"Old" Neuro assessmet of Nipple Twisting of Pinching - page 3

by Zachhorse 18,923 Views | 32 Comments

Can anyone give a little history regarding nursing's involvement with nipple twisting or pinching in order to elicit a neurologic response? Approx. how long was it a part of our nursing assessment? Appreciate any information on... Read More


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    Quote from ThrowEdNurse
    No offense taken, nursel56. I only found this question when I stumbled across it because I had a burn question. Maybe you'll get more varied and open minded opinions and experiences in the ER forum. I've posted alot there and never been told by someone who disagrees with me that they hope a pt attacks me because I am cruel and assault my pts which is wrong.....whatever that rational means. To answer your questions, I have seen it used often by people with varying degrees and have used it myself!
    Oh, God, no. They'll have me for lunch! Just kiddin'. I've seen some of your posts, so I know you aren't some deviant lurking about the hallways. Happy Holidays! (I do know holidays are pretty hairy for the Emergency Dept what you guys seeing the dark side of all the party animals and wacky family stuff)
    ThrowEdNurse likes this.
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    Quote from ThrowEdNurse
    No offense taken, nursel56. I only found this question when I stumbled across it because I had a burn question. Maybe you'll get more varied and open minded opinions and experiences in the ER forum. I've posted alot there and never been told by someone who disagrees with me that they hope a pt attacks me because I am cruel and assault my pts which is wrong.....whatever that rational means. To answer your questions, I have seen it used often by people with varying degrees and have used it myself!
    in mass. this would be battery, in ct assault......maybe you should stop and think about your use, of this absollutely unnecessary and abhorent "skill". always use the least invasive/dangerous/painful way to get the info you seek, and you have already admitted that that would be the "smelling salts".....as you sow so shall ye reap.
    LovebugLPN likes this.
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    If someone is unresponsive the appropriate action is to check for response to voice, then pain. When the patient feigns unresponsiveness to voice they can expect the nurse to check responsiveness to pain. Fully assessing the patient makes him a good nurse, not cruel or sadistic. Now if he did it twice for good measure, yeah, that would just be revenge.

    I agree that nipple twisting just isn't appropriate, there are ways to assess responsiveness that don't involve disrobing the patient, and can't be considered sexual acts.
    Altra likes this.
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    Quote from canoehead
    If someone is unresponsive the appropriate action is to check for response to voice, then pain. When the patient feigns unresponsiveness to voice they can expect the nurse to check responsiveness to pain. Fully assessing the patient makes him a good nurse, not cruel or sadistic. Now if he did it twice for good measure, yeah, that would just be revenge.

