Male pericare - page 3

I have a lot of concerns when it comes to performing pericare on a male. So far I have only done it on a maniquin (sp?). That didn't bother me because there was no real person attatched to the... Read More

  1. by   MrsBradyMom
    I think making sure the pt. urinates beforehand would be a big help. Like another poster pointed out, men are more apt to get an erection in the AM with a full bladder.
    My husband calls it morning wood
  2. by   talaxandra
    Quote from MedEthicsResearcher
    Why does no one suggest that, if available, perhaps the patient should be given the choice of a male nurse? Do you ever ask?
    I appreciate that you qualified this with "if available" - male staff comprise less than 10% of nurses and though I have no statistics (and don't work in the US or with CNAs) I'd be surprised if this was higher in the CNA population. The logistics of offering all patients or residents (depending of the facility) their choice of male or female, even where available, would in most situations be untenable - while patient-centred care is unquestionably important it would be naieve to suggest that this is always (or even often) going to trump the other needs of all the other patients. In addition, this would mean that male nurses and CNAs would end up performing a disproportionate number of peri washes. Of course, all this presupposes that male patients have a preference for male staff, which has not been my experience.

    Quote from MedEthicsResearcher
    And what does it mean to "put on my CNA game"? That's interesting. Sounds like it might be a kind of distancing, objectifying the patient, going into routine mode, focusing on the task not the person. Is that it? Interesting that the new nurse felt better about the whole situation because the patient was more embarrassed than she was. I suppose from her point of view that made it less threatening. But how about from his point of view?
    For me 'game face' is about shielding the patient from my human reactions by interposing a professional demeanour. If a patient has blood pouring out of them, or a fatally fast heart rate, or if that 'nasal biopsy' completely removed the patient's nose, I don't panic or scream or run from the room shouting for help, like a normal person would. I'm a nurse. I stay calm, I get help, and I minimise the issue ("your heart beat's a bit faster than I'd like, so I'm going to get a doctor up to have a look at you. To get him up here now I'm going to press this button - a whole stream of people will come pouring in but it's okay"). Perhaps for the OP 'CNA face' is similar - rare is the patient who feels more at ease by learning that their health care provider is encountering something for the first time.

    Quote from MedEthicsResearcher
    And when you suggest that, for example, a witness be brought in, or an RN to assist, does that mean the male will have two females working with him? How will that make him feel? Or would you try to bring in a male nurse?
    Maybe the same way women having gynae exams by a male practitioner and a female witness/chaperone do.

    Quote from MedEthicsResearcher
    I'm trying to look at this from the patient's point of view. You're in a position of power. The patient is naked and vulnerable, not feeling well, perhaps really sick. Most won't ask for the same gender, even if that would make them more comfortable. Just because they comply does not mean they agree. Some men are more comfortable with this kind of situation than others, as are women. Everyone is different.
    The problem with coming to discussion threads like this as an outsider is that it's possible to mistake lack of acknowledgement of these facts as lack of awareness. For most health care providers I work with, and of course there are always exceptions, the power differential, vulnerability and unwellness of the patient are a given.

    I agree that compliance is often read as agreement, and that the question of compliance is in itself fascinating and underresearched, but that's another discussion entirely.

    Quote from MedEthicsResearcher
    Even with all that in mind, never "get used to" these uncomfortable situations to the point that you don't empathize with the patient. Be the one to open up communication in cases like this and be the one to offer the patient a choice of same gender care if it is in any way possible. If you do that, you be surprised. Your honest and compassion may help create a trust relationship and the patient will feel more comfortable working with you instead of a male nurse.
    I'm sure you mean this in a supportive and helpful way. Some things to consider: 1. there's a presupposition that many or most male patients prefer male staff to perform hygeine care, which has not been my experience (based on male patients who've asked for female staff over male staff and those who've expressed no preference either way). While there are unquestionably men who prefer male staff for this, and women who prefer women, men who prefer women, and possibly - though I've not come across any yet - women who prefer men, I'd be interested in research indicating that this is an issue for a sizable number of the patient population.

    2. My honest compassionate care has so far managed to help create beneficial professional relationships with patients, families, medical staff, and colleagues despite my failing to offer my patients a choice of male or female staff to perform intimate care (where available).

    3. I feel uncomfortable with your implication that my gender is something I have to oversome in order to have patients be comfortable with me. It may very well be that other members didn't feel this and I'm being unduly sensitive, but I thought it worth pointing out nonetheless.

    I hope I'm not sounding overly critical of your post, and appreciate your perspective comes from the health ethics field rather than from health care provision. I have great respect for health ethics and health ethics research; it is the front line of current philosphical inquiry, and a previously neglected aspect of health care. Wjhat researchers and philosophers explore and examine has tremendous power, perhaps not with current clinicians, but certainly with the academic framework that influence future practice..
  3. by   MedEthicsResearcher
    Quote from talaxandra
    I appreciate that you qualified this with "if available" - male staff comprise less than 10% of nurses and though I have no statistics (and don't work in the US or with CNAs) I'd be surprised if this was higher in the CNA population. The logistics of offering all patients or residents (depending of the facility) their choice of male or female, even where available, would in most situations be untenable - while patient-centred care is unquestionably important it would be naieve to suggest that this is always (or even often) going to trump the other needs of all the other patients. In addition, this would mean that male nurses and CNAs would end up performing a disproportionate number of peri washes. Of course, all this presupposes that male patients have a preference for male staff, which has not been my experience.

