Ever have a patient comment on his lack of size?

[FireStarterRN]

I felt so embarrassed. :imbar

I had to cath this man who was in his 40's, he ended up having to go for emergency surgery, he was in agonizing abd pain with a perfed bowel. When I went to cath him he managed to mentioned that it was all shriveled up. (Incidentally, he actually appeared to be a normal sized male)

The surgeon actually wasn't sure if he was going to survive surgery, but he did come back with an A-line, CVP line, and a brand new ileostomy. On the second day I had him, he managed to go more in depth into the fact that he "doesn't have much down there that any girl would be interested in" and comments like that. Honestly, this man was totally average looking.

He was a very gentle man, mid 40s, gainfully employed, who still lives with his mother, who was really nice. I just didn't know how to handle this. I think this must have been a life long insecurity. I almost said to him that he wasn't actually small, he really wasn't, but I didn't want to act like I really notice this. But, I do have vast experience with this aspect of nursing, I do notice if a man looks either unusually larger or smaller than the average, and this man definately was actually probably better than average, especially since he was in a cold hospital room in agonizing pain.

Anyone ever run into this issue?

[58flyer]

The first male patient I cathed, had a bladder tumor blocking the foley. My preceptor finished putting it in there. He screamed and cried, and it was fairly jarring for me as well, particularly since he started crying the next day when I went into his room. Not like we were going to go through that again, but anyhow. We didn't know he had a tumor in there, they found that out after I went home. There hasn't been another one quite as traumatic as that. ..........

Yikes Indy! That was jarring for me to read!

Who was advocating for this patient? Certainly not the nursing staff! The poor patient screaming and crying should have been a powerful clue that something was definitely wrong. You might claim dumb because you were new, but the preceptor should have got his/her license revoked.

I've worked around nurses who claimed to be always able to do the difficult cath. They could cath anybody. Sure you can if you just ram it through. I'm sure pride was the motivating factor for pressing on when the prudent thing to do was to back off and call for a uro consult. I wonder how many patients needlessly suffer because of somebody's ego. :angryfire

There is a wonderful invention called anesthesia. Patients shouldn't suffer pain needlessly when alternatives are readily available.

I wonder if that patient's memory of that experience carried over into his approach to his future healthcare needs???

[squeakykitty]

Yikes Indy! That was jarring for me to read!

Who was advocating for this patient? Certainly not the nursing staff! The poor patient screaming and crying should have been a powerful clue that something was definitely wrong. You might claim dumb because you were new, but the preceptor should have got his/her license revoked.

I've worked around nurses who claimed to be always able to do the difficult cath. They could cath anybody. Sure you can if you just ram it through. I'm sure pride was the motivating factor for pressing on when the prudent thing to do was to back off and call for a uro consult. I wonder how many patients needlessly suffer because of somebody's ego. :angryfire

There is a wonderful invention called anesthesia. Patients shouldn't suffer pain needlessly when alternatives are readily available.

I wonder if that patient's memory of that experience carried over into his approach to his future healthcare needs???

There really isn't any excuse to ram a foley in and cause pain. I thought every nurse was taught to call the Dr. if the foley won't go in, and don't ram it in.

[Psychtrish39, BSN, RN]

This is a very embarrassing thing for men. I myself have the shirvling up problem, whent aroused it rebounds nicely but it still is always in the back of your mind.

Twister..

My BF does too and its when he is cold and he rebounds nicely... also... I think its sad men feel bad about their sizes as patients in health care or otherwise... I have had this situation happen one time and it was after a TURP and I said your member is fine and he never said anything again. I was a new graduate nurse at the time and I thought that was the best thing to say... :) He had some much treatment ahead of him.. I hoped at the time I said the right thing but I always have wondered.

[aeauooo]

What I hear is nurses talking. That's all. That's how we survive all of the stresses and psychologically challenging aspects to our jobs - we talk to each other because we understand each other better than anyone else outside of nursing.

I don't find anything wrong with the fact that some of the comments have been light-hearted.

[Indy, LPN, LVN]

Yikes Indy! That was jarring for me to read!

Who was advocating for this patient? Certainly not the nursing staff! The poor patient screaming and crying should have been a powerful clue that something was definitely wrong. You might claim dumb because you were new, but the preceptor should have got his/her license revoked.

