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Source: (consider it) Thread: Traumatizing tattoos in hospitals
Stetson
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# 9597

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This woman is complaining because a nurse's tattoo of a skull caused extreme emotional disturbance during a period when she was already fearing for her very life. She apparently wants such tattoos disallowed in hospitals.

The complainant is being subjected to the expected on-line vitriol about how she shouldn't be so sensitive, etc. Normally, I think I'd join in the mockery, but in this case, I can acknowledge that being in the hospital for a serious illness is a rather traumatizing affair, and that skulls do indeed have some fairly morbid cultural connotations.

[ 06. April 2016, 19:34: Message edited by: Stetson ]

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Doublethink.
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# 1984

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Our trust simply requires anything vivid or distracting is covered at work. This is relatively easy to achieve, without banning folk from specific professions.

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Lamb Chopped
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Why not handle the thing as a one-off? I doubt there is any good way to set a policy to cover every possible upsetting tattoo.

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Stetson
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Yeah, I'd basically just say that a provocative tattoo should be covered up.

Though the devil is in the details. You'd probably get into arguments about which tattoos are and are not inappropriate, with staff aren't going to like being told that some piece of skin art that they are particularly fond of needs to be hidden from view. Especially if it's only one patient complaining.

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Doublethink.
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# 1984

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It is part of our dress code, basic expectations are set, certain characteristics protected, and the line manager's discretion invoked.

As far as I know it has not caused major problems any time in the last eight years.

(The phrase used covering hemlines, close fit etc is that "clothes should maintain the wearer's dignity". - I believe we also specify that the midriff should be covered.)

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Firenze

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Time was, if you were a monk/scholar/pirate/Prince of Denmark an actual skull was a must-have accessory. You either drank wine out of it or used it as an aid to contemplating your latter end and the vanity of human existence.

I'm maybe being a tad unsympathetic here, but listen, dearie, you're going to die. Get used to the idea and then spit in its eye and get on with living.

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Schroedinger's cat

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I would think that anything that is inappropriate for the situation - which would include skull tattoos - should be covered. That does not seem unreasonable. I think anyone who has tattoos of their surgery (yes, I do know someone) would also be included.

The problem is, it might be flowers that someone finds traumatising. Or hearts. It might be almost anything. You can't ban everything that might be a problem for anyone.

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Not

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From the linked account, she was receiving ketamine at the time, which can have marked dysphoric effects on mood and alter perception. That may not have helped. Yes the skull tattoo acted as a focus but she may well have felt just as frightened and disoriented without or with those feelings focussed around something else. I've had patients recover from periods of delirium or sedation with the oddest memories, often recognisable but distorted perceptions of quite ordinary things.

My workplace has similar rules to Doublethink's and that seems reasonable. I'm not sure this story has much bearing either way on what the rules should be and certainly I don't think there's any mileage in trying to define which tattoos are inappropriate or scary. There will be obviously offensive ones (visible swear words, sexual imagery) but most others are going to be very much down to subjective judgement.

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cliffdweller
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quote:
Originally posted by Doublethink.:

(The phrase used covering hemlines, close fit etc is that "clothes should maintain the wearer's dignity"....)

Presumably, if the wearer thought it was undignified, they wouldn't be wearing it. I suspect that, despite what is written, what the dress code really means is "clothes should appear dignified to the supervisor..."

Although the phrase is vague enough to sound a lot like the language that appears as the final item in most church staff job descriptions: "...anything that furthers the cause of Christ..."

[Ultra confused]

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Doublethink.
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I guess part of the aim is not to have to rewrite the policy every time social mores shift.

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Boogie

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You are not allowed to even apply to become crew for some airlines if you have a tattoo anywhere on your body, seen or unseen, covered or not.

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Doublethink.
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# 1984

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This strikes me as both stupid and offensive - and a total failure to understand what tattoos mean for people.

[ 06. April 2016, 21:51: Message edited by: Doublethink. ]

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All political thinking for years past has been vitiated in the same way. People can foresee the future only when it coincides with their own wishes, and the most grossly obvious facts can be ignored when they are unwelcome. George Orwell

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LeRoc

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quote:
Boogie: You are not allowed to even apply to become crew for some airlines if you have a tattoo anywhere on your body, seen or unseen, covered or not.
Dp they check that?

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rolyn
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Well I suppose there are picture of skulls, and then there are other pictures of skulls.

If it has a black hood and a scythe nearby then the average hospital patient is most likely going to be worried. OTOH if it's an X-ray image of something each of us has on top of our shoulders then there shouldn't be much problem.

