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Based on observations, policy review, patient interviews, and staff interviews, the hospital staff failed to ensure the patient's right to personal privacy for 2 of 2 observations of personal hygiene activities for 1 of 10 sampled patients (Patient #3).

Findings included:

Review on 03/28/2019 of the policy "Patient Rights and Responsibilities", revised 06/2017, revealed "... this policy establishes guidelines to provide an environment that both respects and protects the rights of patients and patient's families; and to conduct all activities related to care with primary concern for the values and dignity of patients. ... The rights....shall be protected and exercised for each patient...."

Medial record review on 03/26/2019 for Patient #3 revealed a "History and Physical " admission note, dated 11/15/2018 at 0000 stating that the patient was a 53 year old female transferred to facility on 11/15/2018 with admitting diagnosis's including Morbid Obesity (weight of 100 lbs. or greater of ideal body weight), Cellulitis (bacterial skin infection) of right anterior lower leg, Lymphedema (condition where excess fluids collects in tissues causing swelling), and right leg wound. Review revealed that Patient #3 was "discharged to (Facility) ... for further management of wound cellulitis and other comorbidities (presence of long-term chronic conditions) ". Review of a nursing admission note, dated 11/15/2018 at 1438, revealed "... Weight 697.3 lbs., bed scale ...Body mass index = 119 (obese) ...."

Observation on 03/26/2019 at 1425 revealed a "Code Turn" [Code that is activated to indicate the need for assistance with turning], eight (8) staff members presented to Patient #3's room to assist with the provision of personal hygiene care. Observation revealed the team was comprised of staff from the Radiology and Emergency Departments, in addition to staff from the Medical Surgical units. Observation revealed the patient did not know the names of all staff members present and requested that they share their names. Observation revealed the privacy curtain was not pulled during provision of peri care and the patient was not asked if visitors in the room could be present during her care and wound treatments. Observation revealed Certified Nursing Assistant (CNA #1) exited the patient's room while [Paitent #3] was turned on her left side, with no covering, exposing her to the hallway where visitors and other patients were ambulating. Observation revealed a window in the patients room (on the 2nd floor of the hospital), directly beside the patient's bed, which was visible from the outside. Observation revealed the privacy curtain was not pulled to cover the window, potentially leaving the patient exposed to individuals who may be in that area at any given time.

Interview on 03/26/2019 at 1430 with a family member present in the room during patient care revealed, "They never pull the privacy curtain. Observation during the interview revealed the family member was tearful and stated, "It makes me so angry that they [staff] do the right things while the State is here but don't when you're [State] not."

Interview on 03/26/2019 at 1500 with the CNA #1 revealed, "We should've asked her [patient] if it was ok for you to be the room during her care."

Interview on 03/26/2019 at 1510 with RN #1, revealed the same staff do not consistently respond to the "Code Turn" and that it was possible that the patient did not know everyone on the team. Interview revealed, "We should let her [patient] know who is present and assisting with care, and ask permission for visitors to be in the room during care." Interview revealed hospital staff failed to treat the patient with dignity and respect.

Observation on 03/27/2019 at 1020 revealed RN #2 opened Patient #3's door without knocking and informed the patient that she planned to call a Code Turn, "but I have two other patients I'm dealing with right now. We [Code Turn team] will return in about 30 minutes and do your morning care." At 1040, observation revealed nine (9) staff members presented to the patient's room, did not introduce themselves to the patient prior to initiating personal hygiene care, pull the privacy curtain, or ask her if visitors could be present during provision of care.

Interview on 03/27/2019 at 1030 with the Nurse Manager (NM) revealed if the patient was not familiar with staff present during the provision of care, they should introduce themselves. Interview revealed the patient had been in the hospital since November and was familiar with most of the staff and that there may be a "practice drift" because of her length-of-stay. During the interview, the NM confirmed that the privacy curtain should be pulled during the provision of personal hygiene care and that it was not pulled.

Interview on 03/27/2019 at 1130 with Patient #3 revealed, "It is humiliating enough to require assistance with personal care but being treated as though I am less than anyone else because of my weight is hurtful. I feel like I'm being Body Shamed [bully because of weight] every time they [staff] come in here and don't pull the curtain and not being respected enough to be informed of who is helping turn me, especially during personal care."

Observation on 03/28/2019 at 1250 revealed a staff member knocked on Patient #3's door and when the door opened, eight (8) staff members began entering the patient's room. The patient was eating lunch and asked, "What's going on?" Observation revealed no one replied to the patient's question and staff continued entering the room. Observation revealed the patient shared that she was still eating lunch and asked again what staff's intent was. CNA #2 stated, "We're turning" with no other response from staff. Observation revealed the privacy curtain was not pulled and staff did not introduce themselves until after being prompted by the NM. Observation revealed the patient was compliant with being turned and repositioned, spoke kindly to staff, and thanked them as they left the room. Once staff left the room, the patient became tearful and stated, "See what I told you. I feel like they resent having to care for me but I cannot turn myself. I wish I could but I can't. This is why I think I'm being body shamed.

Interview on 03/28/2019 at 1310 with the NM revealed pulling staff together for a Code Turn is challenging but is done to meet patient care needs. Interview revealed, "We have to turn her when we have available staff." The NM did not respond when asked about the way staff initially approached the patient as they entered her room.

NC00149076