Learning Assessment Techniques

  1. I am a first semester nursing student in a BSN program, and I am currently struggling with the way in which my class is learning assessment techniques. We are a small group of seventeen students broken into two groups for assessment lab. We assess one another. We are requested to report to lab in sports bras and shorts. We don patient gowns and play "patient/client" for a fellow classmate. We then return the demonstration to our instructor. While I understand that this may facilitate our learning of the clients' perspective, the need for privacy and dignity and how to provide these integral aspects of patient care, I feel that this has greatly impeded my ability to learn. Assessment of the breast and genitalial was naturally deferred, however, the abdomen, thorax & lungs, and heart assessment were not, and stethoscope to skin contact was required. Then during our head-to-toe return for our final exam, four nursing students (S2 and above - virtually complete strangers to us) plus our instructor set up privacy screens while all of the S1s preformed our final assessment. The meandered in and out of the assessments and critiqued.

    I've addressed some of my falculty and would very much like to see this changed. It is my understanding that this is simply the way it has always been done here, and every where else for that matter.

    You could be a great help to me by sharing your experience and ideas on this matter. Thanks in advance for your input.

    Sincerely,
    Concerned Student
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  2. 10 Comments

  3. by   marilynmom
    Don't take this the wrong with but how else do you expect to learn assessment? You also learn how the patient might be feeling (uncomfortable) when your assessing him/her which is important.

    We assessed each other for everything, wore sports bras and shorts/loose pants (depending on what was being assessed)--some of the girls wore bathing suits. This isn't anything you can practice on manikins, you have to practice on each other and that involves touching each other, skin to skin contact, getting into each others personal space, etc.

    Hang in there!
  4. by   sming
    Hi, I can understand your feelings. In my LPN classes years ago we did our assessments on one another. It was a old instructor who got upset with one of us two guys, doing an assessment with one of our female counterparts. It was not upsetting to us at the time. In my RN program we examined real patients with real problems, this seemed to make more sense to me. We did practice injections on one another which the school did stop. As for what you are feeling, I agree other methods could be used in how to assess without having to strip down. I am sure if you spoke with other class mates you are not alone, and being a student, and wanting a change is a steep hill to climb. Since you are all fairly healthy normal people, you won't see the divergence from the healthy in most cases with class mates, but there could be sombody in your class with some genetic disorder which they may like to keep private. Use of a good quality dummy could be an easy tool to switch to. That probably won't change while you are going through it, it may change for a class behind you and you will be long finished this part of your training. So you have to ask yourself a few questions, is it worth rocking the boat, or to just keep quiet and continue with what has always been. If you are firm with your feelings and emotions question those, what is your motive, where are your feelings comming from, and if you still find that what you are feeling is valid speak to the powerers to be in a calm fashion. You may want to do a little research and present your finding to the faculty. I am sure there are lots of shcools that don't use this teaching model that is causing you some grief. There are some real good sophisticated dummys on the market, that can be programed to do things and teach you.:angryfire
  5. by   nurse4theplanet
    In our program, we learned physical assessment techniques through verbal instruction and watching a very detailed video (detailed meaning boring...but helpful nonetheless). During the physical assessment lecture, we were told to bring our steth's to school and as each system (heart, resp, bowel) was assessed, we were given time to listen to our own body systems. We also had computer programs that simulated abnormal heart and lung sounds. We never had a physical assessment lab to perform on each other, instead we were encouraged to go home and practice on ourselves, friends, and family. While some may argue that this is not adequate, I am very confident that my physical assessment skills are not in any way inferrior to any other new grad who learned in a different manner. I also understand how the patient can sometimes feel uncomfortable during an exam, without the experience of fellow students performing an exam on me. I am a modest person and have felt uncomfortable before during exams and check ups many times so I am acutely aware of my patient having similar feelings when I am the one performing the exam.

