By Shawn Kennedy, AJN editor in chief
Many of you may be familiar with the recent “nursing-in-the-news” topic involving nursing students and a placenta. (For those who’ve been out of touch, here it is in a nutshell: three students were involved in photographing themselves with a placenta from a recently delivered mother and posting it on, where else, Facebook. The students were expelled. One student sued; the judge ordered all the students reinstated. See this article by the Kansas City Star that sums it up.)
The incident has provoked debate on various Web sites, including our own Facebook page, where the discussion mainly concerns whether the students were treated fairly or too harshly:
“It’s a placenta. I agree that it can seem a bit juvenile to photograph yourself with it, but an offense worthy of expulsion?”
“Juvenile? Perhaps. Punishable by expulsion? Absolutely not, imo. What exactly was wrong with taking a picture of a placenta? It’s not like you can identify who the placenta came from.”
“I think she should be punished but not expelled. in all reality a placenta is medical waste after delivery but it showed no respect for her patient, which needs to be addressed.”
And a really interesting question:
“Would she have been handed the same punishment had it been a picture of a full bed pan?”
Other sites also argue the “no harm, no foul” rationale—since there was no way to link the organ to a patient and so no breach of privacy, what was the harm? Comments on one of several posts about this issue at Those Emergency Blues came out in favor of the students. Nurse and blogger Phil Baumann’s post, “The Placenta Incident and The Shawshank Redemption,” did as well.
The school did seem to react harshly, especially when there seems to be some question as to whether the clinical faculty member might have been aware of the students’ activities.
However, there was a decidedly different tone on a blog called The Stir at CafeMom, a Web site focusing on pregnancy and motherhood, that should give us pause. Author Jean Sager writes the following in a post called “New Pregnancy Fear: Who’s Got Your Placenta Now?”:
“I had an expectation that it
[my placenta] would go from my womb straight into medical waste, with no stops for monkey business along the way. To think of my placenta being played with, photographed, and used as evidence of the oddity of one’s educational experience is jarring at best, humiliating at worst.”The comments on that Web site were markedly different from those on nursing sites. While they were not calling for expulsion of the students, and there were a few who didn’t see the students’ actions as a “big deal,” it was clear that most of the commenters were uncomfortable with the behavior of health care “professionals”:
“And good for the school for kicking these ‘little girls’ out. They do not have proper respect for others if they can’t even understand why that was wrong.”
“I can’t even pretend to be shocked at this immature excuse for behavior from yet more people who are trying to be in the medical community which is already plagued with problems. None of these girls needs to be let back in college. They aren’t even close to grown up enough to be working in any part of the medical field.”
“This specific instance is just one more situation that reinforces my feelings on health care professionals. They aren’t very professional and their lacking [sic] with the health care because they are to [sic] busy with shenanigans.”
I wonder if our patients will wonder what other playful and “fun” things might be happening in the back room or when no one is watching. Will patients trust that when they are anesthetized they will be treated respectfully? Will hospitals and other clinical agencies be less inclined to host students for fear of litigation over privacy? I imagine that, at the very least, all nursing schools are now quickly developing social media policies. The American Medical Association has one and the American Nurses Association is, I’m told, developing one.
One entry on AJN’s Facebook wall made an interesting point: “The real issue here is how new media is changing everything. Personally, I would never post anything about my patients or their care. It’s just plain unprofessional. Sounds like this girl was made into an example, which might be unfair—but not totally unnecessary.”
Good comments. You might like to see the NY Times article last week on how the author of the book set up a foundation to benefit the Lack family.
http://www.nytimes.com/2011/02/05/books/05lacks.html
Agree with Gail that everyone should read The Immortal Life of Henrietta Lacks. Fact is we have no rights over our removed parts once they enter the medical waste stream. That doesn’t make the students’ behavior acceptable (kinda reminds me of some famously creepy Iraq photos…) But this was a potential teaching moment which the school totally blew by punishing. The real teaching moment didn’t occur until the students decided to sue.
Regarding the treatment of tissue specimens and its potential sequelae, I strongly recommend reading The Immortal Life of Henrietta Lacks. It illustrates, through the experience of the Lacks family, many of the current and future ethical questions we face as advances in tissue and genetic research proceed. Even more relevant to this situation, the book also shows how actions that might not be considered important at the time can have repercussions for patients, families, and caregivers. Henrietta Lacks’s cervical biopsy tissue became HeLa cells, which have been studied in many ways and have had incalculable value in medical research. This tissue was saved, however, in an era before informed consent was the norm and before DNA testing was available. So while a Facebook post of a placenta by a nursing student seems merely crass and a sign of poor judgement today, what does it bode for the future, and what is the nurse’s role here in tissue and patients’ rights? Where do we stand when commercialism creeps in? If the nursing students in this case had been more schooled in ethical decision making, would this photo have been taken at all?
I am a nurse and believe the clinical hours that nurses are required to complete are critical in the learning process. But as a recent breast cancer patient who had a double mastectomy in October 2009, I understand the patient’s point of view in this matter. The decision to have my breasts removed was probably the hardest decision that I have ever faced as a 43 year-old woman. As I was signing my consents on the day of my surgery, I asked the surgical staff to not allow observers in the operating room, i.e. students, sales rep, etc. for this was a very personal and difficult time for me. They stated they would honor my wishes. Months later, I requested my medical records for my files and as I was reading them, I noticed that a visiting surgeon from another country was an observer during my surgery. Even though she was a medical professional, I felt very violated since I had requested no observers in the room and was assured by the OR circulator that it would not happen. At my 6m recheck, I discussed this with my plastic surgeon, who by the way is a magician, and he apologized profusely and stated he was unaware of my wishes. So students, nurses, please remember that patients have rights. If anyone should have been consulted about the photo, it should have been the patient, she could have happily approved the photographs. Thank you!
