I'm feeling weird about toileting, etc....

Megsd, BSN, RN · Sep 8, 2004

I had my first toileting experience kind of unexpectedly this summer. I went with my roommate to his brother's graduation, and his 4-year old cousin latched onto me and insisted I go everywhere with her. So when it was time to use the bathroom, she asked me to come with. Being an only child with very limited exposure to little kids, I had no idea what I was in for.

After telling me stories that made no sense for a pretty long time, she said "Okay, now I'll hug your leg so you can clean me."

Excuse me, I thought? You want me to do what?

So there I was, trapped in a small bathroom with a 4-year old who counted on me, DEPENDED on me, to wipe her, and I was not having any of it. But, I did it. And I *was* thinking "I can't believe I'm doing this".

I'm sure adults are a whole other kettle of fish, but I feel better for having been at least partially exposed to the situation. Thanks, Kourtney Marie. :)

Meghan

boulergirl, CNA · Sep 8, 2004

One of the first things I got to do as a CNA was "catheter care" on a stroke patient. Took three other CNA's to hold him up in the shower and GUESS WHO got to clean his catheter?!? Me, a 17-year-old virgin who'd never touched a member. Geez. :imbar Thank God for GLOVES!!

All I can say is, it does get better with time, but I still use daydreaming to help me "zone out" just enough to help me focus on what I'm doing without thinking about the weirdness of it. If the patient wants to chat away with you, that can be a blessing.

talaxandra · Sep 8, 2004

The first time I washed a patient during my training it was a bed bath on an elderly woman (that poor woman! My friend and I were so freaked by the whole thing we didn't say a word to her during the whole thing, and we were so inexperienced the sponge took almost an hour! We kept covering her up and going out to get hot water). That didn't worry me too much.

The next day an RN asked me if I'd ever seen a pressure sore before. Of course I hadn't, so she took me in to see the guy in bed 14. She asked him first, then told me to come in behind the curtain - there was a really cute 21 year old guy, lying on his stomach, naked from the waist down! One bun was perfect, the other had a fist-sized hole in it, and scar tissue. The RN told me he got in ICU, and that it used to be twice as big.

I was so embarassed, until I realised that, for him, embarassment was a thing of the past. He'd already been through so much that this was nothing. I also realised that the uniform (or the role) gives patients an expectation of professionalism and confidence, and that it wasn't about me.

I think part of our role is maintaining at least an appearance of equilibrium, even when we're freaking out on the inside. Developing that means that something shocking can happen and your response is calm. Like when you have a little old lady who's come in with a minor problem and the unit notice a lump near her nose and talk her into having the slow-growing tumour resected because in ten years it'll spread. The theatre notes say that the tumour was successfully resected, and when you take down the dressing you expect to see a bit of a divot.

That appearance of equilibrium allows you take down the dressing and say to the patient "I think the Charge Nurse wants to see this." Then you can go to the Chargie and babble "She hasn't got a nose! She's just got a hole in the middle of her face! She hasn't got a nose!" Fourteen years ago and I remember it like yesterday! (I also remember the Chargie telling me not to be ridiculous, going to look at the patient, and coming back to me saying "Oh my god! She hasn't got a nose!)

luckymichelle · Sep 8, 2004

Thank you all so much for sharing your thoughts and experiences. I do hope that I can get "into the zone" as a couple of you have said. The LAST thing I want to do is cause embarassment to a patient. I believe that dignity is #1, so I'm going to just tell myself that I'm going to have to get over it. It's part of care, right? Besides, what am I going to do when I've got to do a testicular exam or fecal impaction? *deep breathe, deep breathe* LOL, I need to stay calm and professional! Is that possible?

Here's another ? for y'all... Have you ever seen someone who couldn't get over the weirdness of being in such intimate situations with patients?

Michelle

Altra, BSN, RN · Sep 8, 2004

I also realised that the uniform (or the role) gives patients an expectation of professionalism and confidence, and that it wasn't about me.
I think part of our role is maintaining at least an appearance of equilibrium, even when we're freaking out on the inside. Developing that means that something shocking can happen and your response is calm.