    With that said, there is probably nothing you can do to change your program's policy. Every school is different and it is likely that your program director and faculty believe their hands on student to student approach is best. There were a few things throughout my program that I felt could have been done differently or more efficiently, but in the end I had to suck it up and be flexible. They are calling the shots and I had to meet their standards if I wanted my degree. Just keep in mind that this is a small stepping stone towards a large goal. It's nothing I would raise a fuss about.
  6. by   nursesaideBen
    I would have a problem with this as well, simply because I have a lot of issues with my body and that kind of exposure would make me EXTREMELY uncomfortable! Luckily for us we were already doing clinicals when we learned assessments so we practiced on our patients which was great.
  7. by   rnin02
    I can't remember all of our programs requirements (pretty sad, I only graduated in 2002), but I do remember for testing purposes we had a partner, and picked an area out of a bucket to assess on our partner. So, for example, we only had to demo a respiratory assessment, or, a neuro assessment, not a full head to toe. For my BSN program, we practiced on each other during lab time, but the testing process was the same. Its awkward at time, but it wasn't too bad. And we didn't have to wear sports bras and shorts, they just said "loose fitting" clothing, so there was maybe more privacy for us probably.
  8. by   RAASN
    first of all i would like to extend my sincerest thanks to those of you who responded. i fell in love with nursing eleven years ago as a high-school drop out (ged recipient) when i landed my first job as a patient care technician at an area hospital. i worked as a tech for three and a half years but left the field to pursue a job in the business world. i was lured in by the prospect of the monday-friday, 9-5 hours and a generous salary. i quickly discovered that nothing could match the profound satisfaction i had been privy to in the healthcare setting. i tried to fool myself and enlisted into business management, economic, and accounting classes at a local community college. i remained in the business world for the next six years. i can honestly say that i disliked my job, however, it was the relationships that i established over the years that kept me there. i have always had an insatiable interest in humanity, absorbing all i can from every contact. i believe deeply that we all have a story to tell. each story that we share can greatly impact the lives around us. through the education we gain from one another we can potential illicit positive changes throughout our neighborhoods, communities, and possibly the globe. i know i'm an idealist. i'm also naive. quite honestly, i hope these are characteristics i never loose sight of.

    so, to get to my point, because i'm sure you are wondering at this point where i'm going with all of this...

    i made it through two years of classes and gained acceptance into the nursing program that i am currently enrolled in. one month after receiving notification of my acceptance i went out to celebrate my friend's birthday. her husband, like mine, was deployed overseas. it was a fairly large group of us that went out and arrangements had been made that anyone who needed to could stay at my house in town, versus driving drunk. once back at my home we stayed up several more hours talking and drinking. i went to bed that night never imagining what would happen next. while my best friend and her husband slept in my guest room and another close friend slept on my couch. i was raped in my own bedroom by the comedian we had all met that night. there are certain things in life, hypothetical situations, that you quite simply think you've escaped the window of opportunity. after all, i was nearly 29 years old, married, and living in literally one of the nation's safest communities.

    skipping six months, now i'm in assessment lab and by shear oversight my professor neglected to inform us that we would be donning patient gowns and assessing each others' abdomens. i just assumed that we would do this on medi-man. i excused myself after the instructions for the day's assignment and sat in the bathroom and cried. how could i possibly get through this? shear will and determination, a strength i didn't know i possessed, kept me from leaving my books and belongings in that classroom and running across campus to my car. i vowed i would not return after that experience. my last patient experience was that of a rape victim in the emergency room having pictures taken of my most intimate parts, being swabbed and examined under the strange green glow of ultraviolet light. somehow, i kept returning to lab and every experience was a violation that i can't begin to explain. i began experiencing major set backs, relying on alprazolam and trazodone which i hadn't taken in a number of months. i began questioning whether or not i jumped back into life too soon. i began questioning if i would be more of a hindrance than a help. would my emotional state put potential patients in danger? would i lose my cool if i encountered a similar situation? the questions and the doubts are endless.

