I hope I will get some gentle tips/assistance with an issue that came up during my first pediatric clinical rotation. I am a junior in a BSN program, and naturally we are expected to do a head-to-toe assessment of each patient.
My first pedi patient was a 13-year-old male recovering from a laparoscopic appendectomy. This young man had his underwear on, and I did not even consider asking him to remove it, feeling this to be an unnecessary intrusion. I was quite surprised to find out in post-conference that I was expected to evaluate his sexual maturity according to the Tanner Scale! When I expressed my surprise, my instructor explained that by failing to assess his genitals, I was not doing my job.
Feedback is requested: Is this is a real-world expectation? If so, then I request help in how to approach this with my patients. . .Thanks in advance for any assistance!
Finally, I want to hasten to add that I assessed for abdominal pain, rebound and guarding, and I auscultated bowel sounds X 4 quadrants, evaluated the laparoscopic appendectomy dressings for drainage, and the like . . .but I really can't come up with a justification for checking under the poor kid's underwear!
I want to learn to be a good nurse, and I treasure this forum for helping me learn the ropes!
I hope I will get some gentle tips/assistance with an issue that came up during my first pediatric clinical rotation. I am a junior in a BSN program, and naturally we are expected to do a head-to-toe assessment of each patient.
My first pedi patient was a 13-year-old male recovering from a laparoscopic appendectomy. This young man had his underwear on, and I did not even consider asking him to remove it, feeling this to be an unnecessary intrusion. I was quite surprised to find out in post-conference that I was expected to evaluate his sexual maturity according to the Tanner Scale! When I expressed my surprise, my instructor explained that by failing to assess his genitals, I was not doing my job.
Feedback is requested: Is this is a real-world expectation? If so, then I request help in how to approach this with my patients. . .Thanks in advance for any assistance!
Finally, I want to hasten to add that I assessed for abdominal pain, rebound and guarding, and I auscultated bowel sounds X 4 quadrants, evaluated the laparoscopic appendectomy dressings for drainage, and the like . . .but I really can't come up with a justification for checking under the poor kid's underwear!
I want to learn to be a good nurse, and I treasure this forum for helping me learn the ropes!
Like another poster said, in my school...we do "focused assessments" in which a Tanner evaluation would not have been appropriate. I can't believe your instructor told you that you weren't doing your job. Sheesh. I would not have done anything different than you did, nor recieved the feedback you did. I am certain of that. JMHO but 13 is a tender age as it is, not a place for student nurses to practice skills that aren't pertinent to the focused care of the patient.
As a peds nurse let me tell you that 9 time out of 10 the admitting doctor will write "deferred" under that section of the H&P form. If there is some newly noticed endocrine problem, then yess that will be assessed and noted by the MD and RN (discretely of course) on admission then "taken for granted" for the rest of the stay.
Maybe if the 17 yo males voice is unusual, facial features show lack of maturing, etc, I might look further into the issue also; do you think you might notice lack of axillary hair while ascultating, etc? Honestly, in this case since he should be coming back from the OR without shorts on this is something I feel certain I would notice on my admission assessment... I wouldn't think "OK now I have to assess his Tanner stage" but anything grossly unusual would jump out at me. I know that because, believe me, I notice the tatoos I would not expect a student to follow-up the admitting nurse with more sensitive assessments (after all I thought a BIG piece of peds nursing, esp in school, was psycho-social development??) Of course, if you really want to learn about a teen's psycho-soc state, peek under his shorts once then eavesdrop on his phone calls when he tells all his friends that the nurses were "checking out my junk!"
Yes, we do ask all teens about sexual activity, and all females (over about 8) about onset of menses and LMP.
I certainly hope that the OP did not get "written up" or docked points for the assessment w/out a fight.
In my "real world" assessment, I ask the patient if there is any difficultly urinating or if there are any other issues they'd like to discuss with either me or the doc regarding that area. (You'd be surprised - once I discovered a patient who had a "funny bump" on her labia - turned out it was some sort of a lesion due to her immune compromised status).
Is it hospital policy there for a child to have that Tanner assessment on admission? If not, then there is no reason for this to be done - other than to put nursing students through more unnecessary paperwork. If I caught a student assessing genitals of childen without good reason (and school assigned paperwork doesn't wash for me) - then I'd be taking it up with my nurse manager and the instructor.
I'd take this up with the coordinator of the course. Not this particular incident, but the absurdity of having to examine genitalia of patients where it is medically unwarranted.
I have a 13 y/o daughter and would ABSOLUTELY not allow a male (and more than likely a female either in a case such as this) student to peek in her unders...she understands the medical need (at times the things a lady has to do, but has never nor will ever be subjected to without me present). I can't believe that you are expected to do that to a youngster that age for something not even related to the genital area! Huh...
Even my 20 y/o dgt who recently gave birth wouldn't let me leave the room when the doc was checking her cervix, for pete's sake!
Maybe simply ASK if anything odd or different has been going on?
Specializes in Education, Acute, Med/Surg, Tele, etc.
I am totally with the others on having an MD field that one! I do ask about urination/deficationflatulance post op and if there is a difficulty in any of them, that is the docs call! Heck, Docs won't even examine those areas without a secondary person in the room...no way am I doing it alone! I won't even check for hemmoroids without an MD present or a nurse (dependant on situation...some elderly folks don't mind at all and are accustomed to it...but a young person....oh boy!).
