"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?

[Philly85]

Good point, I definitely agree with taking out "just."

[Philly85]

Thanks for the tip about using the back of the hand, I agree that is a good idea.

[Meriwhen, ASN, BSN, MSN, RN]

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.

I agree. If the patient is able to lift her breast (or do whatever you need him/her to do), then go with "Could you..." and let them do it if they want.

But if the patient can't/won't do it, or you really need to be the one to do it (e.g., body part has to be placed a certain way or sterility needs to be maintained), then go with "I need to..." and ask for the go-ahead as needed.

And direct explanation is the best way to go. If you need to touch the breast, tell that you need to touch the breast and why.

[hppygr8ful, ASN, RN, EMT-I]

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?

I work in Psych so I always ask before I touch - but even when I worked acute care I was taught that any touch without permission could be viewed as assault. So for basic stuff when it is not an emergency I explain what I am about to do and ask "May I" If it is a more intimate in nature I again explain what I need to do and ask "May I touch you?" I don't think I have ever had someone say no.

Hppy

[Mavrick, BSN, RN]

As a male PACU nurse assessing surgical sites I ALWAYS ask a female nurse to "help" me. I inform the patient of what I am going to do "I am going to check your surgical site to make sure everything is where it's supposed to be." I direct my female assistant to pull the curtain then help me with positioning or hold an arm or leg etc. I use gloves and will move the patient's breast leaving her gown as modesty coverage if I don't need to see the actual breast. I will pull down the blanket to the level of her pubic region and raise her gown only far enough to see the surgical sites. If I have to look for the sites I will share my observations with the patient such as, "There are four camera sites, would you like to see them." If checking a peri pad I will ask my female assistant to confirm what I observe, "Only a little bit of drainage down here don't you agree?"

I am extra sensitive to these personal area assessments as the patient is still waking up from surgery and may not be fully aware of where she is and what I am doing looking at her body. I also will not know if or how severe a previous traumatic experience may have affected her. I can't tell by looking at someone if they have been a victim of some sexual or other personal violence by another person especially a male.

With a procedure like urinary catheterization, I have even more latitude. I will inform the patient that the procedure needs to be done, describe what the procedure is and why we are doing it and that I am completely comfortable and capable of doing the procedure. If she would feel more at ease with a female nurse I will be glad to get one as we help each other out with these things all the time. I use my best relaxed attitude and truly hope she understands that she has the choice because she really does. (Not so much about the cath but who does it) If the patient really doesn't have the choice don't act like you are giving them one. If they say 'No" will you be able to walk away and not do the thing you asked them if it was "OK" to do.

I don't assume a female patient will automatically reject my care for her. I explain everything I am about to do as I approach the patient calmly, "I'm going to get your temperature on your forehead. I'm going to wrap this blood pressure cuff around your arm. Can you turn over so I can check the dressing on your back"

I really think it is about you putting on your best "professional" attitude. You are learning to be a professional in all senses of the word. Something like, "Good morning, my name is Mavrick. I am going to be your student nurse for the day and participating in all aspects of your care."

Act is if. Fake it 'til you make it.

[DeeAngel]

Since you're a student I would recommend role playing with fellow students and seeing what feels most natural for you to say and what sounds best to the others. With practice comes confidence and it will benefit you to gain that before you ever have to ask those questions of a real patient. If you don't have a study group at school you might consider starting one for just this type of thing. You will find this an invaluable tool to use all through your schooling.

[calivianya, BSN, RN]

I don't generally ask, because if you do, many times the patient is going to refuse and nothing is going to get done. I'll offer an option if I can, but the option is going to be between me doing things two different ways, and doesn't include me doing nothing.

"Do you want to lie on your back or be turned to the right?" (Patient already turned left; not turning is not an option I offer)

"I'm going to clean around your foley now."

"The two of us are going to clean you up now."

"I'm going to take a quick listen to you now."

"I'm going to take a look at the skin on your back now."

If they protest, say things like, "We have to make sure your foley stays clean to prevent infection." "We have to make sure you're turned because you'll have to stay in the hospital longer if you get a pressure ulcer." "It will just take a minute and then I'll let you rest."

You won't believe how many people will refuse to have their bowel movements cleaned up. If you give them half a chance, a lot of people will lie in stool and refuse to be turned despite their pressure ulcers all night. Actually asking them if they would like to have their bowel movement cleaned up isn't going to get you anywhere. Asking them if it's okay to turn them isn't going to get you anywhere. You've just got to get it done.

I do believe in patient autonomy, but unfortunately, the regulatory bodies don't. Newly developed pressure ulcers are not reimbursed. CAUTIs are not reimbursed. And if you don't get your assessment done and something happens with that patient, the family's lawyer is going to have a field day when he reads through your charting and you didn't assess something about the patient because the patient didn't want you to. It is what it is.

[BSN16]

i don't give a lot of choices especially with ADL's. Giving patients options about turning, getting up to the chair, etc will get you nowhere.

Saying "OK we're going to get you up to walk!" will work out much better than "Do you want to get up and walk?" I obviously will respect my patient if they are truly objecting after i tell them they are going for a walk...but giving them options makes it a lot easier to say no.

Like another poster said though some things they have NO choice. Like refusing to get cleaned up after a BM. sorry, no choice.

[CG1979]

I respect patient choice, but they CHOSE to come to my ER, so assessments EKG etc are going to happen.

However, I can do one without having a female patient bare her chest to me.

I explain, "OK leads go here and here (shoulders and abdomen) and then down the middle here, OK?

Flip down the top of the gown, top two limb leads.

"We're gonna lift this up about halfway."

Flip up to the top of the abdomen, bottom two limb leads on.

"Can you put your left hand on your left breast and lift up please."

Pt's hand on the outside of their gown, they lift up, gown flips over their hand, Precordial leads on.

Done.

When I get refusals, I explain risks and choices.

"Yes I can get a female nurse. It may take a little time. You should know that there are risks involved in delaying assessment for your chest pain. If you are having a cardiac problem today, delaying the EKG may be life threatening. DO YOU UNDERSTAND?"

And I document THE HELL out of it. I type with quotes, EXACTLY what I said and EXACTLY what they said.

Same way of handling if they want a female doctor, when a female nurse escort just won't do. That's real fun at 3am when we only have one doc and he's a he.

[djh123]

I usually just say something like "I just need to do so-and-so", and may add "and put this here", or touch that there ... but I always make it sound like it's pretty quick and no big deal, which I think makes them more comfortable with it.

[kidzcare]

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."

YES! I have been very conscious of using the word "just" for anything and I feel myself speaking more confidently. The word "just" softens the request and makes it sound unimportant.

[greenerpastures]

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.

As a early teenager, I preferred a female MD and nurse, but that was because I wanted to talk to women about women problems.

However, as an adult female, this notion of rejecting a man who is your nurse always flabbergasts me! Especially with women who don't want a male nurse, but let male doctors touch them all the time. It's so STRANGE to me. Now, as an adult and a nurse, my philosophy and questions include "Are you good at your job?", "Are your hands cold? Better warm them up before you touch me."