Acceptable questions for nursing students to ask?

[linnywho]

I am asking here because I am not sure where to post it. I am a med/surg nurse. Students from a local university are being asked to fill out a 13 page nursing assessment. Some of the questions on this form seem in appropriate.

This assessment is for a med/surg 2/3 class.

Students are doing clinical on a MACU unit, skilled nursing unit, etc.

Examples:

What is your sexual orientation?

Do you have sex?

If so, how is it?

How was your infancy, childhood, adulthood?

How many people live in your home?

What is the cost of your home?

The school is also asking students to palpate the liver. This brings up an entirely different issue related to patient safety. I am afraid that a student could cause a rupture in an alcoholic patient or worse. I am not even sure if a student is allowed to perform such a procedure. I have never done that and would assume I would need a doctor's order if I did.

I am getting a copy of the assessment tomorrow from a student and taking it to my unit manager. But I wondered if these questions were now considered the norm for nursing school now? Or do others feel the students are crossing an ethical or moral threshold asking these sorts of things?

Thanks,

Linny

[Mulan]

I would think those questions were none of their damn business, myself.

[onyx77]

Are you sure they are asking those questions so bluntly? At my school we were required to assess if the patient has any current sexual problems (which isn't simply about having sex, ex: Has this illness or surgery affected the way you feel about yourself as a man/woman), who lives with them that can help with ADLs or home maintenance (help shopping, cooking, cleaning, etc), how do you view your future, do you feel anxious (there may be underlying anxiety issues that need to be delt with), etc. We as nurses need to assess our pts completely and this includes mentally and socially. These questions are given to help nursing students develop their assessments skills on more than just the physical level. And remember they have thoses nasty careplans to do! And so much is involved with those. A patient may have a concern with certain things, but may be embarrassed to ask about it. Certainly these nursing student should not be asking these questions SO BLUNTLY! That would raise concern. I had clinicals with a girl that did ask things in an inappropriate way - she didn't pass clinicals! They need to be practicing therapuetic communication with these questions as well. And of-course there are many times that not all of these questions apply - they need to figure out the appropriate times to ask these.

The only questions I see that you listed that are completely inappropriate is how much their home is and what their sexual orientation is. That's no one's business!

Hope this other perspective helps.

[MNmom3boys]

While I would agree that the questions you have listed are a bit invasive, I know the pyscho-social needs that they are supposed to be assessing where traditionally one of the weakest areas in care plans that I and my classmates turned in. Perhaps they are trying to give their students more guidance in assessing these areas?

There are times when some of these issues do impact care, but I would think that the students should be allowed a little more leeway to use their critical thinking skills as to when these of questions would be appropriate and relevant to the nursing care being provided. (I think the questions could be better phrased to get the relevant infomation - ie living conditions - w/out completely trodding over privacy lines!)

[linnywho]

I can agree that wording and discretion can make the questions seem more appropriate; however, I feel someone's sexual orientation should not be asked. In fact I plan to advise students who have my patients to not ask certain questions on the assessment.

Does anyone know if students should be performing liver palpitations?

[Dolce, RN]

Wow, those are really personal questions. When I was in nursing school we had questions that addressed spiritual and psychosocial needs of the patient. A lot of students felt uncomfortable asking patients about their spirituality. Our instructors never forced us to ask questions that our patients didn't feel comfortable answering. If a patient brings up the subject than it is perfectly okay to talk about it. But, I would never outright ask a patient what their sexual orientation is. I don't think that is relevant to their care.

[MNmom3boys]

I would tend to diagree - sexual orientation can have an impact on the patient's needs. (Many newer textbooks have sections on this topic, especially in the context of new families, etc.)

ETA - We were flat out told we would be unable to palpate a healthy liver, and were not encouraged to attempt an unhealthy one.

[flightnurse2b, LPN]

Does anyone know if students should be performing liver palpitations?

we were taught that only physicians, PA's, or advanced practice nurses could perform liver palpation....

[vashtee, RN]

I am a student, and I wouldn't ask those questions unless they came up in the course of a normal conversation or if they were directly related to the patient's diagnosis. If my instructor insisted we ask, I would be tempted to just make up an answer for her. Also, liver palpation is considered an advanced practice procedure in my school.

So far as I understand it, you are still the RN for the patients, and you get the final say about what the students can do. If you are uncomfortable about letting them palpate livers, just tell them you don't want them to because you consider it advanced practice.

[studentnurseNTN]

I'm a nursing student and I can't see how those questions are relevant on a med-surg floor, maybe in a public health setting but not here. We were told by the instructor that we never deep palpate. In fact, she says that as a Registered Nurse, she has never done this either.

[Hydakins]

I also am a student and assignment sheets like that mostly are guidelines to help gather information for care maps/plans and/or charting. You must pick what questions pertain to your patients situations. There are 50 ways to ask for one piece of information and the assignment sheet will NEVER list all 50 for each topic listed. Thats where the practice of communication skills and learning to deal with different types of people come into play. I highly doubt that the students were to ask those questions in a blunt manner. I think its just a guideline to follow although I dont know about that "what is the cost of your home" question. If it was inherited, it still has a cost--I dont understand that question at all.

As for liver palpation, we were shown how to do it but--I agree with everyone else-that IS for advanced practice professionals.

[PeachyERNurse, BSN, RN]

When I was in nursing school, we asked patients similar questions as part of our patient assessment tools (aka care plans). We were required to ask these questions when interviewing the patient. First we asked the patient's permission to interview them, and if they felt uncomfortable answering certain questions, we just documented that they didn't feel comfortable answering. It really wasn't a big deal. I NEVER had a patient that verbalized a problem with me asking about sexual orientation, # of sex partners, safe sex practices, or any other question.

Also, we were taught how to palpate the liver as part of our complete head to toe assessment. I've never actually done it in a clinical setting (only in lab on fellow students), but I wasn't aware of any rule stating only MDs, PAs, and NPs could do it.