"Is it OK if I" vs "I just need to" vs "Could you please"

[Philly85]

Nursing student here...just wondering how you all personally approach the situation of needing to touch someone intimately.

For example, if I'm a man assessing a woman in a sensitive area, would I say "Is it OK if I do such and such" or would you say "I just need to do such and such" and then just see if she objects? Also, if the patient is able to help, like say lift up her breast so that you can listen to heart sounds better, do you say "Would you lift your left breast up a little bit for me" or do you say "I just need to lift up your left breast", etc, etc.

Thoughts?

[BSNbeauty, BSN, RN]

Would it be okay if I touch your breast to x,y,z?

I always ask permission when assisting with breast feeding.

[Philly85]

My one lab instructor has been saying to not approach it that way b/c it comes off as you potentially being uncomfortable about doing xyz and thus making pt uncomfortable. She always says, "Be the nurse first." By saying "Ok, I just need to do such and such now", it still gives them opportunity to say "Well, I can do it" or "Well, I'm not really comfortable with that", although I guess a meeker patient might not say anything.

[JBudd, MSN]

I just tell people what I am about to do, whether or not it is an intimate area. I tell people "I'm going to touch your forehead and behind your ear" with the thermometer. Any touch is personal.

As far as the auscultation, you can ask, "I need to move your breast in order to listen to your heart, or would you rather do that (lift it up) yourself?".

[OrganizedChaos, LVN]

My one lab instructor has been saying to not approach it that way b/c it comes off as you potentially being uncomfortable about doing xyz and thus making pt uncomfortable. She always says, "Be the nurse first." By saying "Ok, I just need to do such and such now", it still gives them opportunity to say "Well, I can do it" or "Well, I'm not really comfortable with that", although I guess a meeker patient might not say anything.

That is why I ask when having to do something in a personal area. Yes touch is personal but a woman might not mind letting you take her blood pressure or temperature but when it comes to a sensitive area, she might not want a man doing it. If the patient is shy or just naturally quiet they might not stop you unless asked. But they might not stop you at all even if asked. Just do whatever makes you comfortable. As long as you portray confidence the wording doesn't matter.

[NurseCard, ADN]

I prefer "Okay, now I'm going to touch this thermometer to your forehead"

or, when inserting a foley, "Okay, you are going to feel me touching you

down here". Basically, the direct approach.

[NuGuyNurse2b]

as a fellow male nurse, you will have patients who are not comfortable with a male nurse no matter how politely and courteous you address them. So just keep that in the back of your mind and don't take it personal.

[Double-Helix, BSN, RN]

Always, always ask before touching someone. It is far better for you to be perceived as uncomfortable than to be perceived as aggressive.

[NightNerd, MSN, RN]

I work with the psychiatric population, so if I asked for permission for everything I did, NOTHING would get done. Like others have said, I always give them a heads-up of what's going to happen, regardless of how non-intrusive I may perceive it to be. For more private areas and especially with patients who have a history of trauma, I do directly ask, "I need to (whatever). May I (whatever)?" Each step of the way I'm explaining why this part of the exam is important and how I will do it. It helps a lot.

[AliNajaCat]

One caveat, and it applies in lots of places: The word "Just" is a minimizer. It makes the speaker sound less authoritative/experienced/convinced.

Compare "I just need to do such and such" to "I need to do such and such."

I'm willing to bet that this breast has been lifted for heart/breath sounds and EKG before. You might need to be extra gentle and explanatory with a teen or very young woman, though.

[Julius Seizure]

I would suggest that whenever possible, you have the patient touch their own intimate areas. For example, the patient can usually lift her own breast out of the way for you to auscultate. It will keep you safer from wrongful accusations, and it will allow your patients to feel more in control of what is going on.

For times when you DO need to touch an intimate area, it is possible to ask and still appear confident and professional. Just be matter-of-fact about it. The specific words are not as important - but the comment about dropping the word "just" from the sentence is a good tip.

Also, for when you need to do something like move someones breast or touch another intimate area in the course of an assessment or personal care, if possible I would suggest that you touch the patient with the back of your hand to do it. No cupping! It makes things a little less weird somehow.

[foggnm]

Asking is probably a good idea. I usually even ask people "is it ok if I press on your belly?" As nurses we listen to heart sounds way too much. Unless you're working in a cardiac ICU or trauma, heart sounds are such an overrated point of assessment. Plus most people don't have the experience with abnormal heart sounds to truly know when something is dysfunctional. Just saying "I hear a murmur" is useless. When I did my CCRN and 12 lead training I still had a hard time putting it to use in the area of heart sounds. Plus most of what we assess about the heart in the hospital is based on ekgs, labs, echos, and xrays. I always felt the ER focused assessments were the best way in nursing: assess only what is related to the chief complaint/plan of care.