Inappropriate Pt. Behavior?

[wanna_be]

I'm a clinic assistant currently (also in nursing school) and curious if I should do anything about this situation. I was working the other day and a patient came in for a screening. At the beginning of the consultation, they picked up a model of female anatomy from the table, and said, "so, that's what it looks like" and proceeded to point to the cervix, uterus, fallopian tubes, and ovaries and ask me the name of each. Since I work in reproductive health and value patient education, I cheerfully named each. The patient then proceeded to do the same thing a second time, asking me to name each part, then going back to the cervix and uterus and asking again. I felt a little strange about it but it didn't really raise a red flag in my mind. Then, I asked the patient to rest their finger on the table so I could preform a fingerstick. Instead, the patient rested their hand on my knee in a rather firm manner. At this point, I began to feel uncomfortable and again asked the patient to place their hand on the table while I performed the stick. The patient did so for a moment, but then moved their hand back to my knee. It was such a subtle move, but it left me with the impression that the patient was trying to "get away" with doing something inappropriate when I reflected on the entire visit later. Nothing else happened; the patient left...now I'm wondering if I should let my supervisor know, and put a note in the chart? It was such a small action, but I also want to alert other staff if this person tries anything in the future...

[Libby1987]

I don't think the patient needs a note in their chart as much I think you need more experience in maintaining professional boundaries and assertiveness to take you forward in the beginning of your career.

[wanna_be]

I don't think the patient needs a note in their chart as much I think you need more experience in maintaining professional boundaries and assertiveness to take you forward in the beginning of your career.

I don't really understand what you mean, could you please elaborate?

[Jules A, MSN]

That sucks. I would discuss it with your supervisor.

[vintagemother, BSN, CNA, LVN, RN]

I don't really understand what you mean, could you please elaborate?

I don't mean to put words in the OPs mouth but I think that she's referring to the fact that you you should have immediately stopped the pt from touching you.

And you probably should have tried to position yourself in a way that a pt would not be able to touch you in an inappropriate manner.

We, as professional nurses, need to set the tone and course of our interactions with pts firmly from the outset as much as possible.

[Purple_roses]

I understand why you would feel so uncomfortable. If a patient (or anybody for that matter) does not have a valid reason to touch you, he/she should keep his/her hands completely off of you. It's called respect.

[wanna_be]

Thank you, vintagemother. I actually have many years of patient/client experience (beginning as a massage therapist, then as a case manager, and now as a clinic assistant). I think what tripped me up about this situation was how subtle it was, and it made me question whether or not I was "making a big deal of nothing". I've had patients who were WAY out of line, and I've had no qualms about either ending the interaction, or firmly telling them that they were being inappropriate. But the asking about the female anatomy didn't seem weird until the other thing happened, and that was so subtle it was like, maybe the patient didn't hear me? Maybe the patient is just nervous about getting a fingerstick (people get funny all the time about getting a fingerstick)? As for positioning myself in a different way, there's really no other way I could've positioned myself that would've prevented it from happening, since I needed to access the patient's finger. Please understand that even with my own experience, this caught me off guard. I think it can be easy for us to question our own gut feeling when we don't want to "overreact". From what I'm hearing, though, this gut feeling that the patient was being inappropriate was enough for me to take action (set boundaries, possibly let my supervisor know). That's the question I had. Thank you!

[vintagemother, BSN, CNA, LVN, RN]

He may not have meant the knee touch in a bad way. But I can tell you I've never had a pt touch my knee. Though I have hugged pts, been struck (not hurt) etc.

I think it's mostly about having "feelers" or "antennae" out to determine a pts tendencies or intentions and deflecting in an assertive non condemning manner.

Yes, I agree, sometimes we have to position ourselves in a manner that involves somewhat close proximity to the pts body.

The knee touch was too close for comfort though I think and I wish it hadn't happened.

Have you thought of ways to prevent this from occurring in the future?

[Been there,done that, ASN, RN]

Too much thought into this.

"get your hand off my knee". If the patient does not get their hand off your knee.. call security.

[Libby1987]

Vintage mother pretty much explained what I meant.

Without knowing anything about the client, anything worth placing in the chart probably needed to be dealt with right there, or reported immediately. But placing something forever in their medical record over a "small action" that you weren't sure of the time nor felt the need to address at the time would be more of a learning moment in my opinion.

ETA if the patient intentionally violated a clear boundary, then I would report it.