I'm not a nurse, but I'm hoping someone can clear something up for me.
I accompanied my husband to hospital several times over the past few weeks, and a couple of things have really puzzled and slightly annoyed me.
First off, we went to see a consultant, who had to examine my husband's abdomen. The consultant asked my husband to remove his shirt and lie on the bed, so my husband started taking his shirt off as he was walking to the bed. The consultant hurriedly ushered my husband towards the bed, and closed the curtain as if trying to protect my husband's privacy (from me - his wife?!). I found that a bit odd, especially as he only had to remove his shirt. Does he not think I've seen my husband's chest before?
Secondly, when my husband went into the same hospital for a procedure, the porter asked me to leave the room whilst they (four people including two females) transferred my husband from the trolley to the bed.
In both these situations it struck me as a little odd that a spouse would be asked to leave, and I felt a bit annoyed that the staff wanted to shield him from me, as if me being there would upset him somehow. When in fact he would feel no loss of dignity or privacy if I saw any part of his body at any time.
He is more comfortable with me seeing his body than anyone else in the world, especially female hospial staff. If he was going to suffer any loss of dignity, it would be from them seeing him, not me.
I should think that would be the case for most couples (except perhaps the odd vicar / nun combination).
Shouldn't the patient be asked?
All staff knew we were married, because he introduced me as his wife to all staff members who assisted him.
I realise I'm taking this way too personally, andpeople will think I'm getting upset over nothing. I've tried to put this out of my mind, but unfortunately it's not going anywhere, and I'm hoping someone can enlighten me as to the rationale behing asking spouses to leave in the situations described above. It might help me feel a bit better.
I don't want to ask the hospital, because they might think I'm neurotic and paranoid, which I am due to a couple of mental health conditions.
Specializes in Trauma Surgery, Nursing Management.
classicdame said:
sometimes an embarrassing moment occurs and it is more embarrassing if a visitor is around. Give them space to do their job
Oh, yeah!! I was taking care of my nurse manager's husband (at her request) during surgery. She said that she wanted to be there during induction, but then promptly left to allow us to do our jobs. She called in the OR a few times just to check on him, and then said that she would like to be there when he woke up. I told her that it would be best if she waited until he was settled in the recovery room first. Boy am I glad that I did, because when he was transferred from the OR bed to the PACU stretcher, he let out a HUGE fart...that wasn't entirely air. He was thankful that his wife wasn't in the room because he would have worried more about her witnessing the stinky mess that he made rather than breathing deeply and focusing on recovering.
If a nurse had asked my husband whether he wanted me to be present with him when he had been medicated with morphine or dilaudid, he may have given a different answer to the one he would have given when he was not influenced by a mind altering medication.
I do of course recognize that not all patients want their spouse/family members to be present at certain times or any of the time they are receiving medical care, and that legally and ethically the patient's wishes must be respected.
That is exactly the problem though. How could I, as the nurse who has not met the pt before, know that his hypothetically verbalized desire to be alone in the room is influenced by medication and is not the answer he would have given when non-medicated? If it is your word against his expressed desire then I will choose his expressed desire, as I am advocating for the patient first.
Specializes in Trauma Surgery, Nursing Management.
applewhitern said:
I always ask people to leave the room. Otherwise, I would never get anything done. If I want to ask the patient a question, I want to know what the patient has to say, not the wife, girlfriend, sister, etc. It amazes me when I try to talk to an alert, oriented patient, and the wife (usually the wife!) wants to do all the talking! I try to stare directly at the patient's eyes when I talk, to assess them, but if there is a family member in the room, you can bet that person will jump right in and try to answer every single question, as if the patient wasn't able to talk. We always ask everyone to exit the room when we are transferring a patient; there is no reason for anyone else to be there. Once the patient is settled, they can come back in. I want to allow my patient to feel like they are part of their own healthcare, and give them the opportunity to tell me stuff they might not say if other's are in the room. I have had patients who did not want their spouse to know they took viagra, and once I had a 21 year old woman who didn't want her mother to know she was pregnant. What about the female who couldn't tell me her husband hit her, because he was in the room?
