So I'm still a rather new RN student, almost finished with my 2nd semester, and I have a huge problem: Patient Rights. Specifically their autonomy. In my classes we talk about advocating for the patient, for their rights, for their autonomy. But in clinical I've already been told to violate my patients twice! The first time I did violate my patient and I felt disgusted with myself. The second time I refused to violate the patient and made others angry at me. So I need your help! Please help me sort this out so I can have my morals in-tact and also stay on everyone else's good side! If someone could please take this really serious that would be so great as I'm stressing out big because of this. Also, please know this is barely my second clinical I've been to, and we were only taught how to do a head-to-toe assessment thus far, and that's all we're allowed to do. NOTHING else!
So here's the first scenario:
I walk into a female patients room. She was in a car wreck and cannot move much or talk, but can still make conscious decisions by shaking her head yes/no. My teacher tells me that she doesn't want any male nurses helping with changing/bathrooming before approaching her. The first thing my teacher wants me to do is auscultate posterior lung sounds so I walk up to her, introduce myself, and tell her what I'm going to do. As I move my stethoscope to her back she shakes her head no. Presumably, I think she doesn't want me to touch her as she feels uncomfortable with a male nurse. So I ask her if she doesn't want me to listen to her lungs and she shakes no. She shakes her head and her shoulder, "no". So I tell my teacher, "she doesn't want me to touch her." My teacher tells me, "It's okay, just do it." My teacher brings me to her and tells me to auscultate the posterior lung sounds as the patient remains tense as I'm listening. I myself feel awkward and disgusted with myself. Did I do the wrong thing? Cause I'm sure I did. I literally think I wont forget the way this female looked like and what I did to her... I have a huge problem with violating peoples' rights/autonomy.
The next scenario is a little different. This is the one I want the focus to be on. It's a little long as I want to give you the nuanced details.
A male patient about 9 days after having a right sided CVA is paralyzed on his left side of his body. At this point in time he has no decreased LOC. A nurse tech is with me in the room as the patient states he needs to urinate. As the patient says this, the tech states he needs to go and asks if I can help the patient. I naturally tell him yes.
So I'm in the room alone with the patient and the patient tells me they have him urinate into these containers with measurements on them that are sitting on the table by his bed. I pick it up, walk over to the patient's bed and ask him if he's ready to urinate. In my mind (as I was never taught this) I'm assuming I need to grab his member for him and place it into the container so he can urinate into it or at the least hold the container for him while he holds his member with his functional right hand (this is what I thought "help the patient" meant when the tech told me to help him). Anyway, the response he gives me after asking him if he's ready to urinate is, "Yeah, but I can do it by myself." I say, "Okay, would you like me to step out as well for your privacy?" He says, "Yes." So I step outside of his room for awhile. As I'm outside his room the tech comes back and says, "Did you help him?" I tell him, "Yes, let me see if he's done." I ask the patient if he's done and he tells me, "I don't know who designed these thing but when I ****** into it, it just came back out." I say, "Okay, so your bed is wet now?" He says, "Yes."
So, I tell the tech who is right outside the door, and he looks angrily at me and says, "Didn't you help him?" I said, "Yes. He told me he wanted to do it himself and he wanted his privacy." The tech then angrily tells me (which is what I'm shocked about): "Of course they're going to tell you that. You just do it anyway!!!" Immediately my brain breaks. Is this right? Am I supposed to disregard what my patient tells me? "Just do it anyway"!!!???
I feel bad for "causing" the mess so I offer to help the tech clean it/change the bed linens. He tells me, "No, just go away. I got it." And I once again feel like crap for this time doing what I feel was the right thing. Could someone please tell me if I did the right thing and also tell me how I can deal with this problem of wanting to stick of for the patients rights/autonomy without having others hate me for it? I feel like I'm less valuable to a employer for not possessing this trait.
Please, I'm so stressed. I'd gladly disregard a patients autonomy if their LOC was diminished in certain situations, but if they are alert and have complete LOC, I have no idea how I could ever violate their requests.