    First of all, thank you for your thoughtful response. And no, you're not sounding overly critical. I've started another thread. Do a search under Male Medical Modesty. I've cited some research on this subject. I'm not doubting your experience, but significant research shows that more males than you think would much rather have a male doing intimate care on them. Check out the thread.


    For me 'game face' is about shielding the patient from my human reactions by interposing a professional demeanour. If a patient has blood pouring out of them, or a fatally fast heart rate, or if that 'nasal biopsy' completely removed the patient's nose, I don't panic or scream or run from the room shouting for help, like a normal person would. I'm a nurse. I stay calm, I get help, and I minimise the issue ("your heart beat's a bit faster than I'd like, so I'm going to get a doctor up to have a look at you. To get him up here now I'm going to press this button - a whole stream of people will come pouring in but it's okay"). Perhaps for the OP 'CNA face' is similar - rare is the patient who feels more at ease by learning that their health care provider is encountering something for the first time.

    I mention an article in the other thread about how medical professionals deal with these kinds of situations -- the kinds of strategies they use. Thank you for your explanation of the 'game face' mentioned. The article I mention is somewhat difficult to obtain unless you have access to a major university's research archives.

    Maybe the same way women having gynae exams by a male practitioner and a female witness/chaperone do.

    I would respectfully suggest that, although this may happen, women have many more options when it comes to the gender of who is in the room with a doctor with them. As you mentioned above, due to staffing and the lack of men in the field, men just don't often have the option.



    The problem with coming to discussion threads like this as an outsider is that it's possible to mistake lack of acknowledgement of these facts as lack of awareness. For most health care providers I work with, and of course there are always exceptions, the power differential, vulnerability and unwellness of the patient are a given.

    I'm an outsider and I'm not an outsider. I see your perspective, but there's another way of seeing this. As a patient, I'm sould be just as much a part of the inside as the doctor or nurse. Once we're in the room together, I'm not just a body or an object, I'm a member of the team. Now, please don't think I'm saying professionals don't realize this, intellectually at least. Some of the things I'm talking about here are patient perceptions of what's going on around them during an exam or whatever. Sometimes they are made to feel a part of the procedure, sometimes they are not. Regardless of how they are made to feel, they are not outsiders, and their opinions and perceptions are not outside the box.

    I agree that compliance is often read as agreement, and that the question of compliance is in itself fascinating and underresearched, but that's another discussion entirely.

    Sorry, but I disagree, respectfully. It isn't another discussion. It's an integral part of this discussion. It involves good communication and observation skills on the part of the medical professional. Sometimes effeciency, speed, routine becomes more important that patient feelings and, even though the caregiver knows the patient probably doesn't really comply, the procedure goes on anyway. Although problems in the system or policy may necessistate this, that doesn't make it right, ethically.


    I'm sure you mean this in a supportive and helpful way. Some things to consider: 1. there's a presupposition that many or most male patients prefer male staff to perform hygeine care, which has not been my experience (based on male patients who've asked for female staff over male staff and those who've expressed no preference either way). While there are unquestionably men who prefer male staff for this, and women who prefer women, men who prefer women, and possibly - though I've not come across any yet - women who prefer men, I'd be interested in research indicating that this is an issue for a sizable number of the patient population.

    Again, I'm not challenging your personal experiences, but the research suggests otherwise. We're all different. Some men may prefer female nurses; others, male nurses. Some men are homophobic and want female nurses. Same with women -- some prefer male doctors, others females. Go to my other thread and check out some of the research, and you'll see that there is much stereotyping as to what people think males prefer. Many males don't express their feelings and emotions well, and are so embarrassed during these kind of procedures with female nurses that they are even too ashamed to comment. They pretend they're macho and just take it. Later they become angry at themselves for letting it happen and not speaking up.

    2. My honest compassionate care has so far managed to help create beneficial professional relationships with patients, families, medical staff, and colleagues despite my failing to offer my patients a choice of male or female staff to perform intimate care (where available).

    3. I feel uncomfortable with your implication that my gender is something I have to oversome in order to have patients be comfortable with me. It may very well be that other members didn't feel this and I'm being unduly sensitive, but I thought it worth pointing out nonetheless.

    Again, I respectfully disagree. Are you implying that gender isn't a powerful force in these situations -- at least for some people? It is. I'm not sure I'd use the word "overcome." I'd say that your gender is something you have to consider, perhaps more closely, in dealing with the opposite gender.