Yep. I try very hard not to appear irritated when a spouse or family member answers all of the questions that I am pointedly asking THE PATIENT. I get that family members want to feel helpful, because it is quite a helpless feeling when a family member can't help their loved one who is in pain/scared/nervous. To feel needed is a very basic emotion, and it makes us feel that we are contributing. Sometimes this can go to the extreme with family members who feel stripped of their role in contributing to the pt's needs, so they overcompensate by being too aggressive. The LAST thing the pt needs is to worry about comforting their family members. The focus should always be on the patient during consults, exams, and procedures.
The human condition is to want to allay our loved ones' fears and pain. However, I also want THE PATIENT to feel some sort of independence in their care. There is a reason that they feel overwhelmed, and to offer a sense of control to the patient allays their fears simply by having a voice in their care. THEIR OWN VOICE.
I am absolutely and staunchly supportive of family members being involved in pt care. But let the health care team have some one on one time with the pt first. THEN we can all gather and talk about the plan for the pt.
"many times, abusers do not want to leave a patient alone, so that's a red flag. I have had several incidents where the only privacy I could get with the patient without raising a stink was to go with her into the bathroom."
we used to have an agreement to call somebody from admitting to have "inconvenient" family members come out to the desk to clarify an insurance issue or something. even for abusers, money often comes first.
I suffered a serious injury because a devoted daughter wouldn't step out while four of us were caring for her father. I have a permanent reminder daily of the need to have space to work in.
I don't come to their job sites and hang around to make sure they do their job well. Just give me space and safety to do mine.
I always ask people to leave the room. Otherwise, I would never get anything done. If I want to ask the patient a question, I want to know what the patient has to say, not the wife, girlfriend, sister, etc. It amazes me when I try to talk to an alert, oriented patient, and the wife (usually the wife!) wants to do all the talking! I try to stare directly at the patient's eyes when I talk, to assess them, but if there is a family member in the room, you can bet that person will jump right in and try to answer every single question, as if the patient wasn't able to talk. We always ask everyone to exit the room when we are transferring a patient; there is no reason for anyone else to be there. Once the patient is settled, they can come back in. I want to allow my patient to feel like they are part of their own healthcare, and give them the opportunity to tell me stuff they might not say if other's are in the room. I have had patients who did not want their spouse to know they took viagra, and once I had a 21 year old woman who didn't want her mother to know she was pregnant. What about the female who couldn't tell me her husband hit her, because he was in the room?
I recognize how a wife who wants to do all the talking for the patient can be a problem, and I recognize the necessity for patients to be able, if they wish, to disclose information without a spouse/family member present. But please consider this particular situation, which I'm certain is quite common: When my husband has been hospitalized, and I have answered questions posed to him, I.e. admission assessment; it has been because even though my husband may be alert and oriented, he is also very sick, and I can at this moment in time answer more accurately and completely for him. It is that simple, and it takes the burden off him, when he is using all his energy just trying to stay alive. I want him to get the best care possible, and if I can contribute by recalling important health information for him, I'm going to do so. Just because someone is alert and oriented doesn't mean that they will easily recall important information, especially when they are very sick (as people usually have to be to get admitted to hospital). I am actually more interested in remembering the details than my husband is; surely what one wants as a nurse is an accurate database, regardless of whether the wife does more or even most of the talking. As a nurse, if the patient was willing for the spouse to be present, I would be more concerned about obtaining correct information about the patient's medical problems, past illnesses/surgeries, allergies, medications etc. so that I could give appropriate care, than I would be worrying about whether the patient personally relayed what they could recall of that information to me.
From the term consultant and porter I guessing you are in the UK/RoI
The being asked to step out during the physical exam may be due not just to privacy but to allow for a objective exam, you have already said you had spoken with the consultant and given your account of your patient health.
Asking to step out while your husband is being transferred could be due to space however they may have also taken the opportunity to check pressure areas and perhaps do admisson mrsa swabs.
