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It's ok to look at their....

Posted

Has 5 years experience.

New school nurse in a private school (prek- 8th) after substituting at a public school and I need help. If a student c/o a rash on belly, do you look? If a 5 year old is inc of diahrea everywhere do you change the poor kid or wait til the mom comes? where do you draw the line? The other rn and I have different opinions. Thanks!!

OldDude

Specializes in Pediatrics Retired.

There are varied opinions. Some women think they are less likely to be accused of something inappropriate so some are ok with stuff like that. Anyway, since I'm a guy...without a parent request (and then only with another staff member present) I don't look at anything covered by clothing unless I think the situation could be urgent or emergent. I do not change potty accidents.

Cattz, ADN

Specializes in School Nurse. Having conversations with littles.. Has 35 years experience.

If a student wants to show me their belly, back, arm, leg (as far as they can pull their pant leg up, but not above about the mid thigh), I will look. I do not do anything with bathroom accidents or anything covered by underwear, unless it seems to be an emergency.

Rash on belly, yep. Potty accidents, nope. I don't want to see anything in any area that is covered by a swim suit. If a kid says they have a rash, say on their upper thigh, I'll give them caladryl on a gauze pad and tell them to put it on in the restroom and describe the rash to me through the door. Potty accidents, I have the kiddo try to clean up as best they can with wet wipes and give them clothes to change into, if the child cannot do an adequate job, the parent needs to come clean them up.

Eleven011

Specializes in Home Health,Dialysis, MDS, School Nurse. Has 20+ years experience.

If I have a kid come in with a rash on belly or back, I ask them if its ok if I look. I don't take clothes off, but I'm ok with lifting a shirt up to see if my little person is covered with something. Most of the time they are walking into my office with their shirts half pulled up anyway to show me their owies. I will also look as far as they can pull a pant leg up, but wont have them take them off or pull them down.

As far a potty accidents, I will give them clean clothes, a grocery bag and wipes and they can use my bathroom to clean themselves up.

Supernrse01

Specializes in Telemetry, Gastroenterology, School Nrs. Has 18 years experience.

I'm like all the rest here! I will look at a belly, as long as the student says it is OK, and I let them lift their own shirt, only helping if they start to lift too far! Potty accidents, nope. I give them things to clean up and a change of clothes, and always call someone to let them know the situation so that they can come and pick them up if necessary.

MHDNURSE, BSN, MSN, RN, NP

Specializes in Pediatrics, Community, and School Health. Has 21 years experience.

I will help change an accident if they need help but always have a second staff member with me so no adult is alone with a kid getting changed. I will look at a rash if it is under a shirt, but not in private areas. I had a little boy c/o pain in his groin area and I called mom to come pick him up b/c I couldn't evaluate him. Thankfully turned out to be nothing but she was totally happy to come to school and get him.

Flare, ASN, BSN

Specializes in school nursing, ortho, trauma.

I'm like the rest. I'll ask the child if I can check. If they say no - then I won't. For the most part, I have children take care of their own bathroom issues, but there are those times that the kid needs an extra hand. Those times I will find another staff member, preferable of the same gender as the child to stand by as an extra set of eyes.

JenTheSchoolRN, BSN, RN

Specializes in School nursing.

If the clothing can be lifted by the student (i.e. shirt for belly stuff, pant leg, etc.) and the student is okay doing so, I'll check. Bathing suit area I consider off limits. I have given students my sample packs of hydrocortisone for upper thigh rashes, had them go into my restroom and apply it after describing the rash to me. I had one urgent circumstance where I did look at an area I normally won't (upper thigh/outer butt area not covered by underwear) after a student had sat in a thorn bush, but AFTER and while I had the parent on the phone and another adult present since the student was freaking out. Student still went home and I documented the hell out of that one.

I deal with the older kids - I don't typically have potty incidents. But I do have period incidents and hand the girl new pants, pad, and underwear if needed for her to take of it in my restroom.

MrNurse(x2), ADN

Specializes in IMC, school nursing. Has 28 years experience.

My T1D uses the OmniPod and we have had to change it 3 times this year. I always get a witness since the pod goes on her upper thigh. I stay away from bathing suit areas and always ask child's permission to see anything covered by clothing. Next year I will have full recording capability in my office for my protection.

kidzcare

Has 5 years experience.

I will have a student lift a shirt (behind a curtain) for a rash. If a student requires assessment of the "bathing suit" areas, I feel like it would be prudent to have another adult in the room. It does not have to be a medical person and they don't even have to look at the affected area, they are there as a witness. If a student later says "The RN made me feel uncomfortable when he/she touched my rash" then the witness can say "I was there. The RN wore gloves and clearly asked permission to run a finger along the rash to check for drainage/raised/warm areas"

Many times I've had a young man come in from PE after getting hit on the groin/testicles. I always ask if there is open skin or bruising. I tell them that I don't need to take a look unless there is a serious injury and they are always relieved. If sometime I do have a student who is bleeding from a groin injury, I would do the same as above- have another adult in the room with me!

I think there are issues in all areas of nursing when it comes to nurses/CNAs handling sensitive areas. We become so accustomed to it that it may not seem like a big deal to adjust an elderly woman's breast in her bra while helping her dress but it could feel like to her like she is being accosted. I always stay aware of this and have pulled aside other staff (CNAs or other nurses) to remind them that they need to explain to a man that they are about to touch his genitals or that they are about to uncover a sensitive area when bathing. It goes a long way as far as having respect for our patients.

JerseyTomatoMDCrab, BSN

Specializes in med-surg, IMC, school nursing, NICU. Has 9 years experience.

If it can be seen by moving but not REmoving clothing (lifting the shirt, rolling up pant legs and sleeves, etc) I will look at it. Rashes, bruises, scrapes and the like are often concealed by clothing but easily exposed without actually undressing. I had one girl in 4th grade tell me that she had a "rash on her privates". I obviously didn't assess it but I did call mom to let her know. She was already aware. Turns out the student had made an unwise decision about where to squat to pee while camping over the weekend. OUCH. In cases like that, calling a parent is always wise.

As far as bathroom accidents, I do help but only in extreme cases. I had a little kindergarten dude last year who simply chose to constantly poop himself. The first time, I provided a change of clothes and some wipes and told him to go to town. It was only afterwards, when I walked into the bathroom to find poop everywhere, wipes in the toilet and a very naked child, that I realized some cases require more assistance than other. I had another little guy with diarrhea down his legs and up his back. He went through a full change of clothes and a whole package of wipes and he STILL had to go home because he wasn't really clean. Mom works here, however, and was totally okay with me cleaning him up.

I would go on a case by case basis. It's important to foster independence and teach the kids to do what they can for themselves but you also have hygiene and privacy to think about. The overwhelming majority of my bathroom accidents don't require anything from me other than clean clothes. The kids do mostly everything else themselves.