Awkward Situation

Lily C. · Dec 26, 2008

I'm definitely wearing gloves a little more often than I already do.

Virgo_RN, BSN, RN · Dec 26, 2008

I think you handled it just fine.

lovehospital · Dec 26, 2008

Yesterday, I was distributing meds, and I knocked on the next pt.'s door (16 yr. old male). There was no reply. So I knocked a second time, louder, and waited a few moments. I decided that the pt. must be asleep, so I opened the door and went in, and he lying in his bed masturbating. I was momentarily stunned, but I left quickly.
I have never encountered this before... How do you handle the situation professionally?

OMG funny,I had a similar experience..when I was doing perineal care on an older male patient he got excited and it was the first time I ever experienced that and it felt so akward but I pretended like nothing happend.

I'm just surprised that your patient didnt hear the knock!!Wow...

lovehospital · Dec 26, 2008

After all my years of doing this work. That wouldnt surprise or shock me either, not in the least. Ive seen teen boys, adult males, elderly males, even some women. I just say excuse me, I will return in 10 minutes. I act like it never happened. yes I wear gloves. That is always smart thing to do anyway.

Haha,I arleady get the feel of that,I always tell my family friends I almost seen it all (since I'm still a nursing student) and I'm sure soon I will see a lot more of it,anyway nothing is gross to me anymore...

HM2VikingRN, RN · Dec 26, 2008

He was self medicating his pain wth endorphins :>>>>.

I think you handled it well.

lovehospital · Dec 26, 2008

He was self medicating his pain wth endorphins :>>>>.
I think you handled it well.

You just made my day....poor boy:chuckle

Saifudin · Dec 26, 2008

I agree. I don't believe the patient is a "perv". Perhaps the patient was feeling better and fantasizing about one or more of the nurses. The nurturing environment of the hospital creates intimate contact that this young, immature patient may misconstrue as something other than the normal caring of health care providers. This patient may never had the type of attention from what is likely a majority of female staff. If this is his first in-patient experience along with his already heightened hormonal tone this patient was just likely acting out his sexual urge. That doesn't mean I condone it however, I think just move on. There's not much else you can do unless some other behavior follows that and a new situation arises during his hospitalization that is a sign of other issues that need evaluation.

I agree with above comments; glove while in his room (lol).

statphleb SN · Dec 26, 2008

That was nice of you to respect his privacy. :specs:

sassijac · Dec 26, 2008

I think you handled it very well. He was acting normally (unless that's what he does 10X a day). I wouldn't bring the subject up with him unless it's relevant to his plan of care. And do wash hands frequently. I wouldn't wear gloves giving meds, think increased incidence of latex allergies because of overuse.

dnp2004 · Feb 19, 2009

First let me say this is my first post to ALLNURSES.ORG because I just signed on with you folks yesterday! Believe it or not I found your website about a month ago after using GOOGLE to research information on electronic prescription and records keeping/charting systems. If anyone has hands on experience with any of these systems I would be grateful for your opinions. 337,111 sisters and brothers worldwide at my fingers, wow!!! I wish this site great site was around with I first broke in to this field!

About me, I have worn numerous hats in healthcare over the past three decades, it runs in my blood. They call me the diplomat because everyone always comes to me if they are facing and/or presently involved in an unusual, uncomfortable, potentially explosive, complex or embarrassing situations. I love a good multifaceted challenge and try to look at problems from all perspectives. My mother says I could have been a lawyer. Nah, I like to find the truth, not manipulate it. Besides, do no harm right? Oh, I have been a patient a few times as well.

So for my first challenge, I mean search, I typed in the word "awkward" and good Lord, if this thread is not awkward for many of us, I don't know what is (ha)! Seriously though, I will put in my two cents for what its worth because my goal is to try to prevent awkwardness between patient and caregiver due to misunderstanding. Actually this is a very normal situation to say the least, well as long as the caregiver does not overreact. There a few things to all must remember:

1)When the patient is caught (male/female) I have found they are rarely a "perv". Usually quite the opposite. Many times while they are engaged in that kind of activity, they may not notice things such as knocks or even caregivers quietly entering their room after noticing such things as an elevated heartbeat on a remote monitor (thanks scribblerpnp).

2)Some patients will have a much higher frequency of that activity in a hospital setting than in their normal surroundings because of social isolation, confinement, boredom, anxiety, stress, fear, etc... Though if they are not completely bedridden everything is more likely to happen in the privacy of a bathroom. Hence we may not be aware of it. Obviously this is better for both the patient and caregiver.

3)If accidentally "caught" most patients are extremely embarrassed, apologetic and may even ask you not to "tell on them" or chart it. They might not look you straight in the eyes for the next few days for fear that you and the other staff will not respect them anymore. For most people, just getting caught is usually far, far, more upsetting to them then having any other bodily function being seen by the caregiver.

