Physical exam on women

[OwlieO.O]

Hey, everyone. So I'm doing clinicals in the hospital now and I'm having difficulty. I'm finding it difficult to initiate physical examination of women (as I'm a male) that incorporates observing or touching the breast tissue and perineum. I personally believe that it isn't a big deal d/t it being necessary for proper medical and nursing care - however I just seem to not be able to get over the hurdle and put these beliefs into practice. I feel like I'm not shy, but rather nervous about them questioning why on earth I have to be so invasive and believing I shouldn't be doing such a thing.

So does anyone have advice on gaining more confidence with doing these invasive assessments on the opposite sex?

[ScrappytheCoco]

You can never go wrong with having a female chaperone in the room if examining these areas is necessary. Many physicians do this as a regular part of practice. I am female, but if I find it necessary to touch a woman's breasts during an exam or procedure (applying EKG leads for example) I always use the back of my hand, and ask their permission prior to any touching, "I'm going to move your breast out of the way so I can apply these leads properly, is that ok with you?" Most of the time they look at me like I'm nuts, of course it's ok with them, but it's always better to cover yourself.

[CamillusRN, BSN]

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?

Something to consider - in the field, even in massive trauma cases "trauma naked" still allows the medics to leave undergarments intact if the index of suspicion doesn't indicate examination of the private areas. Sure, they'll come off in the trauma pit, but they stay on during transport (barring, again, no indication to check those areas). Now I assume you are discussing the "well-person" examination - no trauma, no c/o of pain or abnormalities of the perineum and breasts; am I correct? In such a case, examining those areas without a clinical indicator for doing so would be unprofessional and would put you at risk for a lawsuit (which you would likely lose). Integ checks can be done without having to check private areas unless you are required by policy or circumstance to do so, and even then I would have a person of the same gender check those areas with a chaperone in the room (regardless of the provider being the same gender as the patient). CYA.

[Glycerine82, LPN]

When I worked inpatient acute rehabilitation, the nurses had to do a head to toe assessment on all new admits. Often times they would just ask the pt if there were any issues anywhere they needed to document. Any areas that had incisions or rashes were photographed and our male RNs usually had a CNA with them.

There were times when I would tastefully check under the breasts and groin area for skin integrity issues while I was helping the patient dress and bathe, as it was fairly common for the heavier patients to have yeast issues in those areas. I would always let the nurse know, he would document and get nystatin ordered.