Elephant in the China Shop

[hcworker]

The Elephant in the China Shop

Everybody knows he's there but everybody wants to ignore it.

I'd like to raise an issue all of us are aware of but almost nobody appears comfortable enough to want to talk about.

How do things go when you need to do intimate procedures on a patient of the opposite sex? How do you feel about it and how does the patient feel?

Most of us are female. Let's say you have a male patient on whom you have to place a Foley (or a straight cath). Or you are to administer an enema.

I've had many off-the-cuff talks with colleagues and the reaction is all over the map. Some enjoy the intimacy; some are very uncomfortable. Providers at both extremes may try to cover up their feelings by one means or another. All of us are conditioned from childhood to maintain our own body modesty and it's difficult to violate somebody else's as a matter of routine, if we have any empathy with the patient. (And if we don't have much empathy, why are we nurses??)

And what about the patient? Male or female, most of them do not know they can refuse procedures that make them feel uncomfortable. If they did, I wonder if most of them would, just to avoid embarrassment. If you're female do you tell the male patient he's free to refuse this enema or that catheter? Or that he can choose a male administrator? Or do you charge right in with the enema tube or Foley as if they have no power to refuse? Male patients are very fragile in a way. Their macho makes them feel they need to be in control and they feel so put down if they're shown to be powerless that it's toxic. Especially if they are put through procedures that make it very clear women are in complete charge of their bodies. They've been brought up to think things should go the other way around. And they're too embarrassed to complain about being embarrassed.

I'm trying to put this subject on the table so we can talk about it among ourselves, maybe find better ways of dealing with it and hopefully allow us and the patient to feel more comfortable. I didn't even bring up how you may feel if you're a female patient about to receive an intimate procedure from a male nurse, but there should be similarities.

An unscientific summary after years of observation and talk might go like this, for patients of one sex receiving intimate procedure from nurses of the opposite sex:

1. Some patients are super-embarrassed, extremely uncomfortable. They may feel invaded and take away psychic damage.
   
2. Some are exhibitionistic and enjoy the exposure, glad for a context in which it can occur where nobody can charge they are perverted for seeking (or enjoying) it.
   
3. And everything inbetween those extremes. Very few are indifferent or treat it with the psychological neutrality one would a dental procedure, which also is invasive.
   

And for the nurses:

1. Some are embarrassed and may cover by coming on with cheery professionalism;
   
2. Some enjoy the access and cover by the same (or a different) route.
   
3. Not many are indifferent, probably more nurses than patients since we do these things far more often than they encounter them. But it's been said you might as well try to be indifferent toward sex.
   

A related question is what do you do if your opposite-sex patient, in response to unavoidable genital exposure or touching (as for a catheter), shows signs of sexual excitement. I've heard about all sorts of reactions, from ignore it” (usually easier to do with a female patient) to making remarks to defuse the situation.

In the case of a male patient with a full erection:

1. ‘Well, I'm so glad you're enjoying the examination/ procedure!”
   
2. If you can't get that to come down quickly, it may be painful when I work the catheter into place.”
   
3. Let's try this bucket of ice water I just happen to have here.”
   

Sometimes men get erections just because they're embarrassed.

Also, a male patient may be embarrassed because his erection may be the result of the stimulation of his sphincter due to enema prep. He may be concerned about being considered gay and may need reassurance this also happens to straight men.

I'm posting this here to try to shine some light on an issue usually swept into a dark corner because people are uncomfortable with it. What are your thoughts? Have you found good ways to deal with the subject, whether as nurse or patient, that may help us to know about?

Talk to us.

--hcworker

[OCNRN63, RN]

Talk to us.

--hcworker

Talk to "us"? Do you have multiple personality disorder?

[Ruger8mm]

It's just the human body. No big deal. As an echocardiographer I've been performing arguably intimate procedures on ladies for 16 years. It hasn't been anything special for a long long time. I'm so comfortable now, I can even put the anxious patients at ease.

We are adult professionals. Things such as this topic should not be an issue.

[macawake, MSN]

I'm trying to put this subject on the table so we can talk about it among ourselves, maybe find better ways of dealing with it and hopefully allow us and the patient to feel more comfortable. as nurse or patient, that may help us to know about?

