Embarrassing question from new nursing student

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Hello all! I am in my first semester of nursing school, we just started clinicals, and I have kind of an embarrassing, probably stupid question/issue...I am way too embarrassed to ask my instructors about this (or frankly, even the other students) so hopefully someone here can give me some advice.

When you are auscultating a woman's chest, and she has larger breasts, how exactly are you supposed to do it? Do you just kind of move them out of the way? Do you tell the patient that you need to move it? Also, are you supposed to auscultate through their shirt/hospital gown/bra, or ask them to remove it? Same goes for bowel sounds...I had one of my first patients get mad at me because I tried to pull her pants down a little for bowel sounds (they were so high I couldn't see her belly button, which I use as the landmark for my quadrants), and she yelled at me that I didn't need to do that to listen for bowel sounds...I thought you did because it might be hard to hear through clothing...I apologized profusely to her and she seemed to be ok, but I still feel really bad about it...I mean I certainly wasn't going to pull them all the way down, only far enough to expose her lower belly, but I probably should have at least explained to her what I was doing and why.

Anyway, I'm sorry if this is a dumb or weird question...I've never worked in the medical field at all before and I feel seriously nervous and out of my league in clinicals, and it doesn't help that I'm a pretty introverted person and have never been very touchy-feely. I don't consider myself a squeamish or conservative person (e.g. I really don't care if I'm out in public and see a woman breast feeding or something, nudity doesn't bother me, etc.), so I thought I'd be fine with the more "sensitive" parts of being a nurse, but when it comes to actually doing this to real live patients, I just feel completely lost as to what the right approach is, what you should say to the patient, what's appropriate, etc. I don't feel it's something I can really ask my instructors about and nobody else in my class seems to have a problem with this like I do, and the textbooks say zilch about it....somebody please help!

Thanks for "listening" and I appreciate any advice!!

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I understand! It can be really embarrassing for both you and the patient. I think the most important this is to communicate what you are doing. Make sure you tell them what you are doing when you are about to do it. I've always had the women move their breast out of the way when I told them I needed to listen to their heart.

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Specializes in Hospice.

I'm not in your shoes yet, I start in August, but I would certainly recommend that you must get over your fear of your instructors or other nurses who are supervising you in clinicals as far as asking questions! That is a perfectly ligitimate question, don't be afraid to ask it! I can only imagine the questions I am going to have! :nailbiting:

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If the patient is capable then ask her or him (yes him) to lift their breast up so you can properly listen to their heart. If they are not capable then explain that you will be moving their breast for just a monent. If its a pretty thin hospital gown you can listen tru their gown but anything thicker you can find a place to slip your hand and stethoscope in. Always explain to the pt what you are doing!! As far as bowel sounds when you do your assessment and are inpecting the skin you will need to see their stomach so explain to pt you will be pulling down their pants a little to listen to their bowels and inspect the skin. Don't be afraid of pts, if you have one that is not so corooperative then do your best of what you can and ask your instructor to help you explain why it is necessary.

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I let the patient know that I need to touch them and I use THE BACK TO MY HAND to raise the breast up. That way there is no misunderstanding my intention.

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Specializes in Neuro Intensive Care.

Just be clear as to what you are doing and why. As the PP suggested, I also use the back of my hand to lift up the breast. Another key thing is to ensure privacy not only by closing the door, but also using the curtain. This will help if someone opens the door and you are not expecting it. If there isn't a curtain, I always position myself between the PT and the door, that way my body can "shield" them if it opens unexpectedly.

Patience is the key. If you think it's going to be an issue, wait till the very end to do that part.

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First off if you have a question, embarassing or not, you should ask. I'm sure they've been asked a lot of crazy questions in their day. But like a lot of others have said, ensure privacy, explain what needs to be done, ask permission to do the procedure, and then either have them do it if they're capable or if you have to do it use the back of your hand.

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Don't ever be ashamed to ask a question, because if you have a question, more than likely someone else does too! You may be the only student who has encountered a less than cooperative patient thus far! When you ask your instructor, start with the scenario that happened, saying "Prof, I had a situation that came up in clinicals the other day and I was wondering what I should do in a situation like this..." and go from there! The whole point of clinicals is experience based learning, otherwise you wouldn't learn hands on, you'd watch videos and such. Some people are very cooperative (a little too cooperative, I had a man flash me below the belt without asking because he had a little discomfort) and others are a little more timid. As long as you ensure privacy and keep the patient informed, for the most part they will be cooperative. But your experience will only add to the education of your classmates, so don't be ashamed to share with the class or ask for clarification. I have one year of nursing school left and i still ask over and over again what I should do if a patient refuses meds, gives me a difficult time, etc. The more you learn, the more you know!

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Specializes in Critical Care.

Agree with the back of the hand technique--and OP, I think you identified the #1 issue by saying you should have warned the pt ahead of time! I've not had anyone get mad when I moved an article of clothing or a body part as long as I told them what I was doing and why beforehand. Also, I don't think it was a dumb question. It shows you care about doing things correctly and respecting your pts.

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Jan286, I am going into my third semester in nursing school, and I remember feeling exactly like this. I am very introverted myself and not a touchy feely person either (until nursing school happened, of course). You will adapt soon to that, and it will not be as bad as it is now!! At my school, we have an actual assessment form they like us to follow and like the previous posts said, I just walk in introduce myself and say is it okay if I do an assessment on you? And I'll tell me I'm going to listen to your heart, your lungs, stomach, etc.. And if I cant quite hear it like I should, I say can pull your gown up to get a better listen? Usually, they are okay with it. Some patient's aren't as easy. I have actually been denied to take care of a pt in the middle of an assessment. Some people see you as a "student" and do not realize you have a certain criteria to meet, and at my school, we have to be very thorough. If that's ever the case for you, it's okay! Some pt's are just really sick and just do not particularly care for students to take care of them when they feel that bad. All I know is, if I can do it, you certainly can!! I know this may be too much but practice on your friends if you want to get more comfortable! LOL I know that sounds totally weird, but it helps some people!

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THANK YOU all so very much for taking the time to read my long post and leave replies!! I very much appreciate it! All of your replies have been very helpful (and I feel like much less of an idiot now haha!!) Thank you all very much again!

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Such a great question. It is great that you posted for help.

Suggestions: watch assessment videos, watch youtube assessments, practice in simulation room at your school if available, practice in nursing skills work area, team up with another student in clinicals, bring a smartphone or Samsung hand held device that you have stored school procedures, books for reference, and it gives you internet access for questions and help. Also, use the free nursing tutors at your school for guidance.

The Samsung hand held device or smart phone is a great tool: it should have drug guide, lab guide, school procedures, internet access, a care plan guide. It will get you out of a pinch when you most need it, but you still need the help of professor and fellow students.

These will tools will give you additional places to go to get help. But the most vital is that you get the assessment skills down.

Unexpected issues will come up, it's just getting the help you need so you stay on track. So continue to post, and build up your resources.

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