[ 06. April 2016, 21:57: Message edited by: rolyn ]

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lilBuddha
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quote:
Originally posted by Stetson:

The complainant is being subjected to the expected on-line vitriol about how she shouldn't be so sensitive, etc. Normally, I think I'd join in the mockery, but in this case, I can acknowledge that being in the hospital for a serious illness is a rather traumatizing affair, and that skulls do indeed have some fairly morbid cultural connotations.

I do not think she should be the target of mockery. Nor do I think her fears should receive special attention. Skulls so have morbid connotations to parts of some cultures, but then so do certain colours and varieties of flowers, certain animal species, numbers, etc.

quote:
Originally posted by Not:
I don't think there's any mileage in trying to define which tattoos are inappropriate or scary. There will be obviously offensive ones (visible swear words, sexual imagery) but most others are going to be very much down to subjective judgement.

This.

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Boogie

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quote:
Originally posted by LeRoc:
quote:
Boogie: You are not allowed to even apply to become crew for some airlines if you have a tattoo anywhere on your body, seen or unseen, covered or not.
Dp they check that?
They ask at interview and would be seen at the medical exam.

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LeRoc

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quote:
Boogie: They ask at interview and would be seen at the medical exam.
Hmm, how does this match with medical confidentiality?

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Nicolemr
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I don't think the woman should be mocked, because that isn't a nice thing to do, but I do think she is being absurd.

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Stetson
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quote:
Originally posted by LeRoc:
quote:
Boogie: They ask at interview and would be seen at the medical exam.
Hmm, how does this match with medical confidentiality?
Well, I wouuld assume that if the medical exam is for a job, the doctors are allowed to tell the potential employer about any problems they noticed. Maybe the employees sign a waiver?

Not wrote:

quote:
There will be obviously offensive ones (visible swear words, sexual imagery) but most others are going to be very much down to subjective judgement.
A few weeks back I mentioned the Canadian pop artist ManWoman, whose body was covered in swastika tattoos as part of his crusade to rehabilitate what he ccnsidered a beautiful religious symbol defiled by the Nazis. I'd imagine he might have had some trouble getting a job in a hosptial(or anywhere else serving the public), no matter how patienly he explained his noble endeavour.

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LeRoc

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quote:
Stetson: Well, I wouuld assume that if the medical exam is for a job, the doctors are allowed to tell the potential employer about any problems they noticed. Maybe the employees sign a waiver?
I don't think so. I change jobs often, and this often involves undergoing a medical exams. This is even more relevant because all of my jobs involve living in, or regularly travelling to, the tropics. Most employers hire an external examination clinic for this, but one of the organisations I've worked for is so big that it had its own medical department.

In my experience, before I start such an exam, the clinic will inform me what they are obliged to tell to my employer, and what my rights to confidentiality are. This is even true for the internal medical staff. In all exams I've been through, the medical staff is only allowed to tell my employer whether I'm medically fit to do the job or not.

I've often signed waivers where I indicated that I've understood what they told me about confidentiality; never one that allowed them to tell about non-medical things like tattoos.

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mdijon
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I think in this case the medical examination would include a statement that tattoos were relevant and the employer needed to know. Candidates refusing to agree would probably be out.

What I don't understand is why it matters. Why does the airline think it matters if someone has a tattoo on their back where no customer will ever see it?

I also note reports that birthmarks and scars might be a problem. I wonder if any of this has ever been or could be challenged in court as unfair?

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Lyda*Rose

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quote:
Originally posted by rolyn:
Well I suppose there are picture of skulls, and then there are other pictures of skulls.

If it has a black hood and a scythe nearby then the average hospital patient is most likely going to be worried. OTOH if it's an X-ray image of something each of us has on top of our shoulders then there shouldn't be much problem.

I'd find a sugar skull tattoo rather comforting.

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Galloping Granny
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quote:
Originally posted by Nicolemr:
I don't think the woman should be mocked, because that isn't a nice thing to do, but I do think she is being absurd.

None of us who have been responding would have been upset at seeing the skull. But a frightened patient, facing the outcome of surgery, ill at ease by being in the unfamiliar hospital environment (not that we know she was, just visualising) could well find it un-nerving.

GG

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Curiosity killed ...

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I have a work dress code that doesn't allow visible tattoos and limits jewellery to one keeper or stud earring in each ear for piercings. That's not unusual for customer facing work - a current entry level English exam I'm using has something similar in an exercise, much to the surprise of students I work with.

(My work dress code also bans jeans, trainers, tracksuit bottoms, shorts, short skirts, low cut and/or strappy tops. I'd have to dig it out to check what else I've missed.)