    I agree that nipple twisting just isn't appropriate, there are ways to assess responsiveness that don't involve disrobing the patient, and can't be considered sexual acts.
    BUT this IS what he insists he does....and usually in the case of a behavior issue, not even true neuro issues!!! this is assault....i used pain to assess level of consciousness today, I assure you i felt no need to be twisting anyones nipples!!!! and would have run the risk of arrest had i done so!
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    It's so ironic we are having this conversation as I watched one of the ER docs do it today as I started the pt's IV. I of course didn't tell him his actions were sadistic or punitive or sexual....
    Anyway, I never said I "insisted" on doing it nor did I say it is "usually done for behavior issues."
    I work in a major hospital in a large city. The day after a catastrophic natural disaster, when we were innondated with more pts than we could safely manage, a 19 yoa female presented with weakness. She refused to open her eyes, to say her name, to even lift her head off her chest. VS WNL and no PMH and genuinely sick people waiting to be triaged and not one open bed. We were able to free the paramedics that brought her in to go take care of other pts who needed them in the community, save our last ER bed for somone who is actually sick, and to download her to the waiting room with ammonia in a NRB, a sternal rub, and a nipple twist. In that order. Had she responded to earlier interventions, it wouldn't have gotten to the twist. It has cured many nonverbal pts in my ER. In a perfect world, I would have coddled her, talked to her softly about her needs, given her cold towels, used therapuetic communication...however I work in my ER and that just realistically couldn't have been a possibility at that time.
    Can you look at a pt and just tell when they are going to go bad? You think, just by glancing at their face," damn this dude is sick." You know they kind of have that look and behavior that sets off the flags? Same thing except this one is for malingering and dramatics.
    Sorry it may different than your experiences. I can admit that pts aren't the same everywhere in every hospital. Shame you can't agree. I believe that there is a chance you may have no clue about what you would do similar circumstances to mine. What is so disturbing about your comments isn't that you vehemently disagree with my ideas and techniques (that's normal and commendable) or that you find them somehow personally offfensive, it is your rudeness, your disrespect, your condesencion, and your judgemental and hateful attitude that is genuinely frightening....and sad. Especially when you accuse me of battering or assaulting my pts, the same pts who have scratched me, spit in my face, shoved me, and struck me all unprovoked. Of course based on your previous statements, that probably makes you happy to know that on a daily basis there is a very real possibility of my being attacked by a cracked out pt who is mad I ignored their pseudo sz. We are all nurses and we should all be on the same team and have one another's back.
    I would never go to ICU, or wherever you work for that matter and berate the way the nurses work, their techniques, the things they use to management specific pts in that community with their unique needs. Because that's not my area of expertise. Walk a mile in their shoes and all that.
    The brief nipple twist is not the first go to action. There is a series of questions and actions that may ultimately lead to brief twist. For example, the twist I witnessed today was preceded by a sternal rub. Clearly your work atmosphere, pt populations, medical issues, priorities are different than those I experience daily. I just take offense to your open hostility and the fact that you repeatedly state you hope I am assaulted. Guess I am just sensitive like that.
    Also I don't understand the line between it being appropriate to say....rub the sole of the foot with tongue depressors to assess pain response vs the nipple twist. It's painful stimuli either way, Why is it okay to illicit pain in some methods but not others? What's the standard? Are we so prudish in 2009 that it's about the nipple? I mean, is this really just because it's a nipple and some people think that a small body party that all women and men have is....sexual? How do you clean pts and place foleys without it being sexual if that's the case? I admit I just don't get it.
    Hopefully you can find a way to get past the fact that there is a whole community of us out there that randomly have used this technique and forgive us all for our ignorance. Why can't we just disagree about this matter and not have you wish physical harm on me? If you feel so strongly, what not attempt to educate me and anyone else who is reading a better way, or explain calmly and rationally why you think it's bad. Your responses are just out the box.
    What is it really that you are so mad about???
    It's the Holidays! Merry Christmas! It's all going to be ooookay!!!!
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    i think i seen the nipple twisting thing on an episode of Mercy...lol
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    ThrowEdNurse; I work in a major hospital in a large city. The day after a catastrophic natural disaster, when we were innondated with more pts than we could safely manage. . .
    I've noticed that the Emergency Dept nurses, as a rule, especially those that work in large urban hospitals get waaaayyyy more than their fair share of judgements and pie-in-the-sky advice from other nurses!! :angryfire I salute you guys. Sure, we can disagree, but you are in the trenches, we're not.
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    I would like to weigh in on the debate: I side w/Morte....the nipple is a highly erogenous area of the body, and recognized as such by our society mores, and researched and defined as such by physiology experts. Twisting other erogenous zones on the body 'to provoke a pain response' is not considered a standard of care, so why would the nipple? Most ED nurses I have worked with do not do this anymore, if ever. It was recognized as inappropriate at least 10 years ago, if not more, and yes, it could easily be construed as assault and battery. Excuses as "we were busy", "we needed the bed for someone sicker", "we had a disaster" does not stand up as an effective defense should the point be adjudicated in court. I have not heard anyone objecting to the nailbed procedure or the trapezius muscle pinch procedure (yet). Having witnessed this procedure in the past, on pts. that had a high index of suspicion of playing possum and refusing to cooperate with a medical screening, the behavior almost always screams SHORTCUT in context. May I also add, just because an MD does it, does not mean it is appropriate nursing care.
    In my past experience, (at a large urban hospital), we would assess for fine motor muscle movement of the eyelids. This finding is present in the conscious pt., is very rapid and fine in the awake pt., and is involuntary....the pt. will tell you by his eyelids that he is conscious. Also, gently lifting a pt.'s uninjured hand and holding it 4-6 in. over his nose, then letting it drop, is a procedure that delivers a lot of information: the conscious pt. will usually divert his hand so it does not hit his nose. And thirdly, if you gently lift open the upper eyelid to assess the pupil of a conscious pt who is trying to keep his eyes closed, you will encounter muscle tension in the eyelid resistance) that is not present in the unconscious pt., and they almost always deviate their eyeballs/pupils away from your light. Try these procedures first, before you inflict pain on a pt. you suspect of malingering and having major drama issues. As sick and injured as the disaster victims are, the nonresponsive drama queen must be assumed to be suicidal until a thorough assessment proves otherwise. They deserve an appropriate triage priority asignment like everyone else. If you assume too much, you run the risk of missing the abused or raped victim, or the soldier with pstd exacerbation, so the standard of care will only help. If treatment can be delayed (therapeautic talk, etc.), they at least need a sitter.
    Last edit by trixie333 on Dec 25, '09 : Reason: correction
    morte likes this.
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    The last drama queen I had about 2 wks. ago, wouldn't talk for 30 min. Finally learned from a late arriving friend she had taken a bottle of Tylenol....that queen went to the ICU....
    morte likes this.
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    When did my pt become suicidal?
    I do use all of your suggested recommendations during the secondary, lengthy assessment, they however don't wake the pt.
    I didn't say I do it because the mds do. The original question was "have you seen this?" My response was, "yes today."
    Thanks for all the suggestions. You made some great points. I also appreciate the suggestions for new techniques. Hopefully everyone learned something. I also appreciate your tone. Thanks for not recommending a pt assault me as well. But I probably will use this as needed. I don't do this every day, heck not even every week! But that's okay because those of you who disagree with it don't have to do it, it's just that simple.


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