. I'm out.

Well said, you can't have an intelligent debate when 1)logic becomes overtaken with any personal vendettas or biases and 2)when the person you're having a discussion with has no concrete knowledge about the topic, and no interest in learning. I think most people here have attempted to present the facts calmly and rationally and it's going nowhere...
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Specializes in Operating Room.
If you think this video stuff is ALL so inocent then go to the following:

[This is just a sampling]

http://www.or-live/hartfordhospital/1353.com

http://www.or-live.com

Revolutionary techniques in penile implant surgery March 26, 2007

Watch the full video

Shows no faces but shows ALL except for the hair removal. That has already been done in both videos. Would you want yourself or your husband displayed like this? For OR nurses..Is this how a genital prep is done on a male?

When you're prepping an area, you have to be able to see where you are prepping, so it is done in a sterile manner. I see no problem with how the gentleman was prepped. I don't see what the problem is and again, this process is not sexual or voyeuristic. I think anyone that thinks it is has some severe issues.

This time I'm done...honest!

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