Physical exam on women

vanilla bean · May 6, 2015

I'm confused. Would you mind explaining the situation(s) in which you think it necessary to examine a female patient's breasts or perineum? Are you thinking that you would need to do this as part of a head-to-toe shift assessment? Examining the breasts and perineum is not part of a routine shift assessment unless the patient has a specific need, i.e. wound care to the breast or perineum. If you are providing hygiene care to the patient, you can include a skin assessment as part of the process (although you should always ask the able patient if they would prefer to manage this themselves or if they require assistance). If you are placing a foley or performing foley care, you would assess the area as part of that process.

Have you spoken to your clinical instructor about your concerns? That may help clarify the issue and provide you with some direction about their expectations.

OwlieO.O · May 7, 2015

I'm confused. Would you mind explaining the situation(s) in which you think it necessary to examine a female patient's breasts or perineum? Are you thinking that you would need to do this as part of a head-to-toe shift assessment? Examining the breasts and perineum is not part of a routine shift assessment unless the patient has a specific need, i.e. wound care to the breast or perineum. If you are providing hygiene care to the patient, you can include a skin assessment as part of the process (although you should always ask the able patient if they would prefer to manage this themselves or if they require assistance). If you are placing a foley or performing foley care, you would assess the area as part of that process.
Have you spoken to your clinical instructor about your concerns? That may help clarify the issue and provide you with some direction about their expectations.

Checking integument as a head to toe assessment in general - in a recent case for rashes to screen for Steven Johnson syndrome. Thought I'd cast my net here for a more diverse response before asking my clinical instructor.

If it's not necessary to inspect the whole integument during a head-to-toe, then why do we do so at all unless otherwise indicated?

enuf_already · May 7, 2015

Female nurses do not make it part of their routine to examine the genitalia or breasts of any patient in their care (opposite sex or same) unless it directly involves the reason the patient is receiving treatment.

Surgery to the area or a drainage tube would be the only reason why I would have a need to examine what I consider otherwise private parts.

Bathing an unconscious or totally dependent patient should be done keeping the patient covered as much as possible (and preferably with an escort/aide of the same sex of the patient for your protection)

Is there another reason you can think of that you would need to do an intimate assessment on the opposite sex? Am I missing something?

Just read your comment about Stevens-Johnson syndrome. First, why not ask the patient if they have a rash in those places? Secondly, I'd be checking the oral mucosa before I worried about rushing to check the breast and genitals. If the patient is suspected to have SJS, treatment is not going to be dependent on whether the rash is present there anyway. Yes, you could do a quick skin inspection if someone presents with a rash to document where the rash extends, but not every patient needs to be examined for SJS who walks through the door. It is a very rare disorder.

mimibrown, ADN, BSN · May 7, 2015

I agree with the other posters. Unless assessing those areas are relevant for their current issues, it is not necessary to check them. It is overkill and not a good use of time in that setting. Are you also checking the men?

Just an fyi, if you do find it necessary to check a sensitive area, you should have a second person present. I always ask a nursing assistant to help me for certain tasks, such as inserting foleys, just to be on the safe side and I'm a woman.

OwlieO.O · May 7, 2015

I agree with the other posters. Unless assessing those areas are relevant for their current issues, it is not necessary to check them. It is overkill and not a good use of time in that setting. Are you also checking the men?
Just an fyi, if you do find it necessary to check a sensitive area, you should have a second person present. I always ask a nursing assistant to help me for certain tasks, such as inserting foleys, just to be on the safe side and I'm a woman.

Makes sense. And yes, I wouldn't be discriminating on gender, just generally more comfortable doing assessments on pts. of the same gender.

OwlieO.O · May 7, 2015

Female nurses do not make it part of their routine to examine the genitalia or breasts of any patient in their care (opposite sex or same) unless it directly involves the reason the patient is receiving treatment.
Surgery to the area or a drainage tube would be the only reason why I would have a need to examine what I consider otherwise private parts.
Bathing an unconscious or totally dependent patient should be done keeping the patient covered as much as possible (and preferably with an escort/aide of the same sex of the patient for your protection)
Is there another reason you can think of that you would need to do an intimate assessment on the opposite sex? Am I missing something?
Just read your comment about Stevens-Johnson syndrome. First, why not ask the patient if they have a rash in those places? Secondly, I'd be checking the oral mucosa before I worried about rushing to check the breast and genitals. If the patient is suspected to have SJS, treatment is not going to be dependent on whether the rash is present there anyway. Yes, you could do a quick skin inspection if someone presents with a rash to document where the rash extends, but not every patient needs to be examined for SJS who walks through the door. It is a very rare disorder.

Makes sense, thanks! Just trying to be more careful than not.

HouTx, BSN, MSN, EdD · May 7, 2015

It is unfair and pretty much insulting to our male coworkers, but many organizations have policies in place that require a female "chaperone" to be present whenever a male clinician is in a closed room with a female patient .. of course, this would include any instances in which a physical exam was taking place.

Whenever this is discussed, there is one issue that usually emerges - it is necessary to protect our male staff members from unwarranted accusations. So, there it is. Over the years, I have seen several instances in which male nurses were accused of improper conduct with female patients..... NONE were factual. In one (kind of humorous) incident, a very elderly dementia patient loudly (shrieking at the top of her lungs) accused a male ED nurse of sexual assault - while he was attempting to insert a foley . Apparently, this was her fuzzy mental interpretation of that activity.

My advice? Make sure you are familiar with the hospital's policy (this directs the care of their patients) as well as your school's policy. Always exercise 'street smarts' (due caution) to avoid any situation that could be open to misinterpretation.

direw0lf, BSN · May 7, 2015

I'm a female but I just wanted to say that whether you have to do peri care or assessment or not, or when you insert a foley in the future, your own composure will help put the patient at ease. I speak from personal experience, when I was in the hospital the nurses who were professional and calm were the ones I felt best with. If a nurse was concerned with my embarrassment or nervous at my questions I felt uncomfortable.

OwlieO.O · May 7, 2015

I'm a female but I just wanted to say that whether you have to do peri care or assessment or not, or when you insert a foley in the future, your own composure will help put the patient at ease. I speak from personal experience, when I was in the hospital the nurses who were professional and calm were the ones I felt best with. If a nurse was concerned with my embarrassment or nervous at my questions I felt uncomfortable.

I agree. Confidence helps; it's just taking time to develop it!

OwlieO.O · May 7, 2015

It is unfair and pretty much insulting to our male coworkers, but many organizations have policies in place that require a female "chaperone" to be present whenever a male clinician is in a closed room with a female patient .. of course, this would include any instances in which a physical exam was taking place.
Whenever this is discussed, there is one issue that usually emerges - it is necessary to protect our male staff members from unwarranted accusations. So, there it is. Over the years, I have seen several instances in which male nurses were accused of improper conduct with female patients..... NONE were factual. In one (kind of humorous) incident, a very elderly dementia patient loudly (shrieking at the top of her lungs) accused a male ED nurse of sexual assault - while he was attempting to insert a foley . Apparently, this was her fuzzy mental interpretation of that activity.
My advice? Make sure you are familiar with the hospital's policy (this directs the care of their patients) as well as your school's policy. Always exercise 'street smarts' (due caution) to avoid any situation that could be open to misinterpretation.

Will do. Thanks!

nurseprnRN, BSN, RN · May 8, 2015

Plenty of women entering nursing are scared to see and handle strange memberes, too. Perhaps you could have a discussion at lunch with a couple of male and female students about overcoming those feelings, and see how that goes.