But please consider this particular situation, which I'm certain is quite common: When my husband has been hospitalized, and I have answered questions posed to him, I.e. admission assessment; it has been because even though my husband may be alert and oriented, he is also very sick, and I can at this moment in time answer more accurately and completely for him. It is that simple, and it takes the burden off him, when he is using all his energy just trying to stay alive. I want him to get the best care possible, and if I can contribute by recalling important health information for him, I'm going to do so. Just because someone is alert and oriented doesn't mean that they will easily recall important information, especially when they are very sick (as people usually have to be to get admitted to hospital). I am actually more interested in remembering the details than my husband is; surely what one wants as a nurse is an accurate database, regardless of whether the wife does more or even most of the talking. As a nurse, if the patient was willing for the spouse to be present, I would be more concerned about obtaining correct information about the patient's medical problems, past illnesses/surgeries, allergies, medications etc. so that I could give appropriate care, than I would be worrying about whether the patient personally relayed what they could recall of that information to me.
As a nurse, I ask the patient questions for which I am interested in his/her answer. And observing the patient's ability to answer questions gives me important information about the patient's mental status. If I have any doubt that I have complete information, I will then seek out additional sources of information, including family members present.
Edited to add: Patient assessment and filling out an admission database is not simply filling out a form and checking off boxes. During a conversation with a patient, I am assessing not only his/her basic history and current symptoms, but mental status, emotional state, his/her understanding of primary disease process and co-morbidities, and getting a feel for the individual's perceptions and attitude toward treatment.
I hope this better explains why it's important to speak with the patient.
I always ask people to leave the room. Otherwise, I would never get anything done. If I want to ask the patient a question, I want to know what the patient has to say, not the wife, girlfriend, sister, etc. It amazes me when I try to talk to an alert, oriented patient, and the wife (usually the wife!) wants to do all the talking! I try to stare directly at the patient's eyes when I talk, to assess them, but if there is a family member in the room, you can bet that person will jump right in and try to answer every single question, as if the patient wasn't able to talk. We always ask everyone to exit the room when we are transferring a patient; there is no reason for anyone else to be there. Once the patient is settled, they can come back in. I want to allow my patient to feel like they are part of their own healthcare, and give them the opportunity to tell me stuff they might not say if other's are in the room. I have had patients who did not want their spouse to know they took viagra, and once I had a 21 year old woman who didn't want her mother to know she was pregnant. What about the female who couldn't tell me her husband hit her, because he was in the room?
I have to say this. I am primary caretaker for my mother, who is alert and oriented and quite capable of taking care of herself, though that is a whole different topic. Maybe some mild confusion, but I am mostly in denial about that at the moment. I am her MDPOA. I go into her appointments and into the ER with her and I stay. I guess the point I am trying to make is, while she is more than capable of stating her history and for the most part taking care of herself (she primarily has mobility issues), sometimes, she isn't entirely truthful either. For instance today, after nagging her for a month to fill prescriptions and make an appointment (see totally capable) she wasn't going to tell her NP that she hasn't been taking her Warfarin for a month, and would need to bridge with Lovenox. She wasn't going to mention that she has been more depressed lately. This lack of information would have impacted her treatment plan significantly.
I will stay in the room, and I will answer questions that she is hesitant to answer, or I will give information that she doesn't want to share. I stay out of the way, leave when asked, and will shut up (for the most part) when reminded, and sometimes, I do need a reminder. However, I may have information that might impact her care. Her doctors know me, and for the most part so does the ER staff, from when I either had my mother, or grandmother in, or from when I would cart patients in as a Paramedic.
I am that type of daughter, and I won't apologize for it. I try to not be a pain in the tuchus, however, I will see to it that my mother is taken care of and treated appropriately.
canesdukegirl, BSN, RN
1 Article; 2,543 Posts
Oh, yeah!! I was taking care of my nurse manager's husband (at her request) during surgery. She said that she wanted to be there during induction, but then promptly left to allow us to do our jobs. She called in the OR a few times just to check on him, and then said that she would like to be there when he woke up. I told her that it would be best if she waited until he was settled in the recovery room first. Boy am I glad that I did, because when he was transferred from the OR bed to the PACU stretcher, he let out a HUGE fart...that wasn't entirely air. He was thankful that his wife wasn't in the room because he would have worried more about her witnessing the stinky mess that he made rather than breathing deeply and focusing on recovering.