DonMD

Argo, it's all about the patient, not the nurse. About treating them with privacy, modesty, dignity, and respect. And about respecting their wishes and needs as much as possible. Think of it like a cultural issue, and we're all about "cultural competence" these days. The culture we're woefully uneducated about is patient dignity and privacy in healthcare. I'm not offended when a woman doesn't want a male doc. It happens a few times a month. Often, after talking with her, she's at ease and the exam proceeds. The dying and really sick/injured have NEVER made a gender request. Doesn't stop me from recognizing that shame/humiliation may be adding insult to injury, and trying to alleviate that as much as possible. I never leave them lying naked. Not even the traumas. And there's not a trail of bodies because I covered someone up. It's a false dichotomy to give the patient the option of being treated disrespectfully and without dignity, or dying. Family members are sometimes in the room when we do cardiac arrests. You bet the patient is treated respectfully and modestly and with dignity. That doesn't stop our best efforts to save them. When you're sick, what matters for the caregivers is what's between their ears, not what's between their legs. But even if our patients KNOW that, it doesn't stop them from FEELING differently. And we need to be aware of that. BTW THEY'RE the customer, not grist for our mill. So I'm not calling for gender-identical care. I'm calling for awareness of unseen biases and gender-aware care. And I'm asking for respect for privacy and modesty. Keeping doors closed, curtains pulled, extraneous staff and observers out, cameras off unless explicitly permitted, and treating people with basic decency. That's not so hard, really.

SquirrelRN71 : I really appreciate that you try to maintain a person's modesty. Awareness of the problem is a big part. But often, you believe that you and your female colleagues are treating the patient well because you have a sort of cortical blindness to what really is going on. You are in your own familiar environment with your friends/coworkers, mostly other female nurses, and it's "just us". No one but us seeing the patient, so no problem. You're fully dressed. But the patient is frightened, in a very scary environment, in a room full of strangers. And with healthcare being overwhelmingly female, for a male patient, it is getting thrown in the female locker room naked. We need to be constantly cognizant of the patient's predicament AND gender issues - for EVERY patient. Changing the gender of everyone involved, patient and staff, and then seeing if the situation still feels comfortable is a good self check. No one needs expertise in ANY specialty to remind someone of common decency, or to point out societal myths that we function under but about which we may be unaware. As a multiply boarded physician I've learned tons of things from docs in different specialties, and from RNs, RTs, OTs, pharmacists, even techs. I've learned bunches more from my patients themselves. As for those commenting who DON'T work in healthcare, their comments are VITAL and IMPORTANT - we must understand their worries and fears in order to alleviate them. And everyone "knows squat" about how they personally would like to be treated by medical caregivers. Yes, I know they don't understand why we do things. But their concerns about modesty and dignity are valid nonetheless. We have to see it from THEIR perspective, not ours. Here's a question: Do you understand why you do some things at work, or is it just rote, because "we've always done them this way"(such as leaving trauma patients naked or moving them through the hospital that way)? Is it medical societal ritual, or really needed and beneficial to the patient? Is it beneficial to the patient, or just convenient for the staff? Your comment that "we do not have the staff to accomodate someone who prefers a certain gender. " is unfeeling and harsh. It is also illegal. Several Supreme Court rulings have gone very harshly against providers and hospitals who did not accommodate a patient's request for a certain gender provider. While I do understand staffing constraints, this attitude does not fly. It just isn't a priority for anyone to be concerned enough to solve the problem. But that doesn't mean it is acceptable. That is the typical "deal with it" sneer that men as consumers of healthcare get. Most patients DON'T care about the gender of staff, most especially if they are not being treated immodestly. But the few who have a request should be accommodated, or educated as to why that isn't possible, and then put as much at ease as possible. As far as those who "are not in a condition to ask", that doesn't mean we have carte blanche to be casual about their privacy and dignity. But I see that ALL THE TIME with male trauma or code patients. The unconscious guy is just left lying there naked. The unconscious female is almost NEVER left naked with her legs spread and genitals fully visible. I applaud you for being angry about trauma patients coming up naked. Where is our basic decency? But we get all hyped up in our medical rituals and get so pumped up doing things TO people, and feeling SO important, that we often forget the person who is the patient. If they can't protect their own privacy and dignity they're out of luck. Did you take the next step and call down to the ED or talk to a supervisor or make an incident report about your concern? I bet you didn't, because you didn't want to look silly. If we're going to change the system behavior, we have to make a little noise. And risk our OWN personal embarrassment. I very much agree with you that I want someone in my room who is gentle and compassionate. But they also MUST be aware of gender issues and respectful and treat me with dignity and modesty. The Social Worker in the example in my first post is extremely gentle and compassionate. But she