IS THIS TRUE???

Dogen · Jun 4, 2015

When I did my BSN we did the shorts-and-tanks-under-gowns thing, which seemed okay. I (a dude) had a female partner, and I remember talking to her later on about how much more awkward that was than doing one on a live patient. When I'm assessing a patient I'm like a contestant on Press Your Luck, thinking/wishing, "No murmur, no murmur, no murmur," or, "no crackles, no crackles, no crackles!" When I was doing assessments on classmates I was thinking, "I wish she just didn't have boobs. Wait, am I staring? Dammit, what was I supposed to do now?"

Now, in NP school, we did some physical assessments on each other. Mostly limb stuff - knee ligaments, rotator cuff, etc. - but also the tests for appendicitis and percussion/auscultation. The FNP and CNM students did a prostate exam on a standardized patient (who literally spent four hours bent over an exam table having students practice finding his prostate - worst job ever). We psych students, thankfully, didn't. The day I find my finger in a patient's bum is the day I retire. :)

Oceanpacific · Jun 5, 2015

About 10 years ago, when I worked in public health nursing, 4 of us were given advanced training in clinical breast exams (CBEs) because we were starting a nurse run womens health clinic. These were very lengthy breast exams and included squeezing the nipples to look for discharge. We had to be topless (one at a time) and let one colleague do the breast exam on us while my other 2 colleagues and the "instructor" watched. It was somewhat awkward and really no strong evidence based practice to support CBE. It's a good thing I'm not very modest. Though once you have squeezed your co-worker's nipples it does put a new spin on team building.

allnurses Guide · Jun 5, 2015

I know I differ with many of my fellow nurses who went to school around when I did. I'm totally against this practice for many reasons, the ribald jokes about anatomy, the possibility of triggering memories of prior trauma (I know this happens because people have shared how they felt about it), and the fact that the "no big deal" invalidates those students who have reasons that are really nobody's business why it is a big deal, even with tank tops and shorts.

A big part of the problem is the participants often didn't know this would be expected until a day or two before they were expected to disrobe.

If it's a CNM program or other specialized thing where people are informed ahead of time, that's different to me.

We have a couple of older threads with hundreds of posts that hit emotional buttons in much the same way as our obesity threads. Among the sub-topics are whether the bed bath scenario really teaches empathy.

Medical schools use professional human "models" to learn pelvic exams as far as I know, medical students don't practice pelvics and digital rectal exams on each other.

klone, MSN, RN · Jun 5, 2015

d really no strong evidence based practice to support CBE. It's a good thing I'm not very modest. Though once you have squeezed your co-worker's nipples it does put a new spin on team building.

Ha! I work with midwives in a women's health clinic. When we are in our providers' room you'd laugh at some of the stuff we discuss or show. Perineal lumps, weird breast things, etc. I love that all of our lactating staff pump right there at their desks, next to everyone else.

Elle23 · Jun 5, 2015

Wow...

Thankfully this never occurred in my nursing program. It seems a little....odd, to say the least.

It is one thing for a professional to be touching me/ seeing me disrobed in a medical setting where I am a patient. It is another altogether for friends/ classmates to be poking, prodding, and "assessing" me.

No thank you.

ixchel · Jun 5, 2015

Wow...
Thankfully this never occurred in my nursing program. It seems a little....odd, to say the least.
It is one thing for a professional to be touching me/ seeing me disrobed in a medical setting where I am a patient. It is another altogether for friends/ classmates to be poking, prodding, and "assessing" me.
No thank you.

How did you learn assessments?

Elle23 · Jun 5, 2015

How did you learn assessments?

In the clinical setting, on actual patients.

Isn't that what clinicals are for?

For skills such as IVs and such we practiced on fake body parts before attempting them on people in clinicals.

Sorry, but the thought of stripping down in class just seems laughable to me. And no one needs to be touching any part of my body except for my husband or a licensed professional (the male poster who said his "assessment/ bathing" partner was a female blows my mind!!)

macawake, MSN · Jun 5, 2015

I do recall an older retired nurse saying in her nursing school days...they did all skills on each other including NG tube.
I would NOT have made it if I had to do that.

