Bathing Classmates and Other Personal Boundaries?

rn/writer, RN · Feb 5, 2010

I don't think it's a good idea to do truly invasive procedures on fellow students for a variety of reasons. But there are a number of benefits to doing things like simulated bed baths.

People come into nursing school from all walks of life. Certainly some have prior medical background as a CNA, an EMT, or something similar. But many folks have no previous experience in the healthcare setting. There are few other kinds of jobs where you actually have to touch your "clients," and this is a real hurdle for some. I remember a couple of girls in my class who had been waitresses and really understood the "customer service" part of the training very well. But they freaked at the idea of touching other adults (in a non-flirtatious manner). They needed to do that freaking in the privacy and protection of our lab, not during a clinical where their nerves might have really jarred an anxious patient. Other classmates had a bit more life experience, but still need a chance to fumble and stumble through the bed bath and other assessments to scope out an efficient routine and figure out how to word things properly. A real person offered good feedback on how things felt and what could have been improved.

The other aspect goes beyond empathy. We all cared to some extent or we wouldn't have been in the class to begin with. What I'm talking about is developing sensitivity and awareness. Being on the receiving end of the bed bath allowed us to understand the feelings and needs of a vulnerable patient. The lessons became more than a set of textbook illustrations and became real to us. We had the luxury of experimenting and rehearsing our technique in a non-threatening way with people who would soon trade places. This was so valuable.

I saw the same thing in EMT trainings over the years. Nothing like being immobilized in a KED, extricated from a mock crash vehicle, and strapped to a long board to see into the mind of a frightened patient. No amount of virtual experience could equal such an opportunity.

The OP expressed concerns about modesty, and that is a valid constraint for some individuals and cultures. But if accommodations can be made to address those issues, the exercise has much to teach.

Just to be clear, I'm talking about doing things like bed baths and other assessments with reasonable clothing. As far as other procedures, I suppose that's going to vary, school by school. Many EMTs practice IVs on each other--there aren't always enough patient sticks to keep your skills up--and use each other in various training routines. Safety and respect have to be paramount, of course, in any lab or drill.

Sometimes I think that in the worries over privacy and liability, we allow ourselves to become so hermetically sealed against real life that we run the risk of losing touch--literally--with what we're trying to do. It's important that we not turn every last thing into a simulation when, with some practical considerations, reality is right there in front of us.

allnurses Guide · Feb 5, 2010

Something to think about, people who are saying we need to "see how the patients feel going through this." If I remember correctly, were doing these things to improve their health and well being, to HELP them. Therefore even a student "getting in the patients position" I don't think could still understand what the patient is going through. Like you always hear, you don't know how anyone perceives anything, except for how you do.

I understand what you are saying, I think. I've got a friend who has an illness that renders her immobile, but not paralyzed, meaning she can't move her extremities, but she feels pain, pressure, heat, cold, etc. I mentioned this subject with her in a very general way, fully expecting her to agree with those on the bed bath as lesson in empathy side of things. I was fully expecting her to tell me I was full of it. To my surprise, she didn't. She is the most wonderful person ever. She's had caregivers for over 25 years. Essentially, she made the point above. She related some of the things she has gone through, like being dropped on the floor and breaking a wrist.

Moogie, I don't have a problem at all with breath sounds, bowel sounds, etc. - the bed bath I can see the benefits of it as long as those who might object for cultural or personal reasons aren't singled out and pressured. Some of the responders have said they would ask questions like "well, how do you expect to do these things on real patients if you aren't willing to go through them yourself?" I first learned blood withdrawal and IVs in a private MD office, on real patients from day one, did fine. Later on I had to take a course to add the certification to my license - since it was my classmates I drew blood on my hands were shaking like a leaf! :confused: so things don't always (with me anyway) follow the norm.

We didn't have any Sim people when I went to school- the first one I saw was Resusa-Annie! :) I would have loved to practice a catheterization on a mannequin a few times or a hundred before I had to do it on a real person. Teaching tools have really improved, that's for sure.

~Mi Vida Loca~RN, ASN, RN · Feb 5, 2010

I wanted to reply to this the other night and didn't get a chance, I haven't read all 7 pages now (it was like 2 last time I was here) but I wanted to reply.

I would NOT be ok undressing in class for anything, I am an extremely modest person and I would drop out of nursing school before I stripped down to my underwear (which is what a swimsuit can be pretty much the same) to be vulnerable to my entire class.