    as our final assessment exam rounded the corner i began hearing how it would take place. additional upper class students would be making rounds through the screened off areas and stethoscope to skin contact in all assessments that require auscultation was mandatory. my anxiety level heightened. i had no more strength to draw upon. i ran into my advisor in the hall, the same woman who handled the scholastic portion of my trauma some months back. i burst into tears. she pulled me into her office and we talked about all of this. she then brought in my health assessment professor and i explained my situation. her response, completely not thought through as she asked why on earth i didn't come to her and discuss this matter. as the three of us discussed the matter at hand, the faculty began making arrangements for my final to be different. ah, one would think, "problem solved."

    the problem isn't solved. reason being is that this experience is not uniquely mine. statistically, sadly it could potentially belong to one in five of my fellow students. in the aftermath of my attack one pervasive thought kept me alive. "somehow, this will lead to something good." i had to believe that. i still have to believe this. so this is the hill i choose to die on. sming, you mentioned rocking the boat and thank you for your compassionate response. this will be the boat i choose to rock. this has been an enormous obstacle for me, one that has come very close to preventing me from fulfilling a lifelong dream. despite the doubts, fears, and insecurities that i have, i know that i will be an incredible nurse.

    sexual assault aside, there are multiple other reasons why i think the "learning" of health assessment techniques should be changed. when a patient goes to a doctor's office the idea of disrobing can be somewhat embarrassing or traumatic regardless of the situation but they are not going to spend the next two years with their healthcare provider in study groups, all night cram sessions, or even grabbing a cup of joe. everyone has insecurities about their body and they should have a choice in whom they show it to. take for example the "older-than-average" student whose breasts and abdomen don't come close to resembling that of their nineteen-year-old counterpart. it's awkward. it's uncomfortable. for some, it may very well be a deal breaker. i understand that technology may never offer an exact match to the heart, lung, or bowel sounds that i will hear on my lab partner but my point is this... students should learn the technique, the methodology, through lectures, videos, practice on self, family members, and even willing volunteers and then build upon the skills in the clinical setting on patients who are in the position that assessment is required, being ever mindful of their right to privacy and dignity.

    i'm sorry for the lengthy rant. i guess i needed to get it out. i'm grateful for the anonymous opportunity and i am grateful for those of you who take the time to read this. i welcome and beg for your responses, regardless of opinion. i'd like to gain additional perspective. thanks again.
  9. by   nursesaideBen
    Quote from raasn
    first of all i would like to extend my sincerest thanks to those of you who responded. i fell in love with nursing eleven years ago as a high-school drop out (ged recipient) when i landed my first job as a patient care technician at an area hospital. i worked as a tech for three and a half years but left the field to pursue a job in the business world. i was lured in by the prospect of the monday-friday, 9-5 hours and a generous salary. i quickly discovered that nothing could match the profound satisfaction i had been privy to in the healthcare setting. i tried to fool myself and enlisted into business management, economic, and accounting classes at a local community college. i remained in the business world for the next six years. i can honestly say that i disliked my job, however, it was the relationships that i established over the years that kept me there. i have always had an insatiable interest in humanity, absorbing all i can from every contact. i believe deeply that we all have a story to tell. each story that we share can greatly impact the lives around us. through the education we gain from one another we can potential illicit positive changes throughout our neighborhoods, communities, and possibly the globe. i know i'm an idealist. i'm also naive. quite honestly, i hope these are characteristics i never loose sight of.

    so, to get to my point, because i'm sure you are wondering at this point where i'm going with all of this...

    i made it through two years of classes and gained acceptance into the nursing program that i am currently enrolled in. one month after receiving notification of my acceptance i went out to celebrate my friend's birthday. her husband, like mine, was deployed overseas. it was a fairly large group of us that went out and arrangements had been made that anyone who needed to could stay at my house in town, versus driving drunk. once back at my home we stayed up several more hours talking and drinking. i went to bed that night never imagining what would happen next. while my best friend and her husband slept in my guest room and another close friend slept on my couch. i was raped in my own bedroom by the comedian we had all met that night. there are certain things in life, hypothetical situations, that you quite simply think you've escaped the window of opportunity. after all, i was nearly 29 years old, married, and living in literally one of the nation's safest communities.