4)IMHO there are far worse things to worry about cleaning up in a patient's room. Yes gloves are important but they always should be, right? To put matters in prospective. Over the years, in my world travels I have dealt with many viruses, bacteria, parasites, protozoa, prions, etc. Yes, even Polio and Ebola. Guess what, I am still here to talk to you all about it! So please, don't become overly concerned with any hazard you think you would encounter in that 16 year olds room. Ladies and gentlemen, just follow your training and you will be ok. Actually you have more to fear from E Coli., hepatitis and the common cold.

5)If you think about this pragmatically, it is better for a male patient to have a "controlled release" then to abstain so long they have the much dreaded involuntary nocturnal emissions. Absolutely everybody hates them and yes they can happen to a 16 or a 60 year old. The patient wakes up and realizes there is a mess and fears the staff will find out and punish/hate him. The caregivers, especially if they are female, tend to think the male patient is an out-of-control, perverted, disrespectful, pig that only cares about his own gratification without regards to others. Other patients in the room/ward may make fun of the situation causing further humiliation.

6)Okay all you caregivers, always take mental note of a male patient who suddenly develops a "mysterious coordination problem" in the morning and accidentally spills water or worst, a urinal all over themselves. I have seen several patients do that after they woke up and to their horror, discovered they had "emitted" something in their sleep. They will use the spill to mask the evidence. Hey they rather look like a clumsy idiot than a perv and quite frankly I can't blame them. If I were a 16year old boy in that position I would probably do exactly the same thing to "save face" and maintain a level of dignity. Sadly truth and honesty can have bad consequences.

7)If the patient is male and their caregiver is female, I find he will often feel afraid to talk to her about these accidents/emissions because they think, rightly so in North America, that she will have an out-of-proportion "yuck, ewww, gross" reaction. I have even seen male patients ask a random male caregiver that is not assigned to them, if they could explain and apologize to the female caregiver on their behalf because they don't know how to broach the subject and don't want to loose her respect. To many males a female caregiver reminds them of the person and role model which they respect the most in their life, mom. Hey who took care of you when you were up all night with flu? Mom of course! Most males, even hardened criminals, would not try to hurt or disrespect their own mother. So if a female caregiver asks really disgusted or judgmental it can damage their relationship.

8)The more religiously conservative and/or prudishness (sorry, I can't think of a more appropriate word) that a patient is raised with, the more of a problem this all becomes. I know many of you may think this is all too silly, but most of the world's major religions consider masturbation a sin. So to get caught engaged in it maybe the equivalent "committing adultery in your thoughts". Adultery is a sin that could place you in hell forever! BTW most of these patients prefer same sex providers.

I grew up in a religiously conservative house so I know what I am talking about. I have personally grown up with many people that have never had an intimate exam, IN THEIR WHOLE LIFE! I myself used to be extremely apprehensive about letting opposite sex caregivers (doctors, nurses, CNA) see me. I would like to get in to that some other time because I fear this post is way too long and boring for some or perhaps offensive to others. I honestly hope the later is not true because I am just trying to help everyone maintain a positive and rewarding workplace. Misunderstandings have led to wars!

Once again thanks for having me on this site and I promise I will try to keep my other posts below "novel size"!

The Diplomat

jjensen · Feb 19, 2009

I have walked in on this and I just back away... One patient felt sheepish with me after that... Now, I make sure to knock loudly... I was a cardiac RN and used to see the monitors going like mad too.. Walked in on some sex and that was not nice at all, but if he is feeling good enough to do that, his heart must have been feeling better...

dnp2004 · Feb 20, 2009

jaymejensen,

I have learned to knock loudly twice and then say something like, "good morning this is XXXXX." That way it gives them more time to respond or make quick modesty modifications. Can I trademark that term? (ha) Many patients may have non-perfect hearing. Most bedridden patients do not use their hearing aids either. They may not have been able to bring them to the hospital. So it is very easy to walk right up to them while they are completely unaware of your presence. Talk about a surprise!

Less than 5 years ago I had a cardiac patient's (age 55) heart rate start to rise soon after a young lady friend of his entered his room. I decided to check it out knowing I may be in for an unpleasant surprise. I knocked and she said come in. I looked and did not like what I saw. She winked at me and said, "I just made him very happy."

All of my monitors started showing inexplicably and at times contradicting rapidly changing readings. I was confused and very concerned. The man died in less than 6 minutes because no one or nothing could seem to control the situation. I had never seen a post-op cardiac patient display those readings. I felt defeated, perplexed and deeply dissappointed.

Well, I found out they made each other happy by snorting a combination of street-grade cocaine, PCP (angel dust) and Ketamine (special K)!!! These interacted with the post-op IV cocktail of drugs he was taking for recovery. Which BTW included pain medication of course. She was arrested, convicted and will probably die in prison.

The irony is that he was scheduled to enter a rehab center as soon as he was well enough! She had some drugs still on her person when she was arrested trying to leave the hospital. They were "cut" with baby laxative and all sorts of garbage. I don't get it, those drugs should scare anyone straight!!!!