simply did not see she was crossing a boundary - she was a female with a hospital ID, so the RNs grabbed her to help perform an intimate procedure on a man. Because it was busy and the staff was spread thin. And she just thought she was helping, so it wasn't a big deal. No one even gave it a thought. No one even saw it. Cortical blindness. And that's the point. You must think of these things. Like it or not, inconvenient or not, or "silly" or not. And all the excuses and self exemption on OUR end does not make the action right, or more tolerable for the patient. And since you read the prior few threads, I'm surprised you said "some people just lose it over the silliest things". Being upset at being the only naked one in the room is not silly. Not to the patient. It's not silly to be embarrassed. Labeling something as "silly" is an intent to dismiss it in a derisive fashion. Perhaps you are personally not very body modest or shy, but most in our culture are. It is not "silly" to them. It's not "silly" if a man does not want to be exposed in front of a female stranger who is fully dressed, no matter what initials after her name. It's understandable, or should be. It's our job to minimize the patient's shame, exposure and discomfort. It's not their job to adjust their "silly" attitude to my work needs. Would you think it silly for a woman to be uncomfortable and ashamed and humiliated at being naked in front of an all male staff, or maybe getting a catheter in front of such a group? Probably not. I bet you would be humiliated walking through your OR suites naked. But since the staff is mostly female, and the male staff have all "seen it before", wouldn't that be "silly" for you to feel that way? I hope these posts would at least get you to look at the situation in a new way. Really try to see it from the male patient's perspective, not just yours as a harried female RN. And if you DO see it, try not to dismiss it. :)

tbrd450. EXCELLENT post. You brought up many, many points, all well and succinctly said. And you're right. A male patient who demands privacy and dignity is labelled as "difficult" or an ass. And he is ridiculed as being "silly" or childish. Meaning his demand for decent treatment has inconvenienced and irritated the caregiver. Which further emasculates and embarrasses him. We infantilize patients. Which leads to another observation. We know that girls in our society grow up being taught it's OK if they bathe the baby boy or babysit. We have no problem with a 5th or 6th grade girl helping bathe a 4 year old boy or change a 3 year old's diaper. But would we feel that comfortable with a 5th or 6th grade boy helping bathe the 4 year old girl? We tend to protect the female toddler, but let any little girl see the baby boy. And we all see male statues with clearly defined genitals. David leaps to mind. Ever seen a statue, in public, that shows a woman's labia and lady parts clearly? Nope. So girls are taught from a young age that anyone can see naked guys, it's no big deal. And guys are taught they have no privacy, the girls can see. But a woman's genital's must be kept private. Fully visible male genitalia in movie? It's an "R". Fully visible female genitalia - almost always an "X" if the labia are seen or especially the lady parts. So when the man is exposed in the ED or OR or anywhere, EVERYONE, male and female, is conditioned that it's no big deal. Unless you're the patient, who's the only naked one in the room. THEN it's a big deal to you. (OR unless the patient's in control of the exposure, then he's a flasher or a pervert, and all these professionals who tell him he's silly for being modest will act offended! And demand modesty!) The Abu Ghraib incident is one that has numerous similarities to what happens to guys in a hospital, but speaks to societal conditioning and anti-male bias. It starts with kids growing up being shown that some guy getting kicked in the scrotum is hilarious. It desensitizes us to men's pain. The Pentagon brass put out a memo, literally, that the sexual humiliation was to ONLY be done to men. They knew society would not tolerate it happening to women, but they'd get by with it happening to men. Brutality to men is accepted and condoned. Even sexual degradation. Imagine a photo of a male GI pointing at a woman's labia with her legs spread and snickering while holding the "thumbs up" sign. The firestorm over that would make what happened to those involved in the real incident look like an afternoon at the park. But it's somehow not quite as bad when it happens to the guy, because we've been conditioned that way. The other thing about Abu Ghraib is this: the Pentagon KNEW that being stripped naked in front of a bunch of fully dressed women would BREAK these men! That's why it was done. What does that say about our usual treatment of male patients, and in particular male trauma patients, who often lie naked, for no reason, for 30 minutes to over an hour? The point we need to educate EVERYONE on is that most males DO mind, very much, even if they don't say. Especially with the "size" baggage and the focus on it in our society. Men are often very private, as modest and private as women, and are just as damaged when humiliated. But the guys aren't allowed to show it. So they do what I call "male camouflage" - they either get stoic and quiet, or get angry and do a lot of huffing, puffing, cursing and bellowing. The only two societally acceptable masculine emotions. They may be crushed, ashamed, crying and humiliated on the inside, but to show it only adds to the degradation, loss of control, and perceived loss of masculinity. So you "man up". You maintain control. (Similarly, as a male caregiver, you don't intervene when it happens to some other guy. Because you'll be seen as unmanly, and people will wonder what's the matter with you!) advo-kate2 Incredible post. Truly outstanding. Two powerful paragraphs. I've often wondered the same.