    I hope I'm not sounding overly critical of your post, and appreciate your perspective comes from the health ethics field rather than from health care provision. I have great respect for health ethics and health ethics research; it is the front line of current philosphical inquiry, and a previously neglected aspect of health care. Wjhat researchers and philosophers explore and examine has tremendous power, perhaps not with current clinicians, but certainly with the academic framework that influence future practice..
    Again, you're not being over critical. You're being honest, and I appreciate that. In my response here I'm trying not to repeat what I've written on the other thread I started called Male Medical Modesty. Check that out and make some more comments on what I've written there. I find your response to be very thoughtful and would like to hear more of your ideas and experiences
  4. by   talaxandra
    Quote from medethicsresearcher
    again, you're not being over critical. you're being honest, and i appreciate that. in my response here i'm trying not to repeat what i've written on the other thread i started called male medical modesty. check that out and make some more comments on what i've written there. i find your response to be very thoughtful and would like to hear more of your ideas and experiences
    i agree that, while there's some overlap, these two threads address different aspects on a related topic. this thread is about performing intimate care in an inpatient setting, and therefore has a different focus from the male medical modesty thread, which looks at exams (like testicular sonography) rather than hygiene care, and a lot of the issue appears to come, at least in part, from inadequate medical preparation - patients not knowing what was going to happen etc, and i'm happy to discuss those aspects there. there are a couple of things i'd like to address from this post, though.

    from a health ethics theory point of view, compliance is a complex area that is rarely addressed except in its absence (the non-compliant patient), and it was from this perspective that i stated it was another discussion - this thread is about performing intimate care in an inpatient setting. the aspects you mentioned - efficiency, speed and routine - are consent issues rather than compliance issues.

    when i said you were an outsider i wasn't talking about your perspective as a man or as a patient - i was talking about your view of the posts created on this thread by health care providers. we know about dignity and power imbalance - the point of the thread was about reassuring an inexperienced practitioner that a clinical scenario she was apprehensive about would be less overwhelming than she feared.

    and i apologise to the op for hijacking the thread.
  5. by   MedEthicsResearcher
    i agree that, while there's some overlap, these two threads address different aspects on a related topic. this thread is about performing intimate care in an inpatient setting, and therefore has a different focus from the male medical modesty thread, which looks at exams (like testicular sonography) rather than hygiene care, and a lot of the issue appears to come, at least in part, from inadequate medical preparation - patients not knowing what was going to happen etc, and i'm happy to discuss those aspects there. there are a couple of things i'd like to address from this post, though.

    from a health ethics theory point of view, compliance is a complex area that is rarely addressed except in its absence (the non-compliant patient), and it was from this perspective that i stated it was another discussion - this thread is about performing intimate care in an inpatient setting. the aspects you mentioned - efficiency, speed and routine - are consent issues rather than compliance issues.

    when i said you were an outsider i wasn't talking about your perspective as a man or as a patient - i was talking about your view of the posts created on this thread by health care providers. we know about dignity and power imbalance - the point of the thread was about reassuring an inexperienced practitioner that a clinical scenario she was apprehensive about would be less overwhelming than she feared.

    and i apologise to the op for hijacking the thread.

    i see your point of veiw on some of this. but i also see a danger in separating whole persons from the procedure. wouldn't the apprehension of the new practitioner be connected to how the patient feels about the modesty issue? i don't know the context, but both patient and practitioner emotions get tied up in this. i can see if you're specifically talking about the task and technique. that would make sense. but i don't see how a thread on performing intimate care in an inpatient setting is not directly conntected to the broad topic of patient, specifically male, modesty -- considering the majority of staff likely to be doing the intimate care would be female. but thanks for your clarification, especially on the compliance issue.
  6. by   SunnyRN2010
    Quote from amanda1229
    I agree, I think male pericare is so much easier. And I'm a female! It's only because, really, who uses eight washcloths to wipe after they use the bathroom? So this whole lengthy procedure involving eight corners, etc. is INSANE to me. Makes sense, but so annoying!

    The worst thing I've ever seen was, when performing male pericare, is a HUGE wad of yeast-like buildup when pulling back the male's foreskin. I had seen it before in female pericares, but I was just .. oh, it was just weird, and it was so much, I was shocked.
    Yeah, that gross and sad.. I've seen that before when other ppl don't clean under the foreskin and a patient isn't "with it enough" or is too embarassed to ask to be cleaned properly.. This is why good CNAs are so important!:heartbeat I've even had one guy that just about had his foreskin glued on with crusties..
  7. by   Absolutely13
    This is an old thread, but an important one both genders need to talk about.

    Erections are involuntary, much like women can't "decide" to have erect nipples. When the conditions are right, it's going to happen. I would be mortified if I were a patient and got an erection during peri care. "Oh my God, what does she think I'm thinking?"

    Men get erections when men are providing peri care too. It's OK, just go about business. It's normal function. It's also a good sign of vascular health if you want to get clinical about it.

    The male body does that and that's all there is to it. As far as the dirty talk, that is a whole different animal - erection or not.

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