Shawn — you may well be right, and I was also struck by the disconnect between public perception of the event and how nurses were commenting on my blog. I personally think the connection made by the media and others between the photo and “trust” is a bit tenuous and illogical. But we aren’t necessarily talking logic here, are we?
As to your other point, I think you’re right, sometimes the curtain is drawn back, and the public does see what goes on behind the scenes, and it ain’t pretty. The ED is notorious for this kind of thing. We know it’s all about context — and blowing off steam. Unfortunately, the public doesn’t see it quite the same way.
Re Torontoemerg comment, “…school’s nursing program itself did more damage to the profession by managing(fairly or not)to have itself portrayed in the media as arbitrary, vindictive and tyrannical — in short, confirming the old Nurse Ratched stereotype in the public’s mind.”
Hmmm. Not sure I agree that that applies here, based on consumer comments. I think that above all, patients want to feel safe when they are in the hospital, which by all accounts they read re medical errors, they know is a dangerous place to be. I think patients want to think that there is someone on guard, protecting them when they can’t speak for themselves, tenaciously watching out for them. A photo with an organ heading to medical waste IS different, but raises the question of what other scenarios ae going on.
I’ve witnessed less than respectful scenarios by various professionals when I was in clinical practice, and in discussions sparked by this incident, others admit they have, too. Has any clinician out there not?
These students are young. They do not have the experience of life to help them understand how this picture violates our patient’s trust in all of us as healthcare professionals. Perhaps a more appropropriate punishment could have been handed down, like apologizing to a group of mom’s, writing a public apology, interviewing new mother’s to ask them about thier expectations of the delivery process.
I have learned to appreciate life and not to dash hopes the longer I am a nurse. To respect people and their moments of need within the healthcare system. Hopefully they too will learn this respect.
Thanks Shawn. The point in at the end, about the erosion in public trust in the nursing profession is well-taken. But I wonder if the school’s nursing program itself did more damage to the profession by managing(fairly or not)to have itself portrayed in the media as arbitrary, vindictive and tyrannical — in short, confirming the old Nurse Ratched stereotype in the public’s mind.
As a fasculty member who has taught maternity, and been in a variety of situations regarding the public image of nursing, I was astounded to hear of the expulsion. This nursing administrator was not using her head. I think the expulsion was an over-reaction. Ridiculous. I am glad the judge was sensible, it affirms my faith in the American legal system.
Here at my school I used this opportunity to remind our students that there were different viewpoints out there, and that we have entered a new era in which easy access to digital technology can be used in ways the user never intended.
I am a senior nursing student, getting ready to graduate in May. My school has very clear policies regarding the taking of photographs in the hospital or any clinical setting, including the lab. I took the time to look for those policies with the involved School of Nursing…they had none. I bet they will now.
Though this was never a HIPPA issue, my first thought was for the women – all the women who delivered at this hospital and how they felt that it might be there placenta displayed with a smiling nursing student. The effect on their confidence in the hospital or quality of care was a strong consideration in my mind.
I will ask this question again. In our society, where are our “children” going to learn respect if they have not learned it at home? With respect being a dying concept, it is up to the institutions who are training and teaching students for the profession to make a better attempt. Professional guidelines may seem intuitive, may seem common sense but for those who are just learning, how will they know unless it is written, unless it is taught?
I will say that doing what these young women did would not and has not ever crossed my mind. My respect for the people I care for tells me this is a wrong thing to do. However, I am a non-traditional student with many, many years of life experience that helped to develop that respect I have for the people I care for.
Has anyone discussed the use of cell phones and cameras in the hospital? we would be in trouble if we were caught at something like that at work… even just having the phone out is trouble.
stupidity will get you in a lot of trouble, and thats what these students displayed.
i personally think it was a stupid move for the student to take the pic. first of all, as adults we need to be smarter, responsible, and more mature. what she did wasnt any of those. i am currently in nursing school and before we even started class we had to get certified in many things. majority of them being about code of ethics. not to mention one of the chapters studied was about legal issues. in my class, if your phone is even heard vibrating there are consequences. we were told to not have our phones on the floor during clinicals in the hospital also so she should have known better. furthermore, if im not mistaken she asked the instructor could she take the pic. there should have been some discipline at that point but there wasnt which in turn leads to this. as a nurse and simply nursing students we need to know about any liabilities as well as being responsible. its not up to me to say whether this girl should have been expelled or not but the program clearly states all rules, laws, and legalalities beforehand. she should have known better is all im saying. when you do something like that be prepared for any serious consequence that may come your way.
NB: In the sentence in my comment “Also: it doesn’t seem to me (unless I’ve missed something), that the important issues which CafeMom raise.” should have read to add: I don’t know if the facility and school addressed the matter of how the patient felt.
Did the facility notify this patient when the incident happened?
Or might this patient have found out via the Press? Because if she found out that way, that’s a whole issue in itself.
Phil
Great points, Shawn.
This is one of the reasons I wanted to raise this on RNchat – there’s a lot of angles here which all need to be viewed through.
I know some consider placentas “medical waste” – I myself don’t see it that way, but that’s how the industry classifies it generally.
On my post, I wasn’t so much defending nor attacking the student nurse: for me the issue is what kind of healthcare system we want, and how students and nurses are treated.
I do think there may have been a missed opportunity to teach.
Also: it doesn’t seem to me (unless I’ve missed something), that the important issues which CafeMom raise.
Healthcare can inadvertently insult patients – it’s an issue professionals work hard to avoid.
But unless we discuss these matters – in a time where anybody, from anywhere, anytime can publish anything.
Social Media – for good or ill – is revealing things about our culture which for too long have been concealed.
Thanks for keeping the conversation rolling.
Phil