The bottom line is that a man without pants is as exposed, in any position, as a woman in stirrups for a pelvic exam, and should be given as much privacy as we accord a woman in that situation. All patients need to be treated as if they are the most modest person on the planet. You won't cause emotional harm if you treat the less modest person with the utmost regard for privacy. But you'll harm a lot if you treat every guy patient based on the myth that "guys don't mind" being seen naked, or "it's no big deal". And speaking of big, the elephant in the room is the issue of member size in our society. Women do look, and do compare and do talk. As a doc, I can't tell you how often I've heard nursing staff making comments. So it's hypocritical to pretend it shouldn't be a concern for the male patient. If in doubt, reverse the gender of everyone in the room, and ask yourself if the situation still seems right. A 30 year old patient who had traumatic brain injury and schizophrenia was brought to the ED by his 40 year old aunt, and a 38 year old woman who the family hired to help care for him during the day. Seems OK, right? The 38 year old woman was actually the next door neighbor who grew up with the patient. The patient was disinhibited, and kept undressing and other disinhibited behaviors. The women cared for him, including assisting him shower. Still seems OK, right? Now change the gender. Would we be OK with the 38 year old man from next door showering a 30 year old female he grew up with? How about the uncle caring for her? No difference in the situations except for the female as caregiver societal conditioning, and anti male (all males are molesters) societal conditioning we have. It's a bias we usually don't see. Another example (true story): a man in his mid 50s with early dementia in the ED was forcibly cathed for a urine specimen. Two female RNs, a female tech, and a female social worker (all mid-20s) went into the room and held him and did it. No problem seen because they were all staff, and the girls had a "it's just us" mentality, and a "it's necessary and we're just helping" attitude. The societal conditioning that it's OK for any woman, especially who work in a hospital, to see a naked guy. They thought nothing of it. Now imagine a 55 year old woman, and 2 male RNs and a male tech go in, and they ask the male social worker to come in and help. Seems different, doesn't it? 4 guys holding a woman down and spreading her legs. One of the men a social worker, not a tech or RN. When I told them it wasn't right to have a female non-clinical staff member help, they responded "Well, he's demented, he doesn't mind". An unconscious female "doesn't mind" if she's fondled, but that doesn't make it OK. Last example, also true. A 42 year old in with a kidney stone is in the emergency department at change of shift . He's been there 40 minutes. As I come in for my shift, I hear a scream from the room, so I go over, and knock, but don't say anything. A nurse says "Come in", so I do. The man is laying naked from chest down, with the gown flipped up. The nurse who said "come in" is trying to cath him. His wife is sitting in a chair, literally wringing her hand. Two other nurses are leaning on the counter by the sink watching. To make a long story short, I asked the RNs to come outside, and enlightened them on their actions. They were surprised I was upset. Truly baffled. They did not see anything wrong. The one RN wanted to get the urine sent before shift change so "nothing was left" for the oncoming RN, and the patient had just urinated before coming in, so didn't feel like he could urinate right then. That was her reason for telling the patient he needed a cath. One nurse was the oncoming rn taking over. The other was waiting for the first nurse to leave, so she could walk out with her at the end of her shift, and was "keeping her company". They were so unconcerned with his privacy that they thought nothing about saying "come in" to a knock at the door - could've been his daughter or co-workers coming to see how he's doing. And they thought an audience for the cath was OK. The patient did what most men in the patient role do. Assumed this was how it is, and if he objected he'd be a bad patient. So he did one of the two options men have. Either "man up" and tough it out and maintain control, or freak out and be aggressive and loud and be seen as an ass. He stayed quiet. Imagine the emotional trauma to this man, who was on his way to work, and then was exposed and humiliated in front of a bunch of women a short time later. What if a three male nurses did that to a woman? For the actions of workers in a health care setting, the bottom line is this: Knock before entering a room, and WAIT for a response before barging in. Keep people covered. Keep curtains and doors closed. Warn before uncovering. Ask permission for others to be in the room, such as chaperones or students. Keep onlookers out unless absolutely essential. Treat everyone as you'd like your loved one treated. Be gentle, and respectful. Put yourself in the patient's shoes, and empathize with their embarrassment and shame and humiliation. Be aware of those societal biases that we have been conditioned to as to not even see. Remember that the patient is the only naked one in the room, and that is extremely humiliating. (Just imagine your embarrassment if you wore a bathing suit to work when everyone else was dressed - then multiply that by a hundred) The patient is incredibly vulnerable. And every patient is a PERSON, not a thing. It's our job to protect their modesty, dignity, and privacy. It's that simple.