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mdijon
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It is worth noting that ketamine does weird things to your brain.

In a sense one can never exclude everything that might be a substrate for a dysphoric reaction by patients with drugs, delirium, dementia, anxiety and various other challenges to their perceptions. On the other hand images like skulls, snakes, dragons and the like seem particularly concerning and I think it would be reasonable to ask for them to be covered up. Not in a "this is the rule and the following images are banned" sort of way, but rather to communicate to staff that they should think about the images on display and show good judgement in covering those that they think might be a problem.

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Schroedinger's cat

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quote:
Originally posted by cliffdweller:
quote:
Originally posted by Doublethink.:

(The phrase used covering hemlines, close fit etc is that "clothes should maintain the wearer's dignity"....)

Presumably, if the wearer thought it was undignified, they wouldn't be wearing it. I suspect that, despite what is written, what the dress code really means is "clothes should appear dignified to the supervisor..."

Although the phrase is vague enough to sound a lot like the language that appears as the final item in most church staff job descriptions: "...anything that furthers the cause of Christ..."

[Ultra confused]

It always remind me of those signs which say "should be left as you would like to find it". What they mean is "should be left as the person who puts up notices to tell people things would wish to find it".

I don't think this lady should be mocked, because that is cruel. She is sensitive, was on strong medication in a frightening situation, and one particular thing triggered her. Fine. But it should be dealt with as a problem with her environment, not with the nurse.

If she raises issues - however trivial - while in the hospital, it may be possible to get her a different nurse. But once finished, let it drop.

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mdijon
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There might be something for the hospital to think about more widely - whether they want to protect vulnerable patients from seeing images that some will predictably find distressing. The question is whether this is an idiosyncratic reaction or more widely predictable.

I think there probably is a case that a minority of dysphoric, delirious and scared patients will predictably find certain images distressing and therefore staff should consider whether it would be kind to cover such images up.

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LeRoc

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quote:
mdijon: I think in this case the medical examination would include a statement that tattoos were relevant and the employer needed to know. Candidates refusing to agree would probably be out.
I would still find this very weird. I can't imagine a medical clinic or its staff going along with this either. I have some friends who are doctors; the medical world takes its confidentiality very seriously. I can't see it wanting to take up a role as informer.

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Boogie

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You are right LeRoc. The doctor isn't obliged to tell the airline anything (which, sadly, led to a depressed pilot flying his plane and passengers into a hill)

But, my point was, that they are asked at the interview and they have a choice to lie or not get past the first stage. The idea that a medical would show up the lie (even 'tho not reported) would make some feel uncomfortable.

Here is some stuff about it.

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mdijon
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I think there are several different scenarios.

a) An employer tells an employee that they need to be medically fit to take a job, and tells them to see their doctor to ascertain that. There would be an expectation of confidentiality here and the doctor would either write a note saying they were fit or not, but wouldn't snitch about tattoos.

b) An employer hires a doctor as an occupational physician. They instruct them to clear employees for certain requirements. There would be zero expectation of confidentiality in terms of the company as a whole although only certain employees of the company who "needed to know" (i.e. the occupation health records would be available to some HR staff and senior management but not to others).

c) If a doctor uncovers something where there is a public health issue, danger to a third party or serious criminal activity then they are required to break confidentiality. Minor depression wouldn't count (and airlines would not be able to act on this information in any case) but serious depression without insight indicating a danger to the lives of passengers and crew would definitely count. So, for instance, does paedophilia or serious transmissible infections such as TB or HIV.

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LeRoc

Famous Dutch pirate
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I'm really unsure whether your scenario b) exists.

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mdijon
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By the way here's a link that has some helpful information.

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Liopleurodon

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I have a mild phobia of tattoos. I think they set off something in my brain that would normally respond to infected wounds. They set off a feeling of fear and disgust. That's not a judgement of people who get them: I fully accept that the problem is with me. I've had to deal with the fact, though, that I don't have any right to not have to see tattoos.

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mdijon
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quote:
Originally posted by LeRoc:
I'm really unsure whether your scenario b) exists.

I should qualify that the applicant needs to be told that a report will go to the employer. The applicant remains free to withdraw their consent at any stage, in which case the only report the occupational physician can make is "I can't make a report due to withdrawal of consent." At which point you don't get the job either.

It is ethically very complex working in occupational health.

You have to balance the needs and rights of employers and employees/patients. Most doctors and nurses have a primary duty of care to the patient.

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LeRoc

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quote:
mdijon: It is ethically very complex working in occupational health.
I agree. I don't have time to read through that now, but I'll try to do so later.

