"Old" Neuro assessmet of Nipple Twisting of Pinching - page 2

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?... Read More

  1. Visit  morte} profile page
    1
    Quote from ThrowEdNurse
    Ummmm, I hate to even say this here, after reading the other responses, but I do this all the time! I work in the ER so maybe it's a little different.....I don't do it to assess for responsiveness to pain, I do it to arouse a drunk or a high drama pt. For instance, I may have a pt who I know can hear me, but refuses to follow commands due to high drama serum level so, I little nipple twist always gets an appropriate response. It's sort of a quick assessment on initial arrival to the ER to determine a true level of consciousness.
    and what happens when that "high drama"young female complains? and if you get a good right hook from one of the guys, i would have NO sympathy for you, what so ever!
    LovebugLPN likes this.
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  3. Visit  nursel56} profile page
    2
    Quote from morte
    and what happens when that "high drama"young female complains? and if you get a good right hook from one of the guys, i would have NO sympathy for you, what so ever!
    I've never heard of that. Nipple twisting as a form of behavior modification on a patient who is not unconscious? I thought the nipple twist was intended to determine an unconscious patient's response to what we used to call "deep pain". If you twist the nipple with the intention of causing pain, that's not a neuro check. Maybe some of the other neuro nurses can explain that. Thanks!
    maloneys and morte like this.
  4. Visit  ThrowEdNurse} profile page
    3
    They don't complain because they are either truly altered or because they are faking and the complaining would give them away. Believe me it works! Kind of like shoving an ammonia cap in their face, except I don't have to go fetch the ammonia. I am shocked that a nurse like yourself who is so sympathetic, compassionate, and caring would "have no sympathy" for a fellow nurse who catches a "right hook." Wow, show those true colors. Also, never said it was "behavior modification." I believe I called it a quick assessment. Any of you are welcome in my ER to show me a better way. I always welcome constructive criticism from a knowledgeable, experienced source.
    maloneys, strength4unityRN, and elkpark like this.
  5. Visit  morte} profile page
    0
    Quote from ThrowEdNurse
    They don't complain because they are either truly altered or because they are faking and the complaining would give them away. Believe me it works! Kind of like shoving an ammonia cap in their face, except I don't have to go fetch the ammonia. I am shocked that a nurse like yourself who is so sympathetic, compassionate, and caring would "have no sympathy" for a fellow nurse who catches a "right hook." Wow, show those true colors. Also, never said it was "behavior modification." I believe I called it a quick assessment. Any of you are welcome in my ER to show me a better way. I always welcome constructive criticism from a knowledgeable, experienced source.
    i reiterate, not one damn bit of sympathy! and i hope for it to happen! this is battery, plain and simple!
  6. Visit  ThrowEdNurse} profile page
    0
    tell me how you really feel!
  7. Visit  nursel56} profile page
    0
    I'm not criticizing you. I only used the term "behavior modification" as shorthand to mean that you employed the technique when you knew the person could hear you but was was not following commands. All ERs have unresponsive drunks and drama, that's why I asked the question. Maybe I should ask it as a thread in the Emergency nurse's forum-- or maybe curiosity about something outside my sphere is violating an unwritten code of etiquette since I'm not an ER nurse myself.
  8. Visit  ThrowEdNurse} profile page
    0
    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!
  9. Visit  nursel56} profile page
    1
    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.
  10. Visit  morte} profile page
    1
    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.
  11. Visit  canoehead} profile page
    1
    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.
  12. Visit  morte} profile page
    0
    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!
  13. Visit  ThrowEdNurse} profile page
    5
    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!!!!
  14. Visit  RENEfromLA} profile page
    0
    i think i seen the nipple twisting thing on an episode of Mercy...lol


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