I'm already comfortable doing these nursing tasks. So are my patients. If they for whatever reason wouldn't be comfortable with me as their nurse, I'll ask the patient if they would prefer that another nurse do the procedure. Not a problem. I don't find the topic embarrassing at all but I really have no need to discuss this topic at any great length or depth, I'm good :)

Talk to us.

Just out of curiosity. Who's "us"?

[LakeEmerald]

Don't overthink. It's just the human body and it does what it does. Just be kind, compassionate, and do the procedure. If you're confident, competent, and comfortable, your patient will have confidence in you. Just keep them covered as much as possible without compromising your procedure.

[MunoRN, RN]

Mixed metaphors aside, I haven't actually found it to be that uncomfortable of an issue, at least until you suggested some people "enjoy the intimacy" of placing a catheter which I don't think is actually all that common. As for obtaining verbal consent and leaving open the option of refusal, that's pretty standard at least in my experience, if there are places where it's not then that should be dealt with.

[icuRNmaggie, BSN, RN]

OP joined yesterday and this sounds suspiciously like a writing assignment.

[macawake, MSN]

OP joined yesterday and this sounds suspiciously like a writing assignment.

I don't know.. It's focused more on male modesty than female and also implies that some female nurses have rather err.. different triggers for sexual arousal than the "norm". I'm sceptical as to this being homework assigned by a nursing professor.

It starts with a false premise. Everybody in the room knows that the elephant is there, but everybody wants to ignore it. "Everybody" knows no such thing. Homework wouldn't in my opinion be based on a flawed assumption.

[Horseshoe, BSN, RN]

The Elephant in the China Shop

Everybody knows he's there but everybody wants to ignore it.

I'd like to raise an issue all of us are aware of but almost nobody appears comfortable enough to want to talk about.

That's not true. We talk about all manner of things on AN, most of the time with very little discomfort. Because we are PROFESSIONALS.

Oh-and welcome to All Nurses.

How do things go when you need to do intimate procedures on a patient of the opposite sex? How do you feel about it and how does the patient feel?

Most of us are female. Let's say you have a male patient on whom you have to place a Foley (or a straight cath). Or you are to administer an enema.

I've had many off-the-cuff talks with colleagues and the reaction is all over the map. Some enjoy the intimacy; some are very uncomfortable. Providers at both extremes may try to cover up their feelings by one means or another. All of us are conditioned from childhood to maintain our own body modesty and it's difficult to violate somebody else's as a matter of routine, if we have any empathy with the patient. (And if we don't have much empathy, why are we nurses??)

And what about the patient? Male or female, most of them do not know they can refuse procedures that make them feel uncomfortable. If they did, I wonder if most of them would, just to avoid embarrassment. If you're female do you tell the male patient he's free to refuse this enema or that catheter? Or that he can choose a male administrator? Or do you charge right in with the enema tube or Foley as if they have no power to refuse? Male patients are very fragile in a way. Their macho makes them feel they need to be in control and they feel so put down if they're shown to be powerless that it's toxic. Especially if they are put through procedures that make it very clear women are in complete charge of their bodies. They've been brought up to think things should go the other way around. And they're too embarrassed to complain about being embarrassed.

You are making a hell of a lot of assumptions. Each male patient is an individual; you have no business deciding that because he's male, he is "fragile," "macho," or believes that "things should go the other way around." I approach each patient with no assumptions and simply maintain a professional, calm, and respectful demeanor. I have no personal discomfort with these procedures you describe.

An unscientific summary after years of observation and talk might go like this, for patients of one sex receiving intimate procedure from nurses of the opposite sex:

1. Some patients are super-embarrassed, extremely uncomfortable. They may feel invaded and take away psychic damage.
   
2. Some are exhibitionistic and enjoy the exposure, glad for a context in which it can occur where nobody can charge they are perverted for seeking (or enjoying) it.
   
3. And everything inbetween those extremes. Very few are indifferent or treat it with the psychological neutrality one would a dental procedure, which also is invasive.
   

And for the nurses:

1. Some are embarrassed and may cover by coming on with cheery professionalism;
   
2. Some enjoy the access and cover by the same (or a different) route.
   
3. Not many are indifferent, probably more nurses than patients since we do these things far more often than they encounter them. But it's been said you might as well try to be indifferent toward sex.
   

Some "enjoy the access"? Oh COME ON.

And what do you mean by be "indifferent toward sex"? Inserting Foley catheters and giving enemas have NOTHING to do with "sex." If you are referring to gender, you need to make that more clear, because as it is, you sound really inappropriate.

