Spouses being asked to leave the room

[Indenial]

Hi

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.

Thank you for reading; I hope someone can help.

[nursel56]

Indenial said:

Anyway, all your replies have helped me see that it was not personal, and I feel much better about the situation now.

Thank you!

As you can see, it touched off quite a discussion that expanded the issue from your concern that they seemed to be shielding you from seeing his chest or whatever may have been visible during a transfer. As somebody else said, pulling a curtain is often a reflex as we're so used to how little hospital gowns cover a person we don't stop and think about it even if they aren't wearing one at that point.

[anotherone, BSN, RN]

People need to keep in mind that your dynamic with your mother/father/bf/husband/wife etc is not everyone else's dynamic/realationship with theirs. There are people who do not care who sees or knows what. Then there are people who do care, have different cultures/religions/views etc ( you can not just tell by looking at them). It is for the patient maybe some people do not want their spouse to see them without clothes on, being cathed, etc even if they have seen them without clothes on many times. What if the pt was too afraid or embarassed to ask the staff member to step out or wanted to share some medical info the spouse/family has no clue about. Happens ALL THE time. (oh fyi i have hep c, i have hiv, i do cocaine, i have a past hx of ivda and have not been tested for anything) or maybe is unfomfortable with his/her clothes off in certain situations in front of his/her spouse even if that person has seen him/her that way before. who knows what goes on.

[hiddencatRN, BSN, RN]

indenial said:

I just thought it was taken as normal that a partner or spouse would not present any dignity or privacy issues.

that's because it sounds like you have a loving and caring relationship with your husband. unfortunately, this is not the case for everyone, and until we know the dynamics of the situation we often have to err on the side of caution. it sounds like there were only two incidents where you were separated from your husband- the curtain consult and transferring him. other than those two moments, did you find that the staff in general respected your presence and input?

I work in pediatrics and some of my teen patients are very open with their parents about things like sexual activity and drug use. most are not though. even though family centered care is very important in peds, and even though parents (usually) are a reassuring presence to their children, when doing a sensitive assessment, I ask the parents to step out or find a way to talk to the teen privately. and sometimes I don't even give the family the option of staying.

I don't think it would be out of place to ask the nurse about it. perhaps in your husband's case it was truly and simply a logistical issue. perhaps they needed a quick moment to do a domestic violence screening. I'm guessing that it had very little to do with you and your husband personally and more to do with policy or unit practice in transferring patients. it might put your mind at ease to know that they were just doing their job and trying to take good care of your husband.

I hope he has a speedy recovery.

[wooh, BSN, RN]

anotherone said:

I do not like asking the patient if the family can stay, becasue I do not know the dynamics of the relationship and the pt may feel pressured into saying yes when he/she really wants to say no.

Really, in what imaginable family dynamic is a person actually going to be able to comfortably answer, "Can your spouse stay?" IN FRONT OF THE SPOUSE, with, "No, I want my spouse to leave so I can tell you things I don't want him/her to hear."????

[yvfair]

It's funny that I came across this post because just this week, my hospital came out with a new HIPPA policy that stated, we needed to ask family members to step out including spouses and ask them is ok to ask medical history and other pertinent info in front of spouse and family members. We, the staff, thought ok we understand other family members but asking the spouse to step out is a bit much!

Not to mention, I work in an outpatient area so of course, if the patient didn't want the family members or spouse to know info, they wouldn't have brought them to begin with!

[kids]

I have a spinal cord injury.

My husband is my best friend, biggest chearleader and at times has been my caregiver.

He is privy to the the most intimate and minute details of everything about me. Everything.

And he has no RIGHT to my health care information.

He has no RIGHT to be present for any care, exam or procedure.

Unless I extend that right to him each and every encounter.

Each time he's asked by a HCP to leave the room, I speak up if I want him to stay. Or I don't, if I don't. At my sickest, most drugged up, rung out, you name it, I've never been unable to communicate if I wanted him there.

It doesn't matter that I have or will be telling him all about it, sometimes I just want to talk to my doctor without a 'witness'. Sometimes I'm still working through something and I need that time where I'm able to focus just on ME and what MY doctor has to say without being concerned about how or what my husband is processing.

Over the last 14 years there have been times that my husband has had to help or even perform some very intimate parts of my self care. That doesn't mean that I'm always ok with him being there when a HCP is performing the same task, sometimes I just don't want him to witness my indignity.

My husband 'gets' it, this is my body, my health and my life. He's ok either way.

[psu_213, BSN, RN]

Susie2310 said:

Altra, I'm afraid your explanation doesn't address a situation such as mine and my husband's, although it does address a textbook situation. I hope both my husband and myself continue to encounter nurses who have some compassion, flexibility and common sense in dealing with life and death.

