"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?

[RegularNurse]

When working with female patients:

EKG: ask patients to lift breasts; drape breasts by manipulating gown; use towel as drape; delegate to female tech; ask permission from patient

Urinary Caths: only do with female present

Always control your non-verbals. People are body conscious, sexual harassment can be about how you made someone feel. Making someone feel a certain way unintentionally is something you can't defend yourself against. When in doubt, just always have a female present.

[Philly85]

I really highly resent the "always have a female present" thing...I know some people just want to cover their a**, but seriously, I feel like this attitude only STRENGTHENS the negative stereotype. It's basically an admission that you could possibly act in a predatory way if not for the lovely female nurse accompanying you.

[Philly85]

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.

Thank you. I feel like this answer best encompasses my feelings about things and will probably be the way I will approach things in my practice as a nurse.

[Philly85]

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.

As a male nurse, don't you feel like this is setting things back a bit, stereotype-wise? It's almost as if you are saying, "Yep, you have a reason to be potentially be worried that I am going to assault you, so let me just go get this female nurse over here who is going to protect you from monstrous me."

[calivianya, BSN, RN]

As a male nurse, don't you feel like this is setting things back a bit, stereotype-wise? It's almost as if you are saying, "Yep, you have a reason to be potentially be worried that I am going to assault you, so let me just go get this female nurse over here who is going to protect you from monstrous me."

I've never seen it this way.

Here's why: (I've seen this happen more than once)

Patient had a male nurse for several nights. Patient never once said anything to the nurse, never acted uncomfortable, nothing. After the patient transfers off the unit, management pulls the nurse aside and says, "The patient you had recently, Ms. X, just told her floor nurse that you touched her inappropriately and sexually assaulted her." An investigation ensues - which is very quickly shot down when that nurse had lots of other nurses in the room with him when he did things like foley care and baths.

Also, PTSD is a real thing with patients. I've read that 30% or more of ICU patients end up with PTSD, false memories, nightmares that continue even after they get home, things like that. The way patients remember their stay can a bunch of people tying them down and doing horrible things to them, which is sometimes pretty dang accurate, really, but not always.

When it's a female in the bed, the sedatives/hypnotics are running freely, the patient is in and out of consciousness, and ICU delirium is setting in, sometimes the way they remember their male caregivers touching them is that they were sexually assaulted. I've heard the word rape thrown around before, more than once. Really.

There's all kinds of interesting studies on the way we process information, and our brain basically reassembles full memories from little pieces of information all the time. In this case, when a female patient who's already paranoid about men for whatever reason has a fragment of a man's face, a fragment of being held down, and a fragment of pressure/touching "down there", those fragments can reassemble into a full narrative of being raped, and those memories can be just as clear as real memories of things that actually happened. And sometimes these women will file formal complaints based on their false memories.

The incidence of that kind of stuff happening may be less in other units. I don't know the research for anywhere other than the type of unit I work in; I only subscribe to critical care nursing journals.

Anyway, this stuff rarely goes anywhere, but when you don't have a witness, it's awfully hard to defend yourself. Investigations get thrown out pretty much immediately when you had a witness every time.

Does it reinforce stereotypes? Maybe. Is reinforcing a stereotype a whole lot better than getting investigated for assault on the job? I absolutely think so.

[lindseylpn]

I work nights so, I'm usually apologizing for waking someone up. I'll usually say, sorry I need to do blah blah blah real quick. I typically say "I need to". I do try to give options though. I have one dementia patient that would like to refuse everything is asked "Can I?" so, I ask her "Where would you like your insulin shot tonight?" instead of "Can I give you your shot?" or I'll ask " Would you like your medicine or eye drops first?" That works well with a lot of people.

When it comes to more intimate things I tend to explain in detail what I'm doing before each step. I'll say "Now that I've done blah blah blah, I'll next be doing yada yada yada, are you ready?"

[greenerpastures]

I really highly resent the "always have a female present" thing...I know some people just want to cover their a**, but seriously, I feel like this attitude only STRENGTHENS the negative stereotype. It's basically an admission that you could possibly act in a predatory way if not for the lovely female nurse accompanying you.

My first thought when I saw that "always have a female present" info was - WHY? I don't have a male present when I, a female, do anything with a male's genitals.

[Kuriin, BSN, RN]

I stopped asking permission when I realized that if I asked permission, I could be denied giving care to my patient. If they are uncomfortable with it, they will speak up and request a female or male nurse to do something to which I will reply, "We have limited X Y and Z, but I will see what I can do,".