Now, our lab is set up like a hospital unit. We have like 13 beds all with curtains like a mini room. I was freaked out enough when our instructor "warned" people to wear underwear for our next lab. When asked why, she said to find the IM spots we would be pulling our pants down on one side for access to the area. That was going to be hard enough for me. I am sure if I would have refused they would have understood, because I did ask for more information from my instructor as to what would be required. We don't really inject each other, it was just to demonstrate we can find the land marks. So what it amounted to was me and another class mate and an instructor in one of the "rooms" with the curtain closed, I had to pretty much expose my hip.

I do not agree with the notion that we should be made to be put in a position to be vulnerable to an entire class, because we are expecting the pt. to be that way to us. A patient has a right to refuse any treatment, they have a right to refuse a student in the room, (and they will). They are not FORCED to allow me to put them in a vulnerable situation or they will be kicked out of the hospital. I always respect my pt's privacy, which I have found in doing my clinicals is seldom done. 4 nights now I have been at my hospital clinicals and 9 out of 10 times the nurses and docs are not pulling the curtain or shutting the door. Even passes the hall while an aide was toileting someone and the door was wide open. I am not like that at all. I will close the curtain when I am doing anything with my Pt. you never know when something might happen.

But point is, I signed up for Nursing school, nothing in the handbook says that in order to go to school I must be willing to strip down and allow fellow classmates to do this or that with me. A pt goes into the hospital to get better, this is usually a choice by themselves or someone they have allowed to make choices for them. They know that in order to get better, sometimes they might have to be "exposed" and when this happens, they expect to have their dignity intact and usually won't mind as long as they are being respected. After all they WANT to get better.

But if at anytime, they are not ok with a nurse or a student or an aide or Dr. being apart of their care, they have a right to ask for someone else, not allow that procedure, etc. etc.

~Mi Vida Loca~RN, ASN, RN · Feb 5, 2010

For the record, I have been a Pt. many times, I have had a hx of female problems and also spent a lot of time in military hospitals were privacy and respecting that, didn't often go hand in hand. I know all about how a Pt. feels without having to strip to my undies and let someone practice a bed bath on me. Me knowing how a pt. feels and things I loved about my care givers and things I didn't, is what made me want to become a nurse. Was all from the impact the good and bad had on me.

If they were practicing with me fully clothes, I have no problems with that.

We have like gazillion sims dolls in my school and that is what we used. Which is totally different then a real person of course, but it was a starting point. So far I haven't had any trouble from going from the SIMS to my first patient. My first injection I was a ball of nerves but I didn't let the pt see and I went in and did. I am sure this will be how it is on all my firsts, and at the end of the day, although practicing on a fellow student is at least a human, it's still not the same as a PATIENT.

tiffanyleigh0212 · Feb 5, 2010

"We have like gazillion sims dolls in my school and that is what we used. Which is totally different then a real person of course, but it was a starting point. So far I haven't had any trouble from going from the SIMS to my first patient. My first injection I was a ball of nerves but I didn't let the pt see and I went in and did. I am sure this will be how it is on all my firsts, and at the end of the day, although practicing on a fellow student is at least a human, it's still not the same as a PATIENT. "

That's what I was trying to say!!!

allnurses Guide · Feb 5, 2010

1988.

Bed baths in panties and gowns.

Feeding each other.

Toothbrushing.

Dressing.

And MY favorite...

Being strapped in a Posey to a wheelchair... for the length on one clinical.

And yes.

You WILL remember that experience when your patient tells you they have to pee.

It's about letting you experience the patient's reality.

bluemushroom · Feb 5, 2010

I can't believe that some people are saying you can't have empathy if you don't experience things such as bed baths, assessments, and, even worse, IVs, catheters, enemas, etc. Some are even saying that students should have to have these things practiced on themselves. Others have gone so far as to say that people who refuse to have these things done to themselves won't be good nurses and should find another career. That is completely wrong, and I think it's just squirrel poop nutty! Nobody should feel forced to let someone cross their personal boundaries just because they feel like they have to prove their desire to be a good nurse. Everyone's sense of modesty is different. Some people may have issues with their body and don't want other students touching them or seeing them. No one should ever have to feel uncomfortable.

Also, the student-patient relationship is a lot different than the student-student relationship. Everything done to a patient is professional, but students socialize with each other and see each other everyday. Things can get pretty awkward when you've practiced certain skills on each other.

I wonder how far all of these people who advocate forcing students to have invasive, embarassing, and private procedures practiced on themeselves are willing to go before they would draw the line if they were told they had to let someone do these things to them. My guess is, not very far at all.

