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.

[Ruby Vee, BSN]

susie2310 said:

altra, your later post "this" in regard to another quoted statement "everyone thinks their situation is different" causes me to believe your reply to me above was sarcastic. you replied initially to my post where I explained the reasons for answering questions for my husband when he was extremely sick. my husband, his doctors and nurses appreciated my help. as a nurse, and a wife who has taken care of my husband through serious illnesses, you seem extraordinarily uncompassionate.

where "uncompassionate" means "you're disagreeing with me" or "you're not giving me what I want."

[canoehead, BSN, RN]

Susie2310 said:

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.

I want an accurate assessment of the patient first, including mental status, knowledge of his illness, any pain he has....and then I want the information the family has. I work in the ER and when I triage a patient the family is wrong about some part of the assessment at least 50% of the time, if I take the time to speak to the patient first.

I don't know the patient's mental status unless I am allowed to speak with them briefly without interruption. They may be slow to answer, is it dementia, or pain, or mental illness, or sometimes, yes, they are totally dependent on their visitors. Imagine you are just introduced to someone, and their spouse answers everything- would you feel like you had gotten any information you could trust?

[NurseLatteDNP, MSN, DNP, RN]

I always ask for everyone to leave the room during transfers due to space issue, but when I am assessing my patient, I ask if it is ok for the person in the room to stay.

[cherrybreeze, ADN, RN]

There really is no such thing as a "textbook" situation....

[cherrybreeze, ADN, RN]

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.

I'm not sure where your statement about using HIPAA to cover up substandard care comes from. it sounds like you assume that's the reason that family members are asked to leave. just one of many problems that come up in regards to this topic (family assuming this).

as far as whether your husband is under the influence of medication or not...doesn't matter. sorry. if I ask him if he wants you in there, and he says "no," the answer is no, no matter what meds he has received. I'm not going to hear him say no, and think, "well, if he wouldn't have gotten morphine he would've said it was okay, so I am going to let her stay anyway." not gonna happen. for whatever reason, at that moment, he doesn't want you in there, so that's the way it's going to be (I'm not saying your husband has ever said that, I'm using it as an example since you did).

honestly, no....having you designated as his poa means nothing. the poa isn't activated, for one thing, so you still have no rights to his info. the act of simply designating you as his poa for the day in the future that he will need one isn't enough to speak to the "trust" he has in you or his "intentions" (thereby including you in every discussion). I am designated as my mom's poa, but that doesn't mean she wants me in the room all the time, especially if the conversation with the nurse or doctor is of a sensitive nature. that's her choice to make at the time the discussion occurs. plenty of married couples designate each other as their poa's. later on, they get divorced. having a copy of the patient's poa on the chart doesn't mean I'm going to see it, think, "the patient designated this person to make decisions for them in the event that they can't, so that means I won't/don't need to ask them to step out for anything." that's a leap, sorry.

you asked: "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?" honestly? if at that moment, I ask the patient if he wants you there and he says no....the answer is nothing. there is nothing that you can do or say that will override what the patient says they want at that time. if he is unable to answer due to his physical condition, then yes, I likely will let you stay. if he is able to answer, even if he's had morphine, his answer trumps everything else. in cases of patients with advanced dementia, it's a little trickier, and those situations are evaluated on a case-by-case basis; there are too many variables. receiving pain medication is not the same as having dementia, though. just because they've been medicated doesn't mean they don't know what they want. if later on, he says to you, "I'm sorry I said no, I didn't realize" or some such thing, well....I'm sorry. that's between you two. I have to err on the side of the patient, though. it's the right thing to do. much preferable to him later saying to me (or someone else), "I told the nurse I didn't want my wife in the room while they did x, y, and z, and she let her stay anyway." not a risk I can take. it's not personal. I don't think less of him or you, if he would want privacy for some things. I'm not "judging" your relationship based on that.

you could try to get an attorney involved, but it would be a waste of your time and money. there is nothing wrong or unlawful about honoring a patient's wishes, even if those wishes change from one day to the next. I think you'd be hard-pressed to find a judge who would say otherwise.

your last statement: "I think that as nurses we should be facilitating that support system whenever possible, while respecting the patient's wishes." exactly. if that patient is your husband and his wish is that you leave the room, I'm going to respect that. I'm not saying that he would ever say that, mind you. I don't know him or you. the same would go for any patient.

[yvfair]

\ said:

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...

You're right! I hadn't even thought about possibly abused patients. Forgive me! I will be more considerate

[destova]

\ said:

You're right! I hadn't even thought about possibly abused patients. Forgive me! I will be more considerate

Thank you. It has taken me quite some time to gather the strength to say out loud that I was in an abusive situation. However, with nurses and other medical professionals I take a deep breath and say (in this case type) it. Because we frequently are the ones that can see warning signs and make a difference...

Even if we don't see warning signs, those few moments alone with the nurse can be a patients only moments of peace and safety in some cases.

*sorry to the OP for hijacking your thread, just wanted to throw in my two cents!

[PeepnBiscuitsRN]

When I was 12 weeks along with my daughter and having a threatened miscarriage, the tech somewhat curtly told my husband to leave the room while they did a pelvic exam. I spoke up (I wasn't mad, although I was an emotional mess) and told them he would be staying. Later, when we had an ultrasound picture of our quite alive, very healthy, (actually 13 weeks and a day or two) baby, my husband told me he wanted to say: "Really? You don't think I've seen down there before? How the heck do you think that baby got in there?!"

[JBudd, MSN]

During pelvics, we often do testing for STDs, and the pt may not want the spouse to know that. Since you told them to let him stay, fine; but not all women are able to say they want to be alone, all she has to do is NOT say anything. So, the "anger" can be directed at me, not the pt, and I could care less about it. I will shield people as needed.

[destova]

\ said:

During pelvics, we often do testing for STDs, and the pt may not want the spouse to know that. Since you told them to let him stay, fine; but not all women are able to say they want to be alone, all she has to do is NOT say anything. So, the "anger" can be directed at me, not the pt, and I could care less about it. I will shield people as needed.

bravo!

[cherrybreeze, ADN, RN]

PeepnBiscuitsRN said:

When I was 12 weeks along with my daughter and having a threatened miscarriage, the tech somewhat curtly told my husband to leave the room while they did a pelvic exam. I spoke up (I wasn't mad, although I was an emotional mess) and told them he would be staying. Later, when we had an ultrasound picture of our quite alive, very healthy, (actually 13 weeks and a day or two) baby, my husband told me he wanted to say: "Really? You don't think I've seen down there before? How the heck do you think that baby got in there?!"

I agree with what JBudd voiced as sound reasoning for asking a spouse to leave during a pelvic exam, but also.....seeing "down there" during the heat of the moment/*making a baby* obviously has a very different feel to it than the clinical setting of a pelvic exam. Many (most?) women have heightened general anxiety during pelvics, and there can be added pressure having a spouse/partner witness the sterility/clinicality (that's not a word, but it sounds good ) of a pelvic in the harsh fluorescent lights of an exam room. Even though he's seen the parts, he's not seen them in that setting or mood. Not all women are comfortable with that. Even if they've been married many years, perhaps they want to keep up a little mystery. ?

[PeepnBiscuitsRN]

Well, what can I say. I wanted him there because I was sure we were going to get bad news, I have nothing to hide. If some other woman wants her husband/boyfriend to leave the room that's fine and dandy. I was a train wreck that night so I needed him around. :)