I've worked around nurses who claimed to be always able to do the difficult cath. They could cath anybody. Sure you can if you just ram it through. I'm sure pride was the motivating factor for pressing on when the prudent thing to do was to back off and call for a uro consult. I wonder how many patients needlessly suffer because of somebody's ego. :angryfire

There is a wonderful invention called anesthesia. Patients shouldn't suffer pain needlessly when alternatives are readily available.

I wonder if that patient's memory of that experience carried over into his approach to his future healthcare needs???

I can't actually respond to this because it's just inflammatory. I know you've had bad experiences, but we don't stick things in people unless they need them. Nurses don't order urology consults, doctors do, and I can't imagine having to go to work thinking I'll get my license revoked because some procedures happen to be painful. You don't get the whole story, you don't need the whole story, you draw your own conclusions no matter what is said.

[rn/writer, RN]

Just as with women and breast size, there are men who actually do have some kind of abnormality about which they are concerned. And there are those whose equipment would be considered normal, but for a variety of reasons, they do not perceive themselves as normal. In either case, in a vulnerable situation such as getting cathed, it is not at all surprising to me that a patient might express such feelings, perhaps with the hope of receiving some kind of reassurance.

There iis little attention paid to the social/emotional aspects of caring for the opposite sex in a nurse's training. This would apply to male nurses as well as female. Most of us try our best to maintain a professional demeanor, but that can be difficult if we don't have a template or an example to follow. When people are caught off guard or feel nervous, they may do or say things that they wouldn't have under better circumstances. Most of us develop a certain "comfort level" after a few years of nursing experience, but it is unrealistic to expect nurses to stop being human, just because they are nurses.

What would be helpful is more talk about "unmentionable" subjects both in nursing school and on the job. It should be part of orientation and ongoing education for a nurse to be given ideas about how to field awkward questions and comments about genitals and other sensitive issues. It would be so much better to have a pre-planned repertoire of possible responses than to fumble around in the moment of need, hoping you're not blushing beet red or saying something inadequate or inappropriate. This could also be an opportunity to learn about setting boundaries with those patients who are truly behaving in a sexually improper way. It's difficult to believe that this is almost never talked about. (Until something unpleasant happens.)

The need for education and information goes both ways. Women are on the receiving end of plenty of improper looks and comments. I will not jump to conclusions and decided that male nurses are unprofessional by choice. I'd rather believe that most want to do right by their patients but aren't certain how to speak or behave in a challenging or uncomfortable moment. And again, this is because they haven't been taught how.

A thread like this one carries some risk that there will be problem posts (and there have been a couple which were removed). But, for the most part, talking about our and our patients' discomfort could lead to a better awareness and understanding of how to navigate such potentially dangerous waters.

It's ironic that in a culture so bombarded with sexually-charged messages and material, that there is such discomfort with our physical selves.

[aeauooo]

Nurses face ethical challenges every time we go to work. We make sacrifices at the expense of our own well-being to provide ethical care for our patients.

Our livelihood and the lives of our patients depend upon our ability to quickly prioritize issues regarding patient safety and care. We lose sleep over our decisions, we develop health problems because of the stress of making these decisions, and some of us lose our jobs or even our licenses because of decisions we've made. Many of us, myself included, struggle with ethical issues years after an event.

"What could I have done to prevent that outcome?" Outcomes like severe injury or death of a patient. Yeah, I've been there - more times than I care to count. Tomorrow when I go to work I may have to - no, I will have to deal with it again.

My wife is a piano teacher. She loves me dearly, but she doesn't want to know what I do on a day to day basis. I have to rely on my colleagues for understanding and support - and I hope that they can rely on me.

[leslie :-D]

What would be helpful is more talk about "unmentionable" subjects both in nursing school and on the job. It should be part of orientation and ongoing education for a nurse to be given ideas about how to field awkward questions and comments about genitals and other sensitive issues. It would be so much better to have a pre-planned repertoire of possible responses than to fumble around in the moment of need, hoping you're not blushing beet red or saying something inadequate or inappropriate. This could also be an opportunity to learn about setting boundaries with those patients who are truly behaving in a sexually improper way. It's difficult to believe that this is almost never talked about. (Until something unpleasant happens.)

omg miranda, i soooo agree with this.

when i started nsg school, i had been experiencing tremendous anxiety about giving my first bed bath to a male pt.

when we were going over bed baths in lab, i asked my instructor, "how do you handle it if a male pt gets an erection?"

the instructor eyes popped out, looked at me as if i had lost my mind and totally ignored my concerns.

she never answered my question-

and.guess.what.happened.on.my.first.bedbath.with.male.pt....

uh-huh.

it most certainly did.