I will also admit that, while I am a very patient and try to accommodate students whenever possible, I got pretty irritated with one student who was "afraid" to let another student give her an injection of saline. What irked me was that this student had multiple tats and piercings, many in places that must have been VERY painful to pierce or tattoo. Also, she had no qualms about giving an injection to another student but she just didn't want to be on the receiving end.

I can understand you being annoyed that the student was willing to give injections to other students but not willing to let someone do it to her. If I don't want to have things done to me, I'll also refuse to do those things to another student. That's why we have mannequins.

However, being irked because you felt that she should be ok with someone practicing an injection on her just because she has loads of tats and piercings is ridiculous. I've had tons of piercings and (sorry if this is TMI) some are in hidden places that would be considered quite painful, but there's no way I'm going to let another student practice an injection or IV on me. I really don't care how silly an instructor thinks it is that I refuse. There's a big difference between getting a piercing that I want versus letting students practice invasive skills on me due to feeling obligated out of fear of what the instructor and other students are going to think of me for refusing.

allnurses Guide · Feb 5, 2010

Being strapped in a Posey to a wheelchair... for the length on one clinical.
And yes.
You WILL remember that experience when your patient tells you they have to pee.
It's about letting you experience the patient's reality.

I guess there must be no limit, then. I hope you guys never have an older female student with stress incontinence.

VespaLPN · Feb 5, 2010

We signed waivers and did IV's on each other, made occupied beds (fully clothed), ambulated, vitals, assessments, and injections, etc.

We have sims we have named for peri care and bathing (one is named George Clooney!),.....

I didn't know some programs had students bathe one another! That's a good heads up for me to prepare for when I go back for my RN degree down the road... :uhoh3:

sharpeimom · Feb 5, 2010

i guess there must be no limit, then. i hope you guys never have an older female student with stress incontinence.

for some strange reason, the mental image that statement conjured up in my mind, made me laugh.

too many years in nursing warps your mind, i think... :cool:

kathy

shar pei mom:paw::paw:

Moogie · Feb 6, 2010

I can understand you being annoyed that the student was willing to give injections to other students but not willing to let someone do it to her. If I don't want to have things done to me, I'll also refuse to do those things to another student. That's why we have mannequins.
However, being irked because you felt that she should be ok with someone practicing an injection on her just because she has loads of tats and piercings is ridiculous. I've had tons of piercings and (sorry if this is TMI) some are in hidden places that would be considered quite painful, but there's no way I'm going to let another student practice an injection or IV on me. I really don't care how silly an instructor thinks it is that I refuse. There's a big difference between getting a piercing that I want versus letting students practice invasive skills on me due to feeling obligated out of fear of what the instructor and other students are going to think of me for refusing.

Excuse me. I am trying very hard to be open to another point of view on this thread. I treat people here with respect and do NOT ridicule anyone for stating his/her feelings. I am offended by your attitude that my feelings in this matter are in any way invalid or "ridiculous". I am offended by your comments that you think it's "silly" for an instructor to be upset when a student refuses to permit someone to test out on her when she tested out on someone else without expressing any concern about that student's fear or feelings.

I was looking for information and wanted to have an open mind to see how others might feel about this. Instead, I am told that I am being "ridiculous". Whatever.

cookderosa · Feb 6, 2010

In all honesty, the school at which I taught had budget issues. The skills lab was so poorly supplied that students could not even practice spiking IVs so I highly doubt they could have justified spending money on a simulator. I will tell you---the situation with the poorly stocked skills lab has made me VERY aware of things to look for when applying for my next position. I really enjoyed teaching skills lab but hated trying to deal with outdated equipment and the general lack of adequate supplies.
Additionally, the student with whom I felt irritated was very manipulative and did several things to faculty, including myself. I felt emotionally drained and violated over the things she did and, when I left that job, I wondered if I ever would return to teaching because the experience was so bad. A lot of people here talk about how one instructor can destroy a student---let me assure you all that it goes both ways. I was able to put the experience into perspective and learn from it but at the time, it was horrible. I felt hazed, too, and ended up getting hazed in other ways as well. It was not a healthy system.

I know and fully understand...really. That's why I'm going into nursing. I have for about 5 years really been too burnt out, but have stayed anyway. It just gets old-- and I know it has nothing to do with this thread, just that you took the time to reply to my post and I wanted you to know I can SO identify with what you are saying!! :)