Hey people, first time poster here. I'm also a first year student and tomorrow I begin acute care clinicals. This will be my second bunch of clinicals, my first being at an extended care facility with elderly patients.
Overall my first experiences with clinicals was good. I had the opportunity to change briefs, give baths/showers, watch a dressing change, assess stage 2 pressure ulcers, perform baseline assessments, etc. Unfortunately there was one part of my experience that I feel I need to improve: lung sounds. I'm a drummer and my ears are pretty crappy as it is. My patient had dementia so communication was a bit tricky and I could never get her to take deep breaths. My patient was also female so naturally I felt awkward trying work around her breasts--What is the best way to listen to lung sounds in a way that makes the patient as comfortable as possible?
I tried to reach down the front of her gown but then my elbow/arm is right up in her face. I was thinking perhaps I could simply untie the gown from her neck and lower it gradually as I work my way down, but then if she's got an IV that could get in the way...and my patient couldn't really straighten her arms so that would have been tricky too.
Any response would greatly appreciated! (Also--I get the impression that people under 30 are thought of as somewhat burdensome...any general wisdom on how I can fight that stereotype?)
When I need to move a patient's breasts out of the way to get a better listen, I just say, "I'm going to move your breast with my hand so I can hear your (heart, lungs) better." I pause a second, just in case they have some objection I need to address, and then just firmly press the breast up and out of the way. Since you are male, if your patient is "with it" (not all of mine are), you might ask them if they prefer to lift it themselves; some patients do. My experience is that older women almost always say, "go right ahead, dear". And then, bonus!!! I get to assess whether they have a fungal rash under their breasts, which is more common than you might think.
Since you are a male student, it wouldn't be a bad idea to grab a CNA or fellow female student or instructor to be in the room with you. But the male RNs I know don't do that; they just act as professionally as possible and the patients "get it".
Also, if you have the patient roll on her side to listen to her lungs, remember that breast tissue conveniently falls toward the downward side, thanks to gravity. :) That can give you an opportunity to hear lung sounds better, too.
Good luck in school. You sound like a conscientious nursing student. :)
This only really matters if you cannot hear anything or if the gown is making excess noise right?... because I do lung assessments in surgical with people's gowns on all of the time. I only have to remove clothing etc, if i cannot hear anything at all to do a sufficient lung assessment. Same as posterior, a lot of post op. patients I will not make them sit up when doing my assessment if they are freshly post operative, unless a really extensive and good lung assessment needs to be done. Usually if i can hear clear equal breath sounds anteriorly and laterally I do not make them move.... unless its decreased a/e to bases then unfortunatly they have to sit up. However I am seeing now this is not necessarily the best lung assessment.... nor good habits to be picking up...
With my fresh post ops I always listen posteriorly too when we turn (I would never make them sit up-yikes) and take the extra linens out. Its when I also check their backside too as some are on the table for up to 12 hrs.
It takes mere seconds to lift a gown or shirt out of the way to stick your stethoscope under, no need to strip anybody and if you're finding this time consuming then you clearly have your priorities in the wrong place. If you're going to do such a half-a$$ed assessment on me, then you wouldn't be my nurse.
Yes, let's base my entire nursing practice on the fact that I can actually hear through a thin piece of fabric. If your hearing is so bad that you can't differentiate between lung sounds and fabric rustle, I hope you're looking into getting a hearing aid. Feel free to be my nurse though, as I recognize that not all nurses are perfect, since Jesus already has a job.
Specializes in acute care med/surg, LTC, orthopedics.
Yes, let's base my entire nursing practice on the fact that I can actually hear through a thin piece of fabric. If your hearing is so bad that you can't differentiate between lung sounds and fabric rustle, I hope you're looking into getting a hearing aid. Feel free to be my nurse though, as I recognize that not all nurses are perfect, since Jesus already has a job.
You specified listening through the gown was a time-saving factor for you and since abnormal breath sounds nurses pick up during auscultation can sometimes make the difference b/t life or death for the patient, this isn’t an area you should be skimping on.
I’d rather you left my *** crack a little dirty than not picking up my impending pulmonary edema.
You specified listening through the gown was a time-saving factor for you and since abnormal breath sounds nurses pick up during auscultation can sometimes make the difference b/t life or death for the patient, this isn't an area you should be skimping on.
You know what, my auscultation skills are just fine. I could list all the times I've caught things, or even the time that immediately after I walked out of a room following a resident and heard him saying to the attending that the breath sounds were clear and I interrupted because they were actually diminished on the one side and when we got the CXR there was a big ol' white out there.