i told him i'd be back in a few minutes.

when i told my ci, she stormed into the room, reminded the pt he was sev'l days post op, and he could do his own washing up.

there's just so much that schools never taught us.

thank goodness, a nurse learns quickly.

leslie

[leslie :-D]

I can't actually respond to this because it's just inflammatory. I know you've had bad experiences, but we don't stick things in people unless they need them. Nurses don't order urology consults, doctors do, and I can't imagine having to go to work thinking I'll get my license revoked because some procedures happen to be painful. You don't get the whole story, you don't need the whole story, you draw your own conclusions no matter what is said.

i don't care if you're a nurse or a doctor.

to 'ram' a cath past a tumor, is barbaric.

to 'ram' a cath past an unknown obstruction, is barbaric.

in 12+ yrs, i have always gotten an md involved when i can't get past obstxn...

and plead for analgesia, sedative or anesthetics.

sorry indy, never in a million yrs would i allow a preceptor to continue w/an invasive, painful procedure....

esp when it wasn't supposed to be.

once she met the obstxn, she should have stopped.

dang, i crossed my legs when reading your story.

leslie

[squeakykitty]

That was my feeling on the matter. I wanted to be nonchalant about the subject and pretend like it was something I never really pay attention to. I'm not particularly curious about this, and avoid glancing 'down there' whenever possible, but definately can't help but noticing at times, esp anatomical extremes.

Incidentally, I've had the patient again, I did perceive some intangible oddness about him, and something odd about the relationship between him and his mother, now that he's feeling better. He struck me as a social drop out, conspiracy theorist type by some of his comments, with OCD overtones. He started doing his own ostomy bag emptying on his own, so he was beginning to cope with this alteration in eliminatory function and body appearance. No more comments on lack of size, his foley was out and he was voiding on his own.

You mentioned the nurses station, I just wanted to comment here that I didn't share this story about his insecurities in report, it seemed very personal.

Does he have any type of support system other than his mom?

[Indy, LPN, LVN]

i don't care if you're a nurse or a doctor.

to 'ram' a cath past a tumor, is barbaric.

to 'ram' a cath past an unknown obstruction, is barbaric.

in 12+ yrs, i have always gotten an md involved when i can't get past obstxn...

and plead for analgesia, sedative or anesthetics.

sorry indy, never in a million yrs would i allow a preceptor to continue w/an invasive, painful procedure....

esp when it wasn't supposed to be.

once she met the obstxn, she should have stopped.

dang, i crossed my legs when reading your story.

leslie

I'm sorry that the general opinion of the anecdote as presented, is that my preceptor was some kind of barbaric nurse who should have her license revoked (not your post Leslie) for her participation. However, the usual response to this would be to provide enough details so that the rest of the nursing world could understand the behavior of the two nurses involved. I'm not going to do that because the details are such that people don't need to know them. The phone calls involved, the physicians involved, the particular social situation of the patient in question, all had some impact on the way the events unfolded. None are relevant here except that if I hadn't been there, if I hadn't taken numerous actions to protect that patient, he would most certainly have been in worse shape than he was during and after the catheter insertion.

I regret that such bad thoughts are being had towards my preceptor but she is and was, a very good nurse. Many people have been helped by the examples she set for me. The man who to this day, was the worst catheter insertion I have ever seen, enabled me to be a better nurse because of what transpired. I guarantee you no patient of mine will have that happen again, but I also won't say bad things about my preceptor and I won't bring the story up again here. If we can't vent, tell a few stories (identifying info left out), and learn from each other then what are we doing on this bulletin board, eh?

[FireStarterRN, BSN, RN]

Just an update on the patient. He is now on Med/Surg, where I floated and had him again. He definately had some OCD overtones to his personality. He was very glad to see me, I think I established a high level of trust with him. He was not at all modest and didn't bring up the subject at all, and made no attempt to even hide his genitals, nor did he make any reference to them, thankfully.

His only visitor was his mother, although he had some phone conversations. His albumin remained 1.9 yesterday and he was third spacing still quite a bit. He was having increased pain and white count >30, so he went back to the OR to have a liter of fluid drained, after an abd CT.

He was very receptive and appreciative of all handouts and information. When I left yesterday he said "You can be my nurse any time!" He definately was a reserved man, very respectful, and I felt like I earned his trust.

Edit: He did have significant scrotal edema which he brought to my attention without difficulty, which he showed me without any nervousness or comments. It seemed that he had gotten past his initial embarrassment