The time is 1:20 am, and I can't sleep. I am bothered by what I did with my patient's condom catheter.
At first, I did what a good nurse should; I explained the need for the procedure, made the patient comfortable, cleaned and dried the genitalia, changed the condom catheter (etc). Everything went fine.
After 30 minutes, the patient called because he " accidentally" pulled off the c.cath. So I taped the sheath back into place, tightened it a little, and reminded him to care for it. But the thing was that he kept calling for the same concern over and over. He won't let anybody but me to do what has to be done. On the 4th time within just an hour that he called for a nurse, I sent the Nursing assistant to check on him; and there he was caught removing the velcro tape. Still he insisted on requesting for me to put the thing back.
I knew I am patient and considerate, but that time my shift was to end in an hour and I still have a lot of documentations to do.
Even so, I went to this patient and said in a very professional manner that he's being manipulative and I won't tolerate it. He smiled and said that I should be enjoying each time I get to hold his genital instead of complaining because it is my job to give "pleasure" to my patients. I felt insulted, really, that I taped his pubic hair to the sheath. He did not buzz anymore.
I know it will be really painful each time he attempts to pull off his condom catheter.
I endorsed it to the in-coming nurse though.
I cannot rationalize for what I did. I feel guilty.
Do you also do things like this with patients who in all means are suppose to be understood and cared for by their nurse?
I don't know that I would have done that necessarily...but no matter. You got the job done and that is what is important. I, too, thought it could be an organic response...but you know the patient best.
I wouldn't beat myself up too much, tatara. You did what you could with the situation. Just remember to document the HECK out of it. You shouldn't have to tolerate that kind of behavior in your workplace.
I think I would also feel guilty if I had done something in order to punish the pt.
And I think that is really not the case here. I mean, he was able to understand the cause and effect. If he were unable to do this, and was going to continue to pull his cath off, taping it to some pubic hair would have been cruel and completely out of line.
In this instance, though, he understood cause and effect, to the point that he knew if he continued to do it, you would continue to come in and handle him. This was a solution to keep him from pulling it off. Frankly, I don't have much experience with condom caths, because we just don't use them. Once in school I had a pt who had one in a nursing home, and there was pubic hair involvement, and not on purpose! I don't know how one of those can be placed without pulling a few hair now and then anyhow.
If this is the worst you do, your world is a good place.
Specializes in psychiatric nursing, med/surg adult care.
BluegrassRN said:
Frankly, I don't have much experience with condom caths, because we just don't use them. Once in school I had a pt who had one in a nursing home, and there was pubic hair involvement, and not on purpose! I don't know how one of those can be placed without pulling a few hair now and then anyhow.
If this is the worst you do, your world is a good place.
It is usually ordered for bedridden, male () patients (or pts in CBR) with urinary incontinence whose urine output has to be strictly monitored. In this case, pt has signed a waiver refusing IFC insertion and that his AP does not consider weighing diapers as an accurate means of measuring urine quantity (because diaper does not just absorb urine, sometimes it also catches poop ), especially that the pt was in IVF challenge and output has to be monitored in an hourly basis.
We favor and carry the brand of condom cath with velcro to somewhat minimize "pubic hair involvement." But with this particular patient, I used the one with special adhesive tape.
I felt bad, maybe because I regret what I did.
You guys have been very helpful. I'm learning so much from you all.
If the pt was with it enough that he could take the tape off of himself and remove the condom cath AND call for you to replace it, why did he have to have one in the first place? Just based on that information, I would have left it off and gave him a urinal.
As a guy my first reaction is "OUCH". (just kidding)
The guy knew exactly what he was doing. Don't make excuses for inexcusable behavior and stop losing sleep over it.
Personally, I can't think of anything that would turn me off much more than to have anyone (female or male) repeatedly grabbing my johnson to put a rubber sack over it to pee through.
Belgarion---Thanks for the male "side of the story"..... Personally, not being a male, I think I would have to agree with you if I was. Anyway, had to laugh a your matter of fact way to describe it.
Well, hard to say how wrong what you did was, but what he did was way more of a sin, so to speak. Is this really so much different than using stickier tape with the goal that a forgettful patient will stop pulling on whatever right away? I guess in the strictest sense you did something wrong but its nothing to beat yourself up about it. Just learn from it. Next time, get in control of your patient's manipulation/harassment before it gets to the point of him/her winning by making you lose your better angel temperment.
And if you have to work with this ass again, just walk onto your shift telling him you won't be taking any crap from him, and if he acts in the slightest insulting/sexually harassing way, you will pursue legal action-if he has a wife mother, explain that you will be calling them first so you can brainstorm with them on how to correct this behavior.
Specializes in psychiatric nursing, med/surg adult care.
As a guy my first reaction is "OUCH". (just kidding)
The guy knew exactly what he was doing. Don't make excuses for inexcusable behavior and stop losing sleep over it.
Personally, I can't think of anything that would turn me off much more than to have anyone (female or male) repeatedly grabbing my johnson to put a rubber sack over it to pee through.
go back to sleep and pat yourself on the back. taping a little bit of pubic hair is at best a nuisance to take off. it's not as if you taped it to his testicles or did something that would cause him an extreme amount of pain.
he knew what he was doing, and these are his consequences if he tries to continue his unacceptable behavior.
nurses are only human, with boundaries just like everybody else.
Specializes in PACU,Trauma ICU,CVICU,Med-Surg,EENT.
I think you came up with an ingenious (and harmless) incentive for this manipulative patient to stop the game playing. He,obviously,has no concern for anyone but himself.
He needs counseling on a number of issues surrounding his CVA and associated infirmities.
) patients (or pts in CBR) with urinary incontinence whose urine output has to be strictly monitored. In this case, pt has signed a waiver refusing IFC insertion and that his AP does not consider weighing diapers as an accurate means of measuring urine quantity (because diaper does not just absorb urine, sometimes it also catches poop 
Cherybaby
385 Posts
I don't know that I would have done that necessarily...but no matter. You got the job done and that is what is important. I, too, thought it could be an organic response...but you know the patient best.
I wouldn't beat myself up too much, tatara. You did what you could with the situation. Just remember to document the HECK out of it. You shouldn't have to tolerate that kind of behavior in your workplace.
Don't lose anymore sleep over it. :)