A related question is what do you do if your opposite-sex patient, in response to unavoidable genital exposure or touching (as for a catheter), shows signs of sexual excitement. I've heard about all sorts of reactions, from ignore it” (usually easier to do with a female patient) to making remarks to defuse the situation.

In the case of a male patient with a full erection:

1. ‘Well, I'm so glad you're enjoying the examination/ procedure!”
   
2. If you can't get that to come down quickly, it may be painful when I work the catheter into place.”
   
3. Let's try this bucket of ice water I just happen to have here.”

How about none of the above? You really couldn't come up with anything better?

Sometimes men get erections just because they're embarrassed.

Also, a male patient may be embarrassed because his erection may be the result of the stimulation of his sphincter due to enema prep. He may be concerned about being considered gay and may need reassurance this also happens to straight men.

No, there is no need to bring sexual orientation into that conversation. You simply reassure them that they are experiencing a normal reaction and leave it at that. Personally, I've never had a male patient experience an erection during foley insertion or while receiving an enema, but if it happened, I know to be calm, professional, and not to make assumptions about how they may feel about it.

I'm posting this here to try to shine some light on an issue usually swept into a dark corner because people are uncomfortable with it. What are your thoughts? Have you found good ways to deal with the subject, whether as nurse or patient, that may help us to know about?

Talk to us.

--hcworker

Hmm, you remind me of someone...another poster who was very focused on this exact issue.

I don't go into a situation announcing that a patient has a right to refuse. I will explain what I am going to do, why it is indicated, and ask if they have any questions. If I am asked to get a male nurse to do the procedure instead, I will gladly comply. It has never happened, but there's a first time for everything. If the patient expresses that he doesn't want to do the procedure, I will tell him that is his right, but owe him information about what possible consequences his refusal could have. I would be remiss if I just said "Okey dokey" without letting them know about any potential outcome of that refusal. I would offer to call the doctor to get them more information, I'd seek out any other materials which might be helpful, all in a caring and non argumentative manner.

I am very good at inserting Foleys. I'm not great at everything, but this is one of the things that other nurses would ask me to do or to help with. I know it is not always a comfortable thing to go through, so I do have empathy for the patient and I believe my compassion is apparent. My male patients have often thanked me for explaining things to them, for being gentle, and often tell me that the procedure was nowhere near as bad as they expected. No matter the procedure, I always do everything I can to respect the patient and maintain his dignity.

[nursel56]

I don't think everybody wants to ignore that topic at all. We regularly have friends and family members register accounts just so they can talk about that.

I have never heard any nurse say they "enjoy the intimacy" of placing a catheter or giving an enema, and since you used the phrase "most of us are female" I would question what it is in your background as a nurse (if that was what the "us" implication meant) that would cause you to include that in your query.

[meanmaryjean, DNP, RN]

Most inappropriate thing I've read today.....

Oh, and it's 'elephant in the room' and 'bull in a china shop'. You're welcome.

[roser13, ASN, RN]

There is no "elephant" in any room (or china shop). This is discussed all the time between health care professionals, and always from the standpoint or providing the most comfortable, professional care to our patients.

Another issue with your post (besides the bull-elephant confusion). You are labeling a medical care procedure as 'intimate.' That adjective contains an assertion of personal, possibly sexual, relationship. Whenever someone attempts to sexualize a medical procedure, my radar goes up.

INTIMATE. Adjective

1.associated in close personal relations:an intimate friend.

2.characterized by or involving warm friendship or a personally close or familiar association or feeling:an intimate greeting.

3.characterized by or suggesting an atmosphere conducive to privacy or intimacy; warmly cozy:an intimate little café where we can relax andtalk.

4.(of an association, knowledge, understanding,etc.) arising from close personal connection orfamiliar experience.

5.engaged in or characterized by sexual relations:too young to handle an intimate relationship.

"I'm posting this here to try to shine some light on an issue usually swept into a dark corner because people are uncomfortable with it. What are your thoughts? Have you found good ways to deal with the subject, whether as nurse or patient, that may help us to know about?"

Talk to us."

Wrong....we are not uncomfortable with performing medical procedures and we don't sweep. I'm talking to all of you even though I don't know who all of you are, other than folks who may have some issues with the sexualization of medical issues.