help!..2 bothering questions...

[tss2507]

I have 2 nagging question regarding nursing in general that has been bothering me...

1.) *As a student nurse, when doing basic personal care on a patient, I know we should always ask the patient first if we can do it...but what if the patient is semi-comatose or just not able to communicate that well (to give a clear expressed consent)?

**For example, I remember last semester's clinical I had a patient who was really old and in poor health that needed a bed bath but didnt answer at all when I asked him if it was okay for me to give him a bed bath, change him, etc. I honestly ended up simply not doing it because I just didn't feel comfortable doing it when he never gave me a clear "yes". Looking back, I probably should have asked my instructor's opinion regarding what would have been best as oppose to simply foregoing it all together but that time has already passed. Anyways, how do nurses approach situations such as this? I imagine this must be fairly common too since nurses frequently take care of the badly injured or geriatrics population.

2.) **As a male nurse, should I always have a female coworker in the room with me whenever caring for a female patient with any scenerio in nursing? Do all male nurses typically do this? I say this because I remember last semester's clinical in which this wasn't the case for the students nor the R.N.s

I'm sorry to bombard you with these unrelated questions but this has really been bothering me. I feel as though there's still a lot in nursing I still need to figure out. God bless to any and all that take the time to answer me!

-Trevor

[OhioCCRN, MSN, NP]

let me take a stab at these:

1. Stinky pt = INSTANT bath...

2. This depends on the scenario-general care there is no problem- some females get iffy about males doing peri care... in that case, hand them the supplies and give them privacy...

also certain cultures prefer female/female- but that will be made clear to you in report.

Hope that helps

[Perpetual Student]

Well, I'm not sure how it'd work as a student, but I provide care to unconscious people all the time. If something needs to be done and you're able to do it, great.

As far as always having a woman present when caring for a female patient, it's ideal if one's in the department or whatever with you, but it's not feasible to always take one into the room with you. If you're doing something like placing a catheter or performing peri care then it would be ideal to have a female present.

[KelRN215, BSN, RN]

1. Patients who are total care often lack the ability to answer your questions. The nature of them being total care is that they need you to do things for them. They should be bathed, changed, mouth care, etc. on a regular basis. It's possible and even likely that they won't answer you when asked permission because they can't.

2. It depends on the situation. If you needed a female with you for EVERYTHING you did with female patients, it wouldn't make sense to ever assign you to a female patient, would it? There's no reason for a female to be in the room if you are doing something like listening to lung sounds, starting an IV or passing meds.

[cindyloowho]

If you had to get a "yes" answer from comatose patients before providing them personal care, they'd all end up with bed sores and maggots in their wounds. Yes, you ask permission from a competant person, but someone who cannot communicate their needs and wishes needs to be cared for in the same way that we know they "should" be cared for. Only competant people get to refuse care and have it be okay for us to document as a valid reason why we weren't able to provide sound nursing care.

Secondly, I understand what you are asking, but if every male nurse needed a witness present before providing care to a female patient, then no one would hire male nurses because that would not only not be cost effective, it would be a burdon to all your coworkers. Not to mention downright impossible and quite frankly, not safe if you had to delay care just while waiting for witness to show up. You are a professional and acting as such will get you a long way in court, should anyone ever "cry rape".

[mazy]

My approach for a situation with a resident who cannot give consent, is to first look for any non-verbal indicators of discomfort. But it is so important to do care, not only for the psychological and physical well-being of the patient, but also to have an opportunity to do an informal head-to-toe assessment while you're doing it.

What I would do is talk to the patient and tell him what I am doing step by step, talk him through it in a comforting tone of voice, and continue to be aware of and adjust to any reactions.

It's a good idea to try and talk your patients through cares anyway, well, some of them at least...with others you never know what kind of response you'll get!

And yes, always ask your instructor if you don't know. If you already knew, you wouldn't be in school. That's how you learn.

[2012RN2b]

tss2507 I'm a student nurse and was a student nurse tech over the summer on an oncology floor and had several pts that could not respond or give consent. What I did was tell them what I was going to do every step of the way and what they would feel (i.e. a cool cloth) even if they couldn't respond. I felt that this way even if they were unresponsive but were aware of what was going on around them they wouldn't feel as if I was treating them like an object. As to needing a chaperon none of our male students had a chaperon if they had a female patient.

[tss2507]

wow thanks a bunch guys! I just want you to know that all 6 of your comments were important to me and make me feel A LOT better! Im new to everything nursing and just wanna be the best nurse possible. I feel like there's a lot for me to learn but I'm glad I have this website lol!

[Esme12, ASN, BSN, RN]

They have already signed "Consent for treatment" and on a comatose/on verbal patient the consent is implied. Even on comatose patients, I always make sure to talk to them and tell them what I am doing even though I know they cannot verbalize a response. As far as males requiring a female to be ....depending on the activity it is the best practice. Yes stereo types are present in nursing and it is the best way to protect yourself against the crazies. Best of luck!

[badmamajama]

As everyone said, talking comotose/nonverbal patients through procedures is the best way to go. Remember we don't know what they hear or understand so it's best to assume they hear and understand everything! The more you talk to them the more it may stimulate their minds and calm them. Talking through it will help you as well as them. At least for me, talking to them keeps me focused on them and keeps my mind from wandering to the ten thousand other tasks I have waiting for me.

As for giving care to a female patient, like the other posters said, it's not always going to be practical to get help but double check your facility policy on when it is required. When you do go in to give care on a female, whether with or without a chaperone, remember to act like it's no big deal, you've done this a thousand times, that "seen one, seem 'em all" mentality. There is a fine line between treating the patient like an object and being uncomfortable being "down there." Watch other male professionals and see how they act and how the patients respond. The ones who are respectful while not making any big deal over seeing a lady's hooha probably have little issue getting even fully alert patients to allow them to give care. Oh, and don't follow my example. Use professional anotomically-correct language in referring to parts. I might refer to my "hooha" but I swear if my OBGYN said that I would fall off the table!

Good luck to you! Keep asking questions!!!

[Psychcns]

When I was a student I had a patient who refused his bath daily. My instructor suggested: walk in with the supplies and say " mr..it's time for your bath."his response" ok, I'll be a good boy." sometimes being matter-of-fact works!!

[loriangel14, RN]

I work with a few male nurses and they provide full care to female patients with no one else present.It's not required and we don't have time for that.