Nurses Being More Sensitive to Patient Modesty

Patient modesty needs to be a high priority during all medical procedures. Nurses are often so busy focusing on the actual procedure protecting a patient’s dignity and modesty gets sidelined, especially in the ER and other busy departments. It is important to keep in mind that many patients are more comfortable with same sex medical professionals for intimate procedures.

Oftentimes, patients are more anxious about their modesty for medical/surgical procedures than the actual procedure itself; therefore, many patients have avoided procedures. Most patients welcome medical professionals of either sex for procedures and exams which do not expose their private parts. Intimate procedures are another story. Many patients prefer same sex intimate medical care such as assisted bathing, insertion of urinary catheters, and assisted dressing. For example, many women prefer a female nurse for intimate care. Many men are more comfortable with male nurses for intimate care.

Modern medicine is gender neutral which means providers, nurses and assistants are equally able to offer their services to all patients no matter the sex of the patient involved.

While it may be true that the mechanics of medical care can be provided by either sex to patients of either sex, there are two important issues hospital administration, nursing homes, and medical professionals should consider if “patient centered care” is truly a priority.

1) Many patients have sex preferences particularly for intimate care.

2) The potential for abuse during intimate care is great particularly when patients are compromised by medication, anesthesia, or by their physical condition.

Many patients and family members are totally unaware that gender-neutral intimate care has become the norm at many facilities. They find this out, oftentimes too late, when they or a loved one is hospitalized or admitted to a nursing home. Some examples include: male nurses in Labor & Delivery departments and male nurses / nursing assistants doing intimate care on women such as bathing, changing gowns, inserting urinary catheters, and vaginal prep for surgeries. There is no valid or specific medical reason for gender-neutral care.

It is difficult for a patient or his/her family to object to this gender-neutral care especially if the patient is in critical condition. Here’s an example: one husband in New York did not feel he could speak up at first when some male nurses and techs helped to dress and bathe his wife who had Endocarditis, a life threatening heart valve infection that almost killed her. A male nurse washed his wife’s genitals because she had a horrible yeast infection due to antibiotics she was receiving. The husband was completely focused on his wife’s survival. Her surgeon had said it would be a week before they would know if she would pull through. It’s sad that patients on the verge of possible death are randomly and routinely subjected to gender-neutral intimate care abuse and as well as modesty violations. Many women and their husbands assume that a female patient will always have a female nurse or nursing assistant help with dressing or bathing. This was the case decades ago but, things have drastically changed with today’s “modern medicine” becoming increasingly gender neutral.

Over the past decade there has been a big increase in male medical professionals - especially nurses and nursing assistants - sexually assaulting women because they perform intimate care on female patients. Check out www.sexualmisconductbydoctors.com to see a list of male medical professionals who have sexually abused women according to news sources.

Ironically, many women’s prisons in a number of states have policies that prohibit male security guards from stripping female inmates—even if they are suspected of hiding drugs—or watch them showering.

Hospitals and nursing homes need to address these concerns as well and enact similar policies by prohibiting male nurses and nursing assistants from doing intimate procedures on female patients to protect their dignity and safety.

Departments such as cardiac units, ICU, general surgery, orthopedic surgery, and psychiatry at in hospitals and nursing homes that serve both female and male patients should hire nurses of each sex. Accommodating the wishes of patients with same sex medical care should be a hospital’s priority—and same sex medical care should be the default where the wishes of the patient are unknown. For intimate procedures, many nursing departments and even nursing homes assign nurses to patients without considering the sex of the patient and without the patient’s or family’s consent.

There is another problem with the gender-neutral approach in medical facilities that has caused a problem with male patients who are more comfortable and less embarrassed with male personnel for intimate care. When a facility assigns a male aide / nurse to some female patients for intimate care, it limits their availability for helping male patients.

In the 1970s and before the ‘gender-neutral’ era, men had intimate procedures such as urinary catheterizations done by male doctors or orderlies in hospital. The gender neutrality of the medical industry changed this and it is pretty common for female nurses and CNAs to do intimate procedures on male patients today.

Numerous male patients have been violated by female nurses who ignored their wishes for modesty. Cases attest to female nurses who have made derogatory comments about the genitals of male patients especially those under anesthesia.

Male patients should always have the option of an all-male medical team for intimate procedures. Medical facilities should give all male patients forms asking about their gender preferences for intimate medical care.

Interestingly, a number of male nurses refuse to work in Labor & Delivery department even if it is allowed or are uncomfortable with doing intimate procedures on female patients, but they are pressured by their female nursing supervisors who do not seem to be sensitive to patient modesty.