But you know what, I've got the respect of my bosses, my coworkers, and the physicians and PAs and NPs that work with me. So I really don't need your approval or respect. I applaud you for doing the careful assessments in the way you need to do them to feel comfortable. In a world where I've seen nurses and respiratory therapists and mid-levels and physicians go into rooms without a stethoscope and then chart what they auscultated, it's probably a good thing that we're arguing over the best way to use the stethoscope we're obviously both at least taking into the room.
Specializes in acute care med/surg, LTC, orthopedics.
You know what, my auscultation skills are just fine. I could list all the times I've caught things, or even the time that immediately after I walked out of a room following a resident and heard him saying to the attending that the breath sounds were clear and I interrupted because they were actually diminished on the one side and when we got the CXR there was a big ol' white out there.
But you know what, I've got the respect of my bosses, my coworkers, and the physicians and PAs and NPs that work with me. So I really don't need your approval or respect. I applaud you for doing the careful assessments in the way you need to do them to feel comfortable. In a world where I've seen nurses and respiratory therapists and mid-levels and physicians go into rooms without a stethoscope and then chart what they auscultated, it's probably a good thing that we're arguing over the best way to use the stethoscope we're obviously both at least taking into the room.
On one memorable occassion, I went in to do my 2nd or 3rd assessment of the night on a stable pt recovering from a crani. In my joyous excitment over having found an ever-elusive pulse oximeter, I forgot to bring my steth. Well, she had been clear as a bell at 8, sats were 98+, HR was WNL, so I checked her incision, felt her pulses, saw no edema, etc., chatted a bit about some things that concerned her, and went on my rounds. I did get my scope for the next one, but didn't think a lot about it until morning, when she told me I was a good nurse, and that she knew what she was talking about because she was a nursing instructor. I very much appreciated the compliment, but walked away thinking, "I told a nursing instructor that a pulse ox was a lazy man's stethescope."
OP: it's vitally important to know how to do things right. But as you get experience, every assessment becomes somewhat a focused assessment. You spend more time looking at what's abnormal, less at what's okay, unless you have a reason to think it might become un-okay. You don't page the attending at 0300 because your sleeping patient's sats dropped from 96 to 95%. If you can gather the data you need through a gown, good enough.
When I was new, I was warned not to let a patient know I was inexperienced. Guess what--most of them didn't have to be told. I was told that when touching a female (or, for that matter, a male) patient in an intimate area, to always look like the consummate professional. Obviously, you don't go around copping feels, but don't act embarrassed or uneasy. Well, guess what again--I'm human. I get embarrassed. I get uncomfortable. I smile and tell the patient if she'll bear with me, we should both be able to get through this okay.
Most of the dumbest things I've done were attempts to be perfect. If I'm just me and do my best, most of my patients feel like they have a nurse who cares how they are and genuinely wants what's best for them. And they will forgive a hell of a lot if they believe that.
If you find touching a bare breast creepy when performing an assessment then you are viewing them as sexual organs and behaving quite unprofessionally. Not only is this a huge disservice to your patients but yourself as well. You need to change your mindset if you want to improve as a health professional; it is a body part like any other human body part. Gloves are used for contact precautions when there is a risk of blood or bodily fluid exposure NONE of which is consistent with moving breasts out of the way to listen to lung sounds (unless there's open puss-filled sores on the breast) and besides... what difference does a flimsy vinyl barrier between your hand and the breast make anyway? You are STILL touching the breast and if this genuinely bothers you, then you seriously need to re-examine why and take measures to improve your professionalism.
I appreciate advice, but please, don't act like you know what I'm thinking or "viewing something as". I assure you, sexual thoughts weren't on my mind when I was auscultating an 81 year old with some very serious problems who would constantly moan in pain and say to me "Daddy...please help."
I'm a 22 year old guy and this is absolutely a legitimate concern--just look at the varied responses this thread has generated. What if I get an extremely religious patient or someone who's extremely uncomfortable with a male touching her breasts? It's probably going to happen and I'm trying to deal with that by posing this perfectly legitimate question to people with more experience than me.
Yeah, I may still be touching a breast with a glove on but that "flimsy" bit of latex does make a difference--details do make a difference. It's like saying "Hurp durp durp it's just a flimsy gown what difference does that make if it's on!" It's the very principle of the thing...