Perhaps my situation is different. I am Dutch, but I usually work for an employer in another European country B, which sends me to live and work in an African or Latin American country C. (I try not to be too identifiable here.)

I don't have Dutch health insurance, and in most cases this means that my employer will offer me a solution for this (this is also in their interest, since normally they have a number of employees in the same situation as me).

So, my employer has a contract with a health clinic. This clinic does the periodic medical exams that my employer requires of me. But as long as I work for this employer, I'm also allowed to use the services of this clinic for free (I guess there's an insurance company involved somewhere).

So, when I am in country C, working for my employer, I can call or e-mail this clinic if I have a medical problem, and if I don't trust the health services in country C to be good enough. I can even visit this clinic if I happen to be in country B for a while.

This very much includes that I may say confidential things to this clinic, like "I'm stressed because of my boss". It would be very strange to combine these things if at another time, this same clinic acts as my employers' informer.

[ 07. April 2016, 10:45: Message edited by: LeRoc ]

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Posts: 9474 | From: Brazil / Africa | Registered: Aug 2002  |  IP: Logged
mdijon
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# 8520

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quote:
Originally posted by LeRoc:
It would be very strange to combine these things if at another time, this same clinic acts as my employers' informer.

Indeed it is strange, but this is the balancing act occupational health physicians manage. If they are seeing you to look after your health needs on behalf of the employer then you have an expectation of confidentiality. They could only break this if what you said gave real cause for concern - e.g. "I'm so stressed by my boss and so I take a knife to work in case I need it".

If they start a meeting by saying that they are reviewing your fitness to work and will need to write a report to the employer you don't have an expectation of confidentiality. But they can't import what they know from other meetings with you into that consultation. However they can only pass on information that materially impacts your fitness to work and with your consent. However you can't selectively withdraw consent for specific items.

The doctor's duty of confidentiality is not like a priest's.

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Moo

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# 107

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quote:
Originally posted by mdijon:
I think there probably is a case that a minority of dysphoric, delirious and scared patients will predictably find certain images distressing and therefore staff should consider whether it would be kind to cover such images up.

A few months ago I was in the hospital suffering from pneumonia and severe sepsis. If I had noticed that a nurse had a skull tattoo, it would have upset me very much. On the other hand, I might not have noticed.

Moo

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no prophet's flag is set so...

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The nurse should cover the tattoos. Period. Self expression and related rights do not trump patient care. The right response is for this to be a learning situation, and for the nurse to understand the impact of their persona on others. Patients come first. The role of nurse is to serve others. Tattoos are not a human right.

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John Holding

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quote:
Originally posted by mdijon:
... to communicate to staff that they should think about the images on display and show good judgement in covering those that they think might be a problem.

But the judgement of a 25-year-old nurse about what tattoos might be a problem is almost certainly different than that of a 55-year-old nurse. The 25-year-old might well be of a group that found tattoos normal and unremarkable to the point of being totally unconscious that they were anything other than perfectly ordinary and to be expected. The 55-year-old might, reasonably enough, be of the opinion that any tattoo visible at work was evidence of a lack of professionalism at best, and of a sea of unnamed perversions at worst.

FWIW, I'm pushing 70 and find it very difficult to get used to the expectation that arms and upper bodies (as I see them on younger men at the gym) will automatically be covered with so much ink that the original skin colour has vanished. My problem, obviously, but assumptions and practices about what is normal or acceptable have changed radically in the last 10-15 years, and not everyone is on the same page -- by a long shot.

John

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mdijon
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True the 25-year-old nurse may feel the tattoo is normal, but nevertheless he/she will understand that delirious, confused and nervous patients might have an adverse reaction to certain images. If they don't a line manager would hopefully notice and say something.

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mdijon nojidm uoɿıqɯ ɯqıɿou
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Stetson
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On the UCC thread in Hell, I posted a link to that denomination's magazine. Coincidenatlly enough, they have an article about clerical tatoos.

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I have the power...Lucifer is lord!

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Stercus Tauri
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Personally, I find all tattoos to be repugnant, but that's purely personal. However, in a hospital it's not unusual for patients to experience distressing hallucinations as a side effect of certain pain relievers and drug interactions (happened to me). The hallucinations can be affected by visual images that the patient has seen before or during these episodes, so while I would have to accept anyone's right to have tattoos, it makes sense to me to ask nursing staff to cover them.

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Thay haif said. Quhat say thay, Lat thame say (George Keith, 5th Earl Marischal)

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Hedgehog

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# 14125

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It seems to me that there is another issue here: that of patient care.