Some facilities do not have enough male nurses and this poses a problem for male patients who care about their modesty. Also, male nurses are usually best suited to lift patients.

*All nurses are encouraged to watch the videos, Problems with Medicine Being Gender Neutral and Surgery and Your Modesty.

Here are some examples of nurses being sensitive to patients’ wishes:

1) A female head nurse helped to honor a man’s wishes for an all-male team for colonoscopy and colonoscopy shorts by scheduling a male technician and ordering colonoscopy shorts before his procedure.

2) A female nurse went to find a male nurse to do a urinary catheter on a man who was more comfortable with a male nurse.

We encourage all nurses to work on being more sensitive to patients. Below are some tips to use as a guide.

Tips For Nurses

1) Never try to convince a patient to accept opposite sex medical professionals for intimate procedures. Don’t use arguments such as “they are professionals”, “they’ve seen it all”, and “they are very skilled and have done this procedure many times”.

2) If any colleagues make derogatory comments about patient’s private parts, report them to the administration. Do not tolerate this behavior.

3) Put a ‘Do Not Disturb’ sign on the exam door so other medical personnel do not randomly enter during intimate exams.

4) Never walk in a room that is closed because the doctor may be doing an intimate procedure. Be sure you ask the doctor what he/she is doing before entering in a room.

5) Let the patient have the choice of who she/he wants to be present for her/his intimate exams. Ask the patient. Some patients, especially male patients, do not want any chaperones (ex: female nurse) to be present. If you have to be present for an intimate exam with a doctor, you should consider standing at the patient’s head so you can avoid seeing the patient’s private parts.

5) Ask for permission before you touch certain areas of any patient’s body. Explain in precise details what you will be doing, especially if the procedure involves private parts. Always respect a patient’s wishes if he/she says “No” to something.

6) Let the patient wear their street clothes as much as possible. Many procedures and tests, including blood tests, blood pressure tests, stethoscope heart exam, eye, ear, nose, and throat examinations, as well as throat cultures can be done fully clothed.

Check out the articles about patients wearing their own clothes: Hidden Beneath the Hospital Gown and Keep Your Pants, and Your Dignity, at the Hospital.

7) Don’t try to dress or undress a patient especially when they want to do it themselves. Be patient with them no matter how long it may take them.

8) Always strive to give patients maximum dignity and respect. Do not unnecessarily expose them. For many surgical procedures that do not involve the genitals, hips, and groin, patients can wear 100% cotton underwear or disposable underwear/shorts as long as they do not contain metals. Check out Unnecessary Underwear Removal for Surgeries. Utilize special garments such as Covr Medical Garments for procedures that require access to the groin, hip, and part of the back (ex: kidney procedure) and the Modesty Bra for women. If a rectal exam or colonoscopy is required, give the patient the option of wearing boxer shorts backwards or specialized colonoscopy shorts that only expose their buttocks. If a patient requires assistance with bathing, look at getting the honor guard garment from Dignity Resource Council.

9) Never push a patient to accept nursing or medical students against their wishes.

10) If you cannot accommodate a patient’s wishes for a same sex team, suggest other facilities or schedule that procedure when a same sex medical team can be accommodated.

11) Educate your nursing staff to be sensitive to patient modesty and privacy. For example, a man may not want to discuss his health issue with a female nurse.

12) During general anesthesia patients continue to expect dignified care. For patients who require surgery that involves exposure of their private parts commit to helping them get a same-sex surgical team if that is their preference. Be open to using local or regional anesthesia if that is the preference of the patient. This allows the patient to remain awake and alert during a procedure and gives many patients peace of mind. Also, patients should have the option of having a personal advocate such as their spouse present for surgeries and procedures. Check out this article, Why You Should Have a Personal Advocate?

13) Treat compromised patients and those who suffer with dementia and Alzheimer’s with dignity and respect for their privacy. Always assume that a patient wants to be treated by a medical team of the same sex if the patient is unable to communicate her/his preference. One female car accident patient was traumatized when she witnessed a male nurse removing her tampon while she was semi-conscious.

14) Never routinely perform intimate procedures such as urinary catheterizations on patients because it is more convenient. For example, a urinary catheter should never be used for incontinence. Adult diapers or Depends should be used instead. Check out Unnecessary Urinary Catheterizations and Lack of Informed Consent.

15) Encourage your facility to make a policy prohibiting male nurses and assistants from doing intimate procedures on female patients to prevent potential sexual abuse. Utilize the male nurses for intimate procedures on male patients as much as possible and use them for non-intimate procedures on female patients.