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First vaginal exam

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How are new nurses taught vaginal exams? Do you just learn about it in theory, and then go in and do it with the patient unaware you don't know what you are doing?

Or does your preceptor go in with you to assist? It just seems to me that a laboring women wouldn't be too keen on being a teaching moment...:confused:

zahryia, LPN

Specializes in L&D, QI, Public Health.

How are new nurses taught vaginal exams? Do you just learn about it in theory, and then go in and do it with the patient unaware you don't know what you are doing?

Or does your preceptor go in with you to assist? It just seems to me that a laboring women wouldn't be too keen on being a teaching moment...:confused:

Good question. I've been wondering this myself. I was thinking of maybe doing it on a patient who has an epidural, cuz my patients look SO uncomfortable when they have an exam.

I hate pap smears, so I can only imagine the discomfort of a freaking hand all up your stuff.

pink85

Specializes in School Nursing, Pedi., Critical Care.

It has been my experience that the patient is aware or you ask the patient if they mind to have a student nurse. My preceptor was always at my side and did the exam right after mine to see if we got the same dilatation. When they know you are a student they usually don't mind. Patients with an epidural is a benefit!

I have no experience as a student nurse...YET! But I can say that when I was in labor...I was at a teaching hospital and I had more then my fair share of oB interns and student nurses with their hands up there! I didn't care though because I know that is how they learn...and I also knew that one day I would be one of those people!

moongirl

Specializes in OB.

As a student, we were not allowed to do vag exams. As a new nurse, the first few I did, I asked to please wait until the epidural was in place. I did not think it was fair to the pt to have someone who had no exp digging around and sometimes around and around searching.

I still apologize to the OB checks that come in that I have to assess, even tho I now know what I am reaching for. No matter how gentle you try to be, it still hurts!!

I would always check before or after my preceptor, and it was always great if they had an epidural. And we had one of those models in a box that we would practice with if there was time.

Take a female nurse partner and do it on each other. That's what we do in midwifery school. If you can learn on someone else, you can learn on each other. Not so bad as it sounds.

Barkow

Specializes in L&D/postpartum.

When I was a new nurse I always let patients know that I was learning, and not a single person ever objected to having both me and my preceptor do consecutive vag exams. I tried to do mostly patents with epidurals at first, and volunteered to check all patients even if they weren't mine, but since it's a small hospital I kind of had to take what was there that day, epidural or not.

cvssc

Specializes in L&D telephone triage. Has 12 years experience.

My preceptor went with me every time. We would tell the patient both of us would be doing the exam as I was new to L&D. They usually had an epidural and were agreeable. I worked in a teaching hospital, so nurses and medical students were learning.

My problem was everyone I checked was 7 or more CM. It was over a year before I felt a closed or less dilated cervix.

And, like the other person, I still apologize for the pain or discomfort. As an Eval nurse, if possible, I save my patient's from too many exams if they are too uncomfortable or nervous.

HeartsOpenWide, RN

Specializes in Ante-Intra-Postpartum, Post Gyne.

I did a pelvic exam on a classmate in a Beginning Midwifery course I took outside of my nursing program. I got to do my first (and only so far) dilation check during a preceptorship through a different nursing program than my own. The preceptor had to duplicate all of my exams for accuracy. I did not learn on my regular OB rotation.

cradlecrewer

Specializes in L&D. Has 23 years experience.

Take a female nurse partner and do it on each other. That's what we do in midwifery school. If you can learn on someone else, you can learn on each other. Not so bad as it sounds.

YIKES!! Besides YIKES...although that would be good if you wanted to know what a closed/thick/high cervix felt like..I ain't doing it!:no::D

brokenroads27

Has 1 years experience.

YIKES!! Besides YIKES...although that would be good if you wanted to know what a closed/thick/high cervix felt like..I ain't doing it!:no::D

"I did a pelvic exam on a classmate in a Beginning Midwifery course I took outside of my nursing program. I got to do my first (and only so far) dilation check during a preceptorship through a different nursing program than my own. The preceptor had to duplicate all of my exams for accuracy. I did not learn on my regular OB rotation. "

^seriously? i cant believe some schools have the students do exams like that on each other. i would not volunteer for something like that LOL and i thought MY school was touchy-feely.

klone, MSN, RN

Specializes in Women's Health/OB Leadership. Has 15 years experience.

YIKES!! Besides YIKES...although that would be good if you wanted to know what a closed/thick/high cervix felt like..I ain't doing it!:no::D

Once you can find a closed/thick/high cervix and identify it, the rest is much easier. And not all non-gravid cervixes are automatically closed thick and high. Women who have had a vaginal delivery almost always have an outer os that's slightly open, and depending on where you are in your menstrual cycle, your cervix might be up to a cm open, soft and pretty low.

I'm starting midwifery school this fall, and it will be interesting to see how they handle it. Afte 5 years working L&D I don't need to practice on anyone, and while I have no problem if others practiced on me, I no longer have a cervix, so I would probably be of limited educational benefit to anyone.

LoveANurse09

Specializes in Cardiac.

I've heard of one school that has the rule, if you dont volunteer, you dont get to practice. Makes sense. This was how it was at my school with practicing IV starts :). I was lucky to feel one cervix during my OB practicum (epidural pt), but in regular clinical in school, it was a NO.

arabianeyez83

Specializes in ER. Has 7 years experience.

Take a female nurse partner and do it on each other. That's what we do in midwifery school. If you can learn on someone else, you can learn on each other. Not so bad as it sounds.

Ouchhhhhhhhhhhh, no wayyyyy

PetiteOpRN

Specializes in PeriOperative. Has 11 years experience.

I promise your first vaginal exam will not be this bad:

My father is a surgeon who knew from the time he attended his first A&P class he wanted nothing to do with anyone's reproductive anything. He's proudest accomplishment in med school was being one of two students who never did a pelvic. No pelvics in internship, either. When he was a 2nd year general surgery resident (so we've had a number of years to completely forget everything we once had to know about female anatomy in med school), the director of the ED decides that every female patient with abdominal pain is getting a pelvic, gosh darn it.

He is on call at 2am and a woman comes in with abdominal pain. This poor woman is clad in a burqa, and doesn't speak a word of English. This was 30 years ago, so cultural sensitivity was not yet in vogue, and I don't know if a female staff member had to be present for the exam. He sticks his hand in, without a clue of what he's supposed to be doing, and she cries out in pain, intermittently.

So, no matter who you are, you are probably doing a better job than the one above.

arabianeyez83

Specializes in ER. Has 7 years experience.

I promise your first vaginal exam will not be this bad:

My father is a surgeon who knew from the time he attended his first A&P class he wanted nothing to do with anyone's reproductive anything. He's proudest accomplishment in med school was being one of two students who never did a pelvic. No pelvics in internship, either. When he was a 2nd year general surgery resident (so we've had a number of years to completely forget everything we once had to know about female anatomy in med school), the director of the ED decides that every female patient with abdominal pain is getting a pelvic, gosh darn it.

He is on call at 2am and a woman comes in with abdominal pain. This poor woman is clad in a burqa, and doesn't speak a word of English. This was 30 years ago, so cultural sensitivity was not yet in vogue, and I don't know if a female staff member had to be present for the exam. He sticks his hand in, without a clue of what he's supposed to be doing, and she cries out in pain, intermittently.

So, no matter who you are, you are probably doing a better job than the one above.

Hahaha...but nowadays, pt's are more intimidating and expect you to know what the hell you're doing! lol

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