If a patient, particularly one in a life-threatening situation, gets upset or distressed at a particular nurse, shouldn't the hospital do something to alleviate that distress, such as assigning another nurse to the case? Is it considered good medical practice to knowingly upset your patient?

There wouldn't be a need for a general policy, but, on a case-by-case basis for the benefit of patient care, some staff may need to be reassigned (or cover up tattoos) for that particular patient once the hospital is made aware of a problem.

Of course, in some situations that might not be possible. The patient may be in such a mental state that any nurse (or doctor) would not meet with approval. This would be part of the case-by-case analysis. But if a simple ad hoc step could be taken, why wouldn't a medical provider consider the best interest of the patient? The way I read the article, if the hospital had taken some action to cover up the tat for this one patient, she might not be complaining now. I base this on the following bit from the article:

quote:
It depicted a skull, was prominently displayed on the arm of a nurse treating her and looked “terrifying,” says Molloy.

Two weeks of nightmares ensued, but hospital administrators in British Columbia refused to take action when she complained...

Two weeks. It terrified her from day one and for two weeks the hospital decided that upsetting a recovering surgical patient was of less concern than asking the nurse to cover up when he was in her room?

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"We must regain the conviction that we need one another, that we have a shared responsibility for others and the world, and that being good and decent are worth it."--Pope Francis, Laudato Si'

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Nicolemr
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No. Read the story again. She saw the tattoo once, when she was in emergency, and had nightmares about it for two weeks thereafter.

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Chill
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I watched a tattoo 'documentary' program on British TV. A former solider turned civilian paramedic had his grim reaper covered up with a dragon! He had had the reaper done during his time as a solider along with the other lads in the unit! That was back when his job involved shuffling people in the opposite direction on our mortal coil. He said he didn't feel it was the best image to have on his arm while performing c.p.r!

[Killing me]

I don't know what bearing it has on the wider questions. [Big Grin]

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Hedgehog

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quote:
Originally posted by Nicolemr:
No. Read the story again. She saw the tattoo once, when she was in emergency, and had nightmares about it for two weeks thereafter.

Thank you. Fair point.

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"We must regain the conviction that we need one another, that we have a shared responsibility for others and the world, and that being good and decent are worth it."--Pope Francis, Laudato Si'

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Soror Magna
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The last time my bestie had surgery, she called me from her hospital room to tell me she had been kidnapped by ISIS and needed to be rescued. Fortunately, she doesn't remember a thing.

Distress is part of life. Hospitals are scary places, with or without tattooed staff. Deal, honey.

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"You come with me to room 1013 over at the hospital, I'll show you America. Terminal, crazy and mean." -- Tony Kushner, "Angels in America"

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lilBuddha
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quote:
Originally posted by Soror Magna:
The last time my bestie had surgery, she called me from her hospital room to tell me she had been kidnapped by ISIS and needed to be rescued. Fortunately, she doesn't remember a thing.

Distress is part of life. Hospitals are scary places, with or without tattooed staff. Deal, honey.

I've been in hospital many times for various purposes, including in A&E on the verge of dying.
There are many more things to freak one out than ink on skin. Especially once drugs kick in.
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And why should the sensibilities of older people outweigh those of younger? It is not as if they were beamed from the time of their youth to the present, the have lived through to the times where variation in one's outwards presentation is more acceptable. That they have not moved with the times is not justification in itself to warrant policy to cater to them.
And hospital staff have lives outside of work, how they adorn themselves is part of this.
Consideration should be balanced. The woman in question is doing no such thing.

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mdijon
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quote:
Originally posted by lilBuddha:
And why should the sensibilities of older people outweigh those of younger?

Because we are talking about an old vulnerable sick person and a young carer. If it was a young vulnerable sick person the sensibilities would be considered differently.

People who work as nurses or doctors or other hospital staff shouldn't really be thinking "deal, honey" as the basis for their approach. Particularly when someone is being given a psychotropic substance like ketamine.

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mdijon nojidm uoɿıqɯ ɯqıɿou
ɯqıɿou uoɿıqɯ nojidm mdijon

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Stercus Tauri
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quote:
Originally posted by Soror Magna:
The last time my bestie had surgery, she called me from her hospital room to tell me she had been kidnapped by ISIS and needed to be rescued. Fortunately, she doesn't remember a thing.

Distress is part of life. Hospitals are scary places, with or without tattooed staff. Deal, honey.

I don't think you can have experienced the kind of hallucinations that are being discussed here. The effects can last for years.

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Thay haif said. Quhat say thay, Lat thame say (George Keith, 5th Earl Marischal)

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