    skipping six months, now i'm in assessment lab and by shear oversight my professor neglected to inform us that we would be donning patient gowns and assessing each others' abdomens. i just assumed that we would do this on medi-man. i excused myself after the instructions for the day's assignment and sat in the bathroom and cried. how could i possibly get through this? shear will and determination, a strength i didn't know i possessed, kept me from leaving my books and belongings in that classroom and running across campus to my car. i vowed i would not return after that experience. my last patient experience was that of a rape victim in the emergency room having pictures taken of my most intimate parts, being swabbed and examined under the strange green glow of ultraviolet light. somehow, i kept returning to lab and every experience was a violation that i can't begin to explain. i began experiencing major set backs, relying on alprazolam and trazodone which i hadn't taken in a number of months. i began questioning whether or not i jumped back into life too soon. i began questioning if i would be more of a hindrance than a help. would my emotional state put potential patients in danger? would i lose my cool if i encountered a similar situation? the questions and the doubts are endless.

    as our final assessment exam rounded the corner i began hearing how it would take place. additional upper class students would be making rounds through the screened off areas and stethoscope to skin contact in all assessments that require auscultation was mandatory. my anxiety level heightened. i had no more strength to draw upon. i ran into my advisor in the hall, the same woman who handled the scholastic portion of my trauma some months back. i burst into tears. she pulled me into her office and we talked about all of this. she then brought in my health assessment professor and i explained my situation. her response, completely not thought through as she asked why on earth i didn't come to her and discuss this matter. as the three of us discussed the matter at hand, the faculty began making arrangements for my final to be different. ah, one would think, "problem solved."

    the problem isn't solved. reason being is that this experience is not uniquely mine. statistically, sadly it could potentially belong to one in five of my fellow students. in the aftermath of my attack one pervasive thought kept me alive. "somehow, this will lead to something good." i had to believe that. i still have to believe this. so this is the hill i choose to die on. sming, you mentioned rocking the boat and thank you for your compassionate response. this will be the boat i choose to rock. this has been an enormous obstacle for me, one that has come very close to preventing me from fulfilling a lifelong dream. despite the doubts, fears, and insecurities that i have, i know that i will be an incredible nurse.

    sexual assault aside, there are multiple other reasons why i think the "learning" of health assessment techniques should be changed. when a patient goes to a doctor's office the idea of disrobing can be somewhat embarrassing or traumatic regardless of the situation but they are not going to spend the next two years with their healthcare provider in study groups, all night cram sessions, or even grabbing a cup of joe. everyone has insecurities about their body and they should have a choice in whom they show it to. take for example the "older-than-average" student whose breasts and abdomen don't come close to resembling that of their nineteen-year-old counterpart. it's awkward. it's uncomfortable. for some, it may very well be a deal breaker. i understand that technology may never offer an exact match to the heart, lung, or bowel sounds that i will hear on my lab partner but my point is this... students should learn the technique, the methodology, through lectures, videos, practice on self, family members, and even willing volunteers and then build upon the skills in the clinical setting on patients who are in the position that assessment is required, being ever mindful of their right to privacy and dignity.

    i'm sorry for the lengthy rant. i guess i needed to get it out. i'm grateful for the anonymous opportunity and i am grateful for those of you who take the time to read this. i welcome and beg for your responses, regardless of opinion. i'd like to gain additional perspective. thanks again.

    your story was extremely moving and inspiring, my heart and prayers go out to you and i agree with you 100%. your strength is mesmerizing and i know you will achieve your goals in nursing and be one hell of a nurse!!!! :icon_hug:
  10. by   SchoolRN,BSN
    Wow. Ben is right. You will be one hell of a nurse.

    Best of luck to you.:redpinkhe
  11. by   little hummingbird
    Thanks for your story. I agree with you that you should choose that "boat to rock."
  12. by   Virgo_RN
    I've been raped on more than one occasion. I have no problem letting other students do a head to toe assessment on me. To me, the nursing lab is not a threatening environment. A deserted street at night is. Of course, my rapes were over twenty years ago and I don't actually think about them often. Perhaps for you, the more recent nature of your assault is a factor here. Also, have you had any counseling or therapy?

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