Patient gown question

pedi_nurse · Dec 11, 2018

When I worked in a pedi office a couple years ago, we would require patients to put on paper gowns for annual well checks, but they could leave their underwear/bras on. Infants and toddlers obviously just stayed in diapers. Paper gowns are annoying, but they serve the purpose and are inexpensive. We would get adult size for teens and pedi size for the younger kids.

pedi_nurse · Dec 11, 2018

I can see the teens feeling more comfortable with cloth, so perhaps switching to paper for the younger kids and keeping cloth for the older kids might be a good way to transition? The younger kids don't get as self conscious about the gowns, so the transition to paper might be easier with them.

twahls65 · Dec 12, 2018

Thank you for your response it was appriciated i would also like to hear from other nurses experience with cloth vs paper gowns and how they handle that situation. I am also dealing with difficult patients especially with adolescent girls not wanting to follow my directions when i give them with me being a male nurse they dont want to have there weight andheight taken when i ask them to step onto the scale or when i ask them to give a urine sample and especially when i ask them to undress and put the gown on during there annual wellness checkup then i have to hear it from the physician as to why the patient isnt changed and ready for there checkup when the physician enters the exam room. How do you handle difficult patients like that any tips or suggestions are much appriciated thank you

twahls65 · Dec 12, 2018

I am sorry if my topics are not interesting to comment on by fellow nurses i was hoping to connect with fellow nurses and start a conversation about these topics and see how othee nurses deal with difficult patients and the cloth vs paper gown issue in different parts of the country.

Pediatric Critical Care Columnist · Dec 12, 2018

You have to realize this isn't a chat room. People come here for a variety of reasons, and they, like you, have issues they need input for. But instant responses rarely happen, unless the topic is of huge significance to MANY members, not just a few. Nurses are busy people, especially in the winter. Your vague thread title won't catch the eye of a lot of people; there are far more non-peds nurses here than there are of us.

From my own observation, there are many pediatric practices where the patients don't disrobe for exams. My three children never did, except for the middle one who has endometriosis and was seen by a peds gynecologist. The pediatricians I've worked with over the years don't insist on patients disrobing for exams, even in our ER. I've undressed many children once they've been admitted to PICU, even after they've been intubated. It's no fun cutting a kid's clothes off, but I've done it.

I can see where you're not getting cooperation from your adolescent female patients; they're at a stage of life where body image is an enormous issue as their bodies change, where their emerging sexuality is confusing and uncomfortable and they don't even want their moms to see them without clothes on. Fixation on weight and eating disorders seem to begin earlier and earlier each generation. Perhaps they're already gathering unwanted attention over their appearance... early bloomers especially. Bodily functions become very embarrassing and distressing - imagine YOU started bleeding from your genitals and knew it was going to happen again and again and again - for 40 more years. The ick factor alone... To call them "difficult patients" is unfair. If you're issuing "directions" to them rather than "instructions" I might resist too. And there's nothing quite so anxiety-provoking for a female than to be naked and only covered by a translucent layer of paper. Totally vulnerable, exposed, cold, more than a little frightened. Cloth gowns aren't a lot better, but they ARE better, at least for girls.

KelRN215, BSN, RN · Dec 12, 2018

FWIW, I don't put the gown on when I go to my own physicals until I know it's time for the GYN exam. I'm not going to sit there and be interviewed in a gown. I don't care if the MA hands me a gown before the doctor comes in or not, I'm not putting it on until I need to. And I'm not a difficult patient.

You probably aren't getting many responses because A) this forum isn't one of the most popular on AN- just look at the other topics in it and B) many of the people who do frequent this forum are pediatric nurses but don't work in Pediatrician's offices. I would say most aren't. I've been a pediatric nurse for 11 years and have never worked in a Pediatrician's office. I would bet that most of my patients do not put gowns on for their annual physicals though, especially since most of them are immobile and changing them into a gown in a doctor's office would be a huge process.

twahls65 · Dec 12, 2018

Please dont get me wrong i am very sympathetic towards any of my patients that i see being either male or female. I just find it hard being a male nurse working with children and giving them instructions ( i misworded my saying earlier when i said i give them directions ment to say instructions please forgive me?) I trully do watch how i word things to my patients when i am talking with them especially my female patients knowing i am a male nurse and they may take what i am saying to them the wrong way. I also realize i have to wait for responses to my posts and it wont be instant response back please forgive me in that aspect as well.

Duranie · Dec 14, 2018

None of my 4 boys had to disrobe past the age of 3-4.... basically from school age on, they only had to "show" the body part that had the cc. For physicals, they stayed dressed.

After the bulk of the exam, the dr. would sit on the stool facing them, and simply ask them to "lower your pants and underwear, if you would please, so that I can check your member and scrotum to make sure there are no problems." While he quickly attended to the exam, he told/reminded them of things that they needed to tell a parent about "right away, because they could be an emergency": severe pain or swelling in the scrotum, sores or anything that looks like a bad bruise, even if it's not painful, pain with urination, and I'm sure there was another item or two. Once they were in 3 or 4th grade, he would ask if they wanted me to leave the room at that point, or just turn around.

It was also at this point that he told them: nobody but other than yourself or a dr. that needs to do an exam should be touching or looking at "parts of your body normally covered by your underwear" (I remember him saying parents too, but with a condition attached. I don't remember exactly how it was worded, but it was clear that it was specific, limited reasons anyone should be wanting to see or touch their private parts)

As they approached puberty, he changed his spiel to one about changing bodies, and what changes were normal, and that they were at an age where they had sperm, did they understand what that meant (i.e. they could get a girl pregnant, must use condoms for any sexual contact, etc.) and that they could make an appointment and be seen without a parent if they had an issue or question related to sexual health, and that it would be kept confidential.

I thought it was handled very professionally, and with matter-of-factness that conveyed normalcy and trust. :up:I'm sure he had similar encounters with the girls. And I remember that he seemed to retain a lot of teens in his practice up until they left for college. He would see kids up to age 21.

Perhaps you could suggest to the patients that if they don't want to change before the doc comes in to see them, the visit is going to take longer, because the doc will have to step out while they change, and might not be able to come back in until after the next patient. You might get better compliance since they probably want to get done and gone. :unsure:

Maybe the problem you are seeing with the girls isn't necessarily because of *you*, but rather it is a reflection of their overall discomfort. In other words, is the doc adept at putting them at ease during the exam? If they are dreading the dr. even examining them, then they're going to be uncomfortable from the get-go... you just happen to catch the fallout of their discomfort. :yawn:

As far as the gown situation.... paper gowns suck! And on the younger patients, they're not going to be durable while they're waiting for the doc. And for the teens, it's gonna make them even more self-conscious... not good. :down:

Some practices have a washer and dryer in the office. I've seen regular ones and the stackable type. You could have a staff member throw all the used gowns in an hour or so before the office closes, and then throw the load in the dryer just before every one leaves. Someone would need to come in a little earlier the next day to quickly fold the load from the dryer. There would also probably be a couple gowns that would get used after the load has gone in for the day.... those would just go in the next day's load.

Would that be a possibility for your office?

I guess that was more than you asked, but I hope it helps.