Since this was an appy, you did exactly what you needed. No need to go assessing the genitals unless the patient has expressed discomfort or a probelm with them. I mean, I don't go around doing a full cranial nerve checks q2 hours for a appy all shift, so why go there unless indicated???
Also, considering the patient had underwear on, does construde as a hint to a possible declination to gential examiniation. So if that is the case, I would simply ask the patient and get a declination or his preferences on whom he wants to do the examiniation if indicated!
Considering this young man proably isn't at risk of genital fold breakdown (dependant on size, and time in bed, hygeine habbits etc), or had a foley in for any real length of time if that...I would proably just ask questions about comfort or rashes and leave it at that (of course implementations if problematic, but usually by MD order at this point!).
I am no peds nurse, but I think if there is a significant developmental problem that parents would be all over it. If there are true endocrine problems I think there would be systemic effects, and this "genital glance" would not be uncovering some glaring overlooked deformity.
Specializes in CCU, Trauma and forensic, Home Hospice C.
I really can't see a good reason for it either. Sounds like you did what was supposed to be done. Then again, some preceptors have their own arcane reasons.
Good Lord! I'm glad you didn't "take a peek" in his undies. I don't think there's much justification for doing that to a 13 year old.....that age group is already so sensitive about their sexuality and privates that to have a 21 year old female poking around down there would probably be an issue. The extent of my assessment of his genitalia would be "Have you pooped since surgery?"
As an aside, I'm an ER nurse and work both peds and adults. Any time I'm in a room with a patient of any age and we're around the genitalia (caths, assessment - assuming there is a good reason to assess the genitalia) I have another staff member at the bedside with me. Especially if I'm working on a male patient. It just isn't worth it!
Good gut reaction.....if your instructor keeps pushing it, I would ask her to explain her reasoning and to be there with you (in a respectful way).
PS-This is why we need new blood in nursing instructors!! I can't count how many of my instructors hadn't done patient care in years except in clinicals. :)
Taking this subject outside of the peds realm but to med-surg nursing, if I have an alert and oriented patient in with something like chest pain, I am not peeking in their underwear during my assessment. I ask them if they are voiding regularly, is it yellow, does it burn etc and if their bowels are moving regularly, no blood in the stool etc. It is still assessing- just not inspecting. If I have a patient on bedrest with briefs etc I will look to make sure there is no yeast to the groin area or breakdown etc. I am SHOCKED that this instructor expected you to do that!
On a side note, I was hospitalized a couple of times as a teenager, and NEVER did I encounter this during an assessment, as my admitting diagnosis was more neuro related. I am sure I would have flipped out.
Taking this subject outside of the peds realm but to med-surg nursing, if I have an alert and oriented patient in with something like chest pain, I am not peeking in their underwear during my assessment. I ask them if they are voiding regularly, is it yellow, does it burn etc and if their bowels are moving regularly, no blood in the stool etc. It is still assessing- just not inspecting. If I have a patient on bedrest with briefs etc I will look to make sure there is no yeast to the groin area or breakdown etc. I am SHOCKED that this instructor expected you to do that!
On a side note, I was hospitalized a couple of times as a teenager, and NEVER did I encounter this during an assessment, as my admitting diagnosis was more neuro related. I am sure I would have flipped out.
Sounds like your instructor needs a reality check
I would just like to say that when i was 15 (i am a female) i went into urgent care for a horrid sore throat. Wa sure i just needed a swab and script for antibiotics for strep throat (had it a million times). Well my mom stayed in the waitin area because my little brother ( 9 at the time) had gone off to use the rest room when i was called back. The doctor shocked me by doing a very "thorough" breast and nipple exam, and did the genital "peek" that i am reading about on this thread. Now i felt VERY uncomfortable with this and couldn't for the life of me figure out why i needed a breast exam and my privates looked at by this man, but decided to chalk it up to some sort of special gland in those areas that i didn't know about, that no one had ever checked before in my numerous bouts with strep throat. My reason for posting this is to say that because of this incident i pretty much have come to believe that the doc behaved very inappropriately with me and was a pervert, so if you guys (and me as well as i am now a nursing student) think that taking a quick peek without saying why and what it is needed for is a good idea, I am here to say please DON"T DO THIS! The fact that i remember this incident so clearly 15 years later is a big red flag! Now that i read this thread, i suppose it is "possible" that the guy was just being extra throrough in his exam, but it sure felt like the big dirty "M" word to me and in a way that is how i perceived it. :uhoh21:
It is appalling to me how way out of touch from the real world some intstructors are. Sometimes all it takes is a step back into objectivity and many are not capapble.
I would not expect a student to follow-up the admitting nurse with more sensitive assessments (after all I thought a BIG piece of peds nursing, esp in school, was psycho-social development??) Of course, if you really want to learn about a teen's psycho-soc state, peek under his shorts once then eavesdrop on his phone calls when he tells all his friends that the nurses were "checking out my junk!" 
RNin2007
513 Posts
Like another poster said, in my school...we do "focused assessments" in which a Tanner evaluation would not have been appropriate. I can't believe your instructor told you that you weren't doing your job. Sheesh. I would not have done anything different than you did, nor recieved the feedback you did. I am certain of that. JMHO but 13 is a tender age as it is, not a place for student nurses to practice skills that aren't pertinent to the focused care of the patient.
~J