Members are discussing the role of family members in providing medical information for hospitalized patients. Some members argue that spouses should be allowed to answer questions on behalf of the patient, while others emphasize the importance of obtaining information directly from the patient. The debate revolves around the balance between respecting the patient's autonomy and ensuring accurate medical history.
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 Wilderness Medicine, ICU, Adult Ed..
Sometimes, during a consultation or examination, we will ask patients about things that even their spouses do not know about them, for example, whether they have ever had sex with someone of the same sex as them, how many sex partners they had before getting married, how many sex partners have they had since getting married, and so on. We are not prying. We need this information, in some cases, to provide the care the patient needs. If you and your husband have one of those rare relationships that would allow him (or you) to answer those questions comfortably in each other’s presence, then bravo! I admire you both! However, many (most?) people do not achieve that degree of honesty, or even if they do, will feel some discomfort reciting the answers with any audience, even their most intimate companion. I am not saying that any of this applies to you or your husband, but we have no way of knowing where the questioning may go, and how you and your husband might feel about them. Therefore, we take the route that is most likely to be the least uncomfortable for the patient. Please believe me, we mean no offense or disrespect, and we are not doubting the strength of your bond with your husband. We are just trying to make it as easy as we can for the patient when we do not know what the answers to our questions might be, or how he would feel about answering them.
Not.done.yet, I like your reply. Makes alot of sense.
My last clincial rotation was at the ICU of a local hospital. I heard the story of a recent patient that was admitted to the unit and his spouse was extremely difficult. She questioned everything being done to the patient; not that there is anything wrong with that, but was deciding what was OK to give to the patient or not all the while the patient was able to make this decision himself but apparently the submissive type. No nurse in that unit wanted to care for this patient if they had a choice because she was always interfering with everything, from providing oral care to everything, as per my preceptor. When the patient was put in the step down unit, she insisted on giving him the meds and he coded as he choked on one of his meds (so we were told), when the patient was going to be resent to the ICU all the nurses there were relieved that this section was full and he had to go to the other side. The nurses that did take care of this patient had to put up with the spouse because none of them wanted to have a complaint from a family member go to administration and be written up.
This story came about because I asked what was the limit of visitors allowed in this unit since on one room there were about six and I saw the nurse, saying "excuse me", "pardon me", so many time as she was going around the bed checking for IV lines, and giving meds and such to another patient and I saw how uncomfortable it was for her.
So my question is, how can you assert yourself and tell a family member that refuses to leave the room, while making sure that he/she knows that is for the best of the patient when they are adamant to stay put?
As a nurse I always ask the family to leave the room before I ask or do anything. If the patient is comfortable with the family remaining in the room then they will ask for them to stay. Many timid patients have difficulty answering questions honestly if posed with a direct question that may or may not be negatively viewed by the family. If the patient states that they want the family to leave then it immediately will create suspicion and possibly tension or negative attention. By asking the family to leave myself I relieve the patient of the dilemma and allow them to make a free decision without burden of upsetting their family.
We are required by Federal law to protect the patient's privacy, should the patient wish someone to know about their care then it is their affair. By not positioning ourselves to relieve the patient of a possible dilemma we do not fully provide the patient with the free will to make an important decision free of duress.
For the second scenario I would say that is more of safety issue. While performing a procedure such as a transfer the family may be asked to leave the room so as to not interfere or provide distraction. This of course is up to the comfort level of the practitioners performing the operation and so there may be significant variation in the requests made. Keep in mind that your husband's safety is of the up most importance to the staff, their requests most likely were conceived with the idea of providing the safest and most prudent care possible.
Yes, I found it odd that you were able to post a question here, but I personally have welcomed it as I have been able to read the amazing posts from experienced nurses and I can take their knowledge in how to handle such an issue when I get to practice as an RN.
Well, Healthstar, I just graduated from nursing school, I took Advance Med-Surge two semesters ago and my last semester was Leadership, we have been taught that now the family is asked if they want to be present in the room while we are providing care to their family member during a code. Working at the ICU on the last rotation I confirmed this with my preceptor. Wow, I cannot imagine several of us trying to address a code while we have family members in the room as well, but that is the new thing apparently.
Well, Healthstar, I just graduated from nursing school, I took Advance Med-Surge two semesters ago and my last semester was Leadership, we have been taught that now the family is asked if they want to be present in the room while we are providing care to their family member during a code. Working at the ICU on the last rotation I confirmed this with my preceptor. WOW!, I cannot imagine several of us trying to address a code while we have family members in the room as well, but that is the new thing apparently.
Usually you try to have only a single family member in the room during the code and that is the next of kin or medical power of attorney. There are a few reasons for this; one is to show the family first hand that everything that can be done is being done to revive their loved one, this helps to reduce gross terminal familial anxiety and incidentally reduce lawsuits. The second rationale is to show the family first hand how traumatic the code process is so that they have a chance to rethink their decision so that they can decide if THIS is really what mother or father wanted. Most lay persons imagine the code process being clean and quiet like they are on TV with negligible trauma or loss of dignity for the patient. Not until they witness the violent nature of the swift and traumatic actions taken by the staff, the sound of the ribs breaking, and watching their loved one stripped of clothing do they understand that this process may not be the peaceful and dignified conclusion to the life that they had imagined it would be.
Specializes in med-surg, geriactrics, oncology, hospi.
Some excellent explainations here, all I agree c. Care is about the PT first, spouse, family, etc. come after. Keep in mind, staff are thinking of your spouse' needs. Also, we all have to remember HIPPA, HIPPA.
Speaking only for myself and my own practice, I will not do a pelvic exam with a spouse/so in the room. Will not. If patient wants them there, they can find a different provider.
BlueDevil, why do you feel that way? I would be highly suspicious of a provider that refused to allow my spouse to be present if I specifically requested it.
Specializes in OR, Nursing Professional Development.
BlueDevil,DNP said:
Speaking only for myself and my own practice, I will not do a pelvic exam with a spouse/so in the room. Will not. If patient wants them there, they can find a different provider.
And I would. There can be many reasons why a patient may want a spouse/SO in the room. For me, I took a friend with me to my first scheduled pelvic exam when I was 28. The reason? I'm a survivor of sexual abuse and would not have been able to mentally handle a pelvic without a support person (hence why I didn't have one until age 28). It's about the patient's needs, and sometimes that means family/support system should be present.
I am also a survivor of sexual assault, at a very young age, so my husband is my rock. I want him present for any invasive procedure, and I think it's very strange to rule out patients who NEED a support person. As I said earlier, I would be very suspicious of that provider.
CountyRat
323 Posts
Sometimes, during a consultation or examination, we will ask patients about things that even their spouses do not know about them, for example, whether they have ever had sex with someone of the same sex as them, how many sex partners they had before getting married, how many sex partners have they had since getting married, and so on. We are not prying. We need this information, in some cases, to provide the care the patient needs. If you and your husband have one of those rare relationships that would allow him (or you) to answer those questions comfortably in each other’s presence, then bravo! I admire you both! However, many (most?) people do not achieve that degree of honesty, or even if they do, will feel some discomfort reciting the answers with any audience, even their most intimate companion. I am not saying that any of this applies to you or your husband, but we have no way of knowing where the questioning may go, and how you and your husband might feel about them. Therefore, we take the route that is most likely to be the least uncomfortable for the patient. Please believe me, we mean no offense or disrespect, and we are not doubting the strength of your bond with your husband. We are just trying to make it as easy as we can for the patient when we do not know what the answers to our questions might be, or how he would feel about answering them.