Excellent post ...

maire, ASN, RN · Sep 8, 2004

It's so ironic that I read this thread today. The first time I had to bathe a patient, I was crimson with embarrassment. Today I was in the elevator after clinical and I thought to myself, "I cleaned a man's member today while we discussed the weather - unbelieveable." LOL It really does get easier with time. Whether you're bathing a boob or wiping an orifice, just think of it as another part of the job. You're there to help them, and they know and appreciate that (usually). :)

not now, RN · Sep 8, 2004

I was talking to my new clinical assignment today and I asked her "So, how well can you get around?" Her reply "I get around fine honey, I only have this foley in because of the Lasix. I get up and poop on my own, I just went earlier this morning so I won't have to go again for a while."

Her frankness (is that even a word?) amused me.

My point? Some patients are so used to the situation that you're probably more aprehensive than they are.

Personally, I've never been scared to give a bed bath or touch any genitals. What did skeeve me out was shower days at an LTC. I can't explain it, it's just...weird.

jaimealmostRN · Sep 9, 2004

I kind of know how you feel OP. While I really don't mind naked people, or genitals (not that way, pervert!), urine or vomit....I really really really really hate poop. Can't explain it. I push myself to clean the cat's litter box just to up my "tolerance." I even have been guilty of not assessing the stool before I flush it. I once bribed another PCT to clean up a pt-gave her my break. I know how horrible that sounds, but I just really don't like it!!! But I"m doing better. I now use Vicks under my nose to keep out the smell and have cleaned up a few people without feeling too traumatized. But I do agree with the other posters, its MUCH worse for the pts. No matter how much I hate that body function, I always smiled and talked with the pt, even if I was mentally throwing out my lunch while doing so!

mitchsmom · Sep 9, 2004

Not a whole lot to add except I feel your pain.

At my clinical the other day I didn't like that people were coming in and out during a pt's shower. The CNA and whatever worker that came in would just stand there and chat.. the pt didn't say anything, was prolly used to it, but still...

PS.. when we first went in the shower room, the guy that was getting bathed said "I don't want the young girl in here" (meaning 33 year old me!). The CNA had to talk him into it... telling him, among other things, that I was married with three children so I knew all about what was "down there"!! LOLOL. I think he loosened up a little bit but he wasn't about to have me shave him! I said "smart man!". LOL By the time the CNA was done and we were toweling him off, he was asking me why I wanted to get into nursing... I told him I wanted to be a midwife and he told me he was born with a midwife, etc. etc...

I guess it's one of the those "If you can't make it, fake it" situations... like someone said, even if you're freaking out inside, make yourself appear matter of fact to take away the awkwardness.

luckymichelle · Sep 10, 2004

I guess it's one of the those "If you can't make it, fake it" situations... like someone said, even if you're freaking out inside, make yourself appear matter of fact to take away the awkwardness.

AMEN. Thank you for this... I'm taking it with me mentally to my clinicals.

LPNalmost! · Sep 11, 2004

Just want to say: it really does get easier with not necessarily time, but with exposure. One year ago, my very first clinical pt was in LTC and incontinent of stool. She had diarrhea during her bed bath and I wanted nothing more than to walk out and go beg the potato chip factory for my job back. But I didn't. And just the other day, while I was thinking about what I wanted to eat for lunch at the same time I was digging around in the urinal hat with my tongue depressor to get a sample of my pt's mostly liquid C-diff stool, an old Virginia Slim commercial suddenly ran through my head: "You've come a long way, baby!" And you will too.

I guess it's one of the those "If you can't make it, fake it" situations... like someone said, even if you're freaking out inside, make yourself appear matter of fact to take away the awkwardness.
AMEN. Thank you for this... I'm taking it with me mentally to my clinicals.

manna, BSN, RN · Sep 14, 2004

We had our first clinical day today, and I was really worried about the toileting/perineal care/etc. Turns out, once we got into the hospital with dependent/total care patients, it didn't really seem like such a big deal after all. I think it's easier, once in that situation, to think objectively about the patient and their needs as human beings. All that worrying for nothing! Good luck. :)