I don't know what you've been taught, but I was taught that asking these sort of questions and making these kinds of observations IS professional. Now I don't have a wopping 5 years of experience yet myself, but y'know what I think might qualify as being unprofessional? Answering a question in a condescending way and making assumptions about someone's professionalism based off of one internet post. Gee, I'll bet that's real conducive to teamwork and teaching.
Specializes in acute care med/surg, LTC, orthopedics.
I appreciate advice, but please, don't act like you know what I'm thinking or "viewing something as". I assure you, sexual thoughts weren't on my mind when I was auscultating an 81 year old with some very serious problems who would constantly moan in pain and say to me "Daddy...please help."
I'm a 22 year old guy and this is absolutely a legitimate concern--just look at the varied responses this thread has generated. What if I get an extremely religious patient or someone who's extremely uncomfortable with a male touching her breasts? It's probably going to happen and I'm trying to deal with that by posing this perfectly legitimate question to people with more experience than me.
Yeah, I may still be touching a breast with a glove on but that "flimsy" bit of latex does make a difference--details do make a difference. It's like saying "Hurp durp durp it's just a flimsy gown what difference does that make if it's on!" It's the very principle of the thing...
I don't know what you've been taught, but I was taught that asking these sort of questions and making these kinds of observations IS professional. Now I don't have a wopping 5 years of experience yet myself, but y'know what I think might qualify as being unprofessional? Answering a question in a condescending way and making assumptions about someone's professionalism based off of one internet post. Gee, I'll bet that's real conducive to teamwork and teaching.
Nope, the gown is there for modesty, warmth etc. 'cause our species doesn't walk around naked anymore like the monkeys do. Gloves are supposed to be used for contact precautions and way too many nurse's think it's okay to wear gloves while brushing a patient's hair or taking a pedal pulse or any other touch contact but if I were the patient I would consider this offensive. Your patient isn't contaminated or gross or any other variation thereof.
If you have a patient who is opposed to you touching their breasts, then you simply don't do it but I wasn't questioning that - I was concerned about the "creepy" comment you made, which you still haven't fully explained except to say it's not sexualization on your part. Whatever.
There is nothing wrong with asking questions but be prepared to find those that will disagree with you, it's what forum communication is all about.
Yeah, I may still be touching a breast with a glove on but that "flimsy" bit of latex does make a difference--details do make a difference. It's like saying "Hurp durp durp it's just a flimsy gown what difference does that make if it's on!" It's the very principle of the thing...
I've worked with quite a few men since my healthcare career began. And you've got legitimate concerns. I mean, it's still considered perfectly acceptable for a woman to insert a foley cath on a man, but I can't tell you how many times I've had to go do foleys on a woman because they're uncomfortable having their male nurse do it. (But I figure it's fair for all the heavy lifting those male staff members end up doing.) And I'll say, doing pediatrics, with the teenagers, we're very careful who we have doing "intimate" procedures. We had 16 or 17 year old guy that needed to be cathed, and his nurse that day was one of our very pretty and very young women. She felt so lazy asking someone to do the cath for her, but we all were, "NO! Let someone older and uglier do it!"
And starting out, just touching the patients is a scary thing. Especially if you aren't a particularly "touchy" person, becoming accustomed to constantly invading someone's personal space is a big change.
If there are any men on staff at your nursing school, I'd highly recommend asking them how they do the "ackward" things. Or if there's a guy at one of your clinicals that seems open to answering a few questions. You can have all the women in the world tell you, "Well just do...." but we really don't get it. No matter how self-righteous we may be. Or pay special attention to the advice of nursemike, as I think nursemike is a "he."
I'm now hoping to get some nursing students to play with when I retire. 
AtomicWoman
1,747 Posts
When I need to move a patient's breasts out of the way to get a better listen, I just say, "I'm going to move your breast with my hand so I can hear your (heart, lungs) better." I pause a second, just in case they have some objection I need to address, and then just firmly press the breast up and out of the way. Since you are male, if your patient is "with it" (not all of mine are), you might ask them if they prefer to lift it themselves; some patients do. My experience is that older women almost always say, "go right ahead, dear". And then, bonus!!! I get to assess whether they have a fungal rash under their breasts, which is more common than you might think.
Since you are a male student, it wouldn't be a bad idea to grab a CNA or fellow female student or instructor to be in the room with you. But the male RNs I know don't do that; they just act as professionally as possible and the patients "get it".
Also, if you have the patient roll on her side to listen to her lungs, remember that breast tissue conveniently falls toward the downward side, thanks to gravity. :) That can give you an opportunity to hear lung sounds better, too.
Good luck in school. You sound like a conscientious nursing student. :)