You and me both. Not only would I've not have made it, I wouldn't even have wanted to try.

Pretty much every procedure comes with risks to the patient. Ethically we should always weigh these risks against the benefits for that specific individual before doing a procedure.

If I had an ileus or a bowel obstruction and needed nasogastric decompression I would consent to the procedure. Other indications like the need for medication or feeding might also make me consent. But for as long as I can eat/swallow and have no bowel issues and there's no existing diagnostic necessity, you're not sticking a tube down my esophagus (well, hopefully my esophagus. I have witnessed one case of tube knotting and another of bronchial placement and that one wasn't pretty).

As a patient I've allowed students (medical and nursing) perform many different assessments and procedures on me. I don't mind at all, as long as there's a preceptor present who seems to know what they're doing :) This has taken place both before and after I became a nurse. As a student nurse I always asked for the patient's permission that I perform the procedures/skills and their consent to the procedure itself, these days I just ask for their consent of the procedure itself. I've never had a problem with that.

The only thing we practiced on each other in nursing school was manual blood pressures and radial pulse. And even that was voluntary in case someone didn't want to bare their arms. Anything invasive was expressly forbidden. Other skills/techniques were taught in sim lab or on patients.

I see many problems with performing assessments and procedures on class mates.

Is there some insurance that covers potential complications? How do you handle the discovery of a pathology? Should a student be put in situations they might not be comfortable with, in front of a large number of students and the teachers who are in a position of power and who assign their grades? All this when the medical indication is zero, zilch, non-existent.

BrandonLPN, LPN · Jun 5, 2015

Some of us male students took our shirts off for the EKG lesson. And on sponge bath day we were told to wear shorts and tank tops (which I guess could be considered "undergarments"). We touched each other to the extent of demonstrating proper repositioning and some of the basics of bed baths and hygiene, assessments etc. Obviously, we did not demonstrate intimate peri-care on one another, or anything like that.

I think that's all standard for any LPN/RN program. I don't see why anyone would have a problem with any of that. If the thought of seeing your classmates in tanks and shorts, or basic touching is frightening, you have some issues to work out before becoming a nurse.

Elle23 · Jun 5, 2015

If the thought of seeing your classmates in tanks and shorts, or basic touching is frightening, you have some issues to work out before becoming a nurse.

It's not frightening to me, just something I would choose not to do (for reasons I won't go into here so the thread doesn't get derailed).

Just because a person is modest and discreet doesn't mean they have "issues" or would not function well in a professional capacity.

AdamantiteEnigma · Jun 5, 2015

Some of us male students took our shirts off for the EKG lesson. And on sponge bath day we were told to wear shorts and tank tops (which I guess could be considered "undergarments"). We touched each other to the extent of demonstrating proper repositioning and some of the basics of bed baths and hygiene, assessments etc. Obviously, we did not demonstrate intimate peri-care on one another, or anything like that.
I think that's all standard for any LPN/RN program. I don't see why anyone would have a problem with any of that. If the thought of seeing your classmates in tanks and shorts, or basic touching is frightening, you have some issues to work out before becoming a nurse.

Or, what was in my case - Newly discovered issues to overcome.

BrandonLPN, LPN · Jun 5, 2015

It's not frightening to me, just something I would choose not to do (for reasons I won't go into here so the thread doesn't get derailed).
Just because a person is modest and discreet doesn't mean they have "issues" or would not function well in a professional capacity.

True, but I guess our definitions of what's modest or immodest must differ.

Shorts and tanks/sports bras, I don't find that immodest or awkward. And I don't see why turning a classmate in bed, or feeling their lymph nodes, or palpating their stomach would be weird. Again, I'm sure no program actually has students performing more intimate care. And the males and females are seperated. Plus, the academic setting of the class lab is similar in my mind to a professional setting of sorts.

When I said the "issues to work out" bit, I wasn't being snarky. I really think that if one's situation is such that they can't bear the thought of a classmate performing basic (non-intimate) hands-on assessments on them, or vice-versa, then one might not be comfortable performing the duties of a nurse.