Changing male patient's brief

[JoMar]

Hey all, 

This is my first post, so be gentle. 

So I work in outpatient surgical and I had a male patient today with sinus surgery. 

His chart says he doesn't like foley Caths and he has OAB and urge incontinence, so he prefers to wear briefs, which he brought from home. 

So he comes out of surgery, groggy but the brief is slightly wet. He asked for his bag so he could change himself, but I didn't think he could do it, so I offered. He said okay.

So during, he did get erect, but he apologized multiple times. He only got erect during cleaning. I put some vaseline on for barrier treatment, but he wasn't erect then. He did wet again, but he insisted on changing himself and I felt he could, this was about 20 minutes later and he did drink a lot of water. I left him alone, and when I came back, he was already finished changing and half way dressed. The brief was a bit crooked, so I offered to adjust it. He said okay, but the brief was never removed this time. Just re-taped, but I felt that he didn't change himself.

My colleague said I did the wrong thing and that he was one of those diaper people. Now IDK if I did the right thing. 
 

This has been bothering me ever since. Was I wrong. 

[JKL33]

JoMar said:

My colleague said I did the wrong thing and that he was one of those diaper people.

That sounds like an inappropriate judgment. Just because a thing exists doesn't mean it applies to every scenario. I am trying not to harshly judge your coworker but if you told him/her the majority of what you've written here then his/her response sounds pretty uneducated.

You will know if/when you meet someone who wants you fiddling down there more than is necessary.

[JoMar]

JKL33 said:

That sounds like an inappropriate judgment. Just because a thing exists doesn't mean it applies to every scenario. I am trying not to harshly judge your coworker but if you told him/her the majority of what you've written here then his/her response sounds pretty uneducated.

You will know if/when you meet someone who wants you fiddling down there more than is necessary.

Honestly, I told her about the erection part and that's when said that about him. 
 

I think that part was more a reaction than anything else. When that happened I could tell he was embarrassed, since he was covering his face, during that part. He watched me put the vaseline on though. 

But want are the things I should look for so I can keep it in the back of my mind. Thank you in advance, Jo

[JKL33]

JoMar said:

But want are the things I should look for so I can keep it in the back of my mind.

Really don't need to worry about it too much.

IMHO you did what was right here, you had a patient whom you weren't sure if they needed help due to just coming out of anesthesia, etc. So you provided nursing care.

My advice is pretty basic: 1) Assess the situation 2) Make appropriate plan/do appropriate intervention 3) Treat people with respect

It sounds as if you did these things.

IF you run across a situation wherein your assessment leads you to a different conclusion, you will do a different thing. For example, if you encounter someone who objectively does not need help with personal hygiene but they make requests that make you uncomfortable because they are not appropriate in nature or not appropriate to the situation, then you do something different. "I'll hand you the wipes" or "I'll put the barrier cream right here on your table" or "Here are the items you'll need to get changed--I'll check back in a few" or  "What process do you usually use at home?" or even "I think you can take care of this" -- all of these and more MAY be appropriate depending on your assessment.

 

JoMar said:

Honestly, I told her about the erection part and that's when said that about him. 

I wondered. Both of you need to know that the presence or absence of erection is not a good indicator of things.

[JoMar]

Curious to hear what others have to say on the topic 

Thanks ? 

[Nurse Trini]

He sounds like he was going to change himself, which lends me to believe he isn't one of "those" types.    I've had males get erections while doing foleys and I doubt there are a lot of people who get off on that.

[Davey Do]

JoMar said:

Curious to hear what others have to say on the topic 

Thanks ? 

Those things have a mind of their own, will rise to any occasion, and only a sharp slap of the sympathetic nervous system will keep 'em down.

Seriously Jo, you handled the intervention well, and if the patient responded to you with no inappropriate statements or gestures, he just had a normal response to some stimuli.

[JBMmom, MSN, NP]

You did nothing wrong. As has been pointed out, sometimes the wind blows the wrong way and there's a response. You were acting in the patient's best interest per his request to not have a catheter, no need for worry.

[JoMar]

Thanks all. 
 

I did work In a urologist office for about 2 years before going to a post op room in a hospital. I knew about the reaction thing but my coworker really threw me off and made me second guess myself. I don't let that happen too often & she labels everybody anyway, so I guess I should have known better

 

[Tweety, BSN, RN]

Erections happen.

I'm curious as to why you would put vaseline on him?  Did he ask you to?  Is it part of his home routine?  Is it part of your skin care protocol for incontinence?   

I might have changed his brief for him if he was too sedated to do it himself, but not vaseline unless he asked or it was a part of his home routine and you felt he couldn't do it himself.  It was a day surgery, no need for a skin protection routine he's not doing.

[foxypaws, BSN, MSN, RN]

I've had patients under MAC anesthesia get an erection just from surgical prep in cysto. It's can be an entirely involuntary reaction. 

[CommunityRNBSN, BSN, RN]

Also, it is actually irrelevant (in this case) whether he was "one of those diaper people.”  Obviously it would be different if you were caring for a man who had no need for help with hygiene at all and was trying to get you to do something. But this person was coming out of surgery, and you felt was too groggy to care for himself, so you performed the appropriate nursing action. So what if your coworker thinks he was "a diaper person"?  If you had suspected that, would you have told this half-sedated surgical patient that he had to figure out a way to change his own brief?  Of course not. You did the right thing!