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 didn't give the impression that anyone should be peeking in undies. I just wanted to remember that we do a lot of assessments "out of the corner of our brains" without even realizing it, for instance during a bath (although I wanted to keep my post age appropriate) Like I said, I don't think that would have been an age appropriate nursing assessment. I understand that the instructor wants her students to understand Tanner Staging, but lets keep it on a theoretical level because until you care for a pt with Klinefelters or some other unsual endocrine syndrome or even the precocious (sp?) puberty that often accompanies CP, Tanner's is just theoretical. Even then, it's assessed and noted by the MD, you'll see it more often on a consult form than an H&P, and nobody expects a nurse to address the stage itse'f, just the implications of the pt being in an age-inapproriate stage... early menses, developmental delay, hormonal instability that may affect blood glucose
And one more thing (from my warped mind, please stop reading if you are among the nurses that have never made an inappropriate joke!!) next time an instructor asks a student for this I want the student to smile that "I'm enthusiastic about nursing and learning new skills" smile and say sure! Now Mrs Instructor, how do I do my teaching? I guess I'll say "Hi Bobby and Mrs Jones! I'm Jane your student nurse. I just need to look in your shorts so I can document how big you are and how much hair you have. I'm going to use this Enfamil measuring tape that you can take home with you Mrs Jones, to add to your son's scrapbook" If that doesn't make an instructor realize she's on the wrong planet, nothing will! (and, yes, I know that measuring tape has nothing to do with it!)
I hope I didn't give the impression that anyone should be peeking in undies. I just wanted to remember that we do a lot of assessments "out of the corner of our brains" without even realizing it, for instance during a bath (although I wanted to keep my post age appropriate) Like I said, I don't think that would have been an age appropriate nursing assessment. I understand that the instructor wants her students to understand Tanner Staging, but lets keep it on a theoretical level because until you care for a pt with Klinefelters or some other unsual endocrine syndrome or even the precocious (sp?) puberty that often accompanies CP, Tanner's is just theoretical. Even then, it's assessed and noted by the MD, you'll see it more often on a consult form than an H&P, and nobody expects a nurse to address the stage itse'f, just the implications of the pt being in an age-inapproriate stage... early menses, developmental delay, hormonal instability that may affect blood glucose
And one more thing (from my warped mind, please stop reading if you are among the nurses that have never made an inappropriate joke!!) next time an instructor asks a student for this I want the student to smile that "I'm enthusiastic about nursing and learning new skills" smile and say sure! Now