Obese Patient -- safe toileting & skin care

[trustsupplyguy]

I am a new male nurse who recently took care of a 70 year old 400 pound female with CHF who became short of breath with minimal exertion, which is what brought her into the hospital.

I was concerned about her ability to toilet without falling. I also sensed she was reluctant to have a male inspect her skin, especially under her breasts and in her peri area. I was too embarrassed to discuss these issues with her openly. Eventually things worked out without incident, but I feel I left myself open to liability, and want to handle this situation better the next time it occurs.

Any thoughts on how to assess this patient's ability to toilet safely? Her unwillingness to allow full skin inspection and care? Who needs to be aware of my concerns? How do I document my assessment and the steps taken? What steps do I take? We have a lift team, but they are too over-worked to respond quickly.

Thanks in advance! P.S. I am not obese-bashing, this woman was a pleasant person.

[al7139, ASN, RN]

Hi,

I am a female nurse, but I work with male nurses, techs etc. If the patient is nervous about toileting, peri care or assessment by a nurse of the opposite sex, they generally ask for another nurse of the same sex to perform that part of the care or assessment. If you are unsure of the patients feelings in this area, ask them, and then respect their wishes. In your case, a female RN could do the care, assessment, and teaching needed, and then document what was done. This helps the patient to be more comfortable, and saves you from a potential problem. It is interesting to note that it is usually the female patients who are uncomfortable with male caregivers, and the male patients could care less if us females see them in their "birthday suits".

[kcalohagirl]

My husband is a nurse as well, so when he has time, I will see if he is also willing to reply. . . .

Some people are incredibly modest. I work in an area that has several differnt ethnicities. With some cultures, it is simply not allowed for a male to see a female unclothed.

And some people just feel uncomfortable with it. It's not a cultural thing, it's not a religious thing, it's not even really a personal thing, it's just that if they are female, they don't want a male to see them naked. Sometimes it may have a basis in the past, and sometimes, it may just be that a male seeing them naked geebs them out.

I don't think it has anything to do with their perception of your abilities as a nurse, it's just a personal preference thing. People don't really look askance at a female if she says that she prefers a female OB/GYN, right?

Sometimes, uncomfortable situations can be defused with a little bit of humor and self-deprecation. And sometimes, people really lie someone to let them off the hook. If you get the feeling that someone may be uncomfortable, it may be easier for them if you pick up on it and say, "You seem uncomfortable. Would you rather a female nurse do this portion of your assessment? Or would you rather a female nurse take care of you tonight?"

If someone is given that "out", they may be more forthcoming. It is so common for patients to feel powerless in a hospital, and it seems like a lot of them are afraid to complain about something because they are afraid that their quality of care will suffer because of it.

Please realize that I am NOT saying that I think a female nurse would be a better nurse than you, I just think some patients may feel more comfortable with that degree of intimacy with another female than they would with a male.

I know that I as a nurse have asked to not be assigned to a male patient who was being creepy and sexual because I was uncomfortable. Patients are so vulnerable when they are with us, that I feel we should do as much as possible to ease their way.

Sometimes, due to census or staffing, or whatever, reassignment is not possible. Then we should do what we can. Have a female aide present. . . .it can be such a sticky situation.

This is an area where I truly feel like male nurses have a harder time than us females. Females are generally seen as the sweet, kind, generous caregivers. In my experience, males aren't usually as modest in front of female nurses as some female patients are with male nurses.

I think attitudes are changing though. People seem to be more accepting of the fact that nurses are PROFESSIONALS, regardless of gender. We're there to help, we are there to help their recovery, we are even there to help them to the bathrrom, regardless of our gender.