I totally agree that not all situation are "textbook" and you are trying to advocate for your husband, and that is important. However, there is some things a husband will not say in front of his wife/partner which may have quite an impact on his care. In 99% of the cases there are times when even the most loving spouse needs to step out of the room--life and death or not.

[psu_213, BSN, RN]

Here's another situation I just though of...I was takin care of a pt in the ER who was sent in because she had abd pain and her doctor wanted to R/O appendicitis. Doctor went in, asked the BF to leave the room for his exam. After a workup it turned out she had PID. Now, would it not seem weird to the BF to have him in the room during the initial interview with the pt and then a hour later the doctor asks him to leave when he delivers his dx? Even though the BF might have thought of himself as an advocate for the pt, it would have made it difficult to have a frank discussion with the pt. (PS. I'm not trying to say that people in this thread arguing the spouse should be in the room are going to be in a similarly 'uncomfortable' situation.)

[destova]

\ said:

Not to mention, I work in an outpatient area so of course, if the patient didn't want the family members or spouse to know info, they wouldn't have brought them to begin with!

Not true, my abusive ex husband went to all my appointments without my having a say. Including the round of outpatient iv antibiotics I had to go through after a bad sinus infection landed me in hospital. I didn't bring him, he insisted on going so I wouldn't have a chance to ask for help...

[Ruby Vee, BSN]

susie2310 said:

I am an RN; my husband has been hospitalized several times for serious conditions, and sees multiple doctors. I have been present with him day and night through his hospital stays, either on a cot in his room, or sleeping in a hospital lounge, and attend some of his medical appointments with him. I fully understand HIPAA, and the responsibilities of the nurse. for the most part the staff have been reasonable in accommodating my wish and that of my husband's, for me to be with him. I have stepped outside when asked by the nurses to have time to settle him; I have waited outside the curtains after the nurse respectfully explained the need to do an assessment. for the most part, everyone was considerate of everyone else. I do recognize the need to tread carefully on the part of the family member, and I do tread carefully, although I will certainly speak up if I observe substandard care, as I am sure all nurses would expect.

I do think that the application of HIPAA needs to be done with intelligence and sensitivity. the intention of HIPAA is to protect the patient's privacy, not the nurse's or other providers convenience. I think it is not really ethical to try to prevent a family member from being with the patient, using the pretext of HIPAA, just because you think they might complain about your nursing care, or because you perceive them as being difficult. if you are afraid they might complain about the care you give, give good care, document properly, and treat the family member with consideration and respect. if you perceive the family member as difficult, try to understand what is prompting their behaviors and find a way of working with them. 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. would you as a nurse take that into account? what would I need to do, having supported my husband through major illnesses, to convince you that I know he would want me to be present? do you think a poa is not enough to demonstrate my husband's intentions and trust in me, even though it only applies when he can no longer make decisions for himself (which could potentially apply at many points during his care, depending on the circumstances)? would I have to resort to an attorney? very often family members, however suspiciously one may perceive them, are the major caregivers and support system for the patient. I want to be with my husband when he is hospitalized 24/7 because I love him and want to support him through his illness, and I know he wants me there. also, I will be caring for him when he is discharged.

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. the nurse's responsibility is to use HIPAA intelligently, respectfully, and considerately, for the sake of the patient and also their spouse and family members. I understand that studies show that patients with a strong support system have better medical outcomes than those that don't. I think that as nurses we should be facilitating that support system whenever possible, while respecting the patient's wishes.

since you are an RN, I'm sure you realize that there are times when it is much better for all involved if the family step outside the room and let the staff get on with assessments or treatments or whatever. I truly hope that you'd just step outside and not threaten anyone with getting an attorney involved.

[healthstar, BSN, RN]

During a code, I cannot stand family members in the room.....no one should be allowed unless they will not cry, scream, faint, ask questions t the time. It is frustrating enough that the pt has coded and there is a 50% probability that the patient might die. It can be pretty scary for family members to watch 30 people in the room, who has the time to explain anything at that moment.....its life VS death situation. Husbands and wives should never have access to their partner's medical records..unless they have permission......divorces do happen !! No one will keep your secrets forever.

[Ruby Vee, BSN]

susie2310 said:

altra, I'm afraid your explanation doesn't address a situation such as mine and my husband's, although it does address a textbook situation. I hope both my husband and myself continue to encounter nurses who have some compassion, flexibility and common sense in dealing with life and death.

and here I was thinking that altra's explanation does address a situation such as yours -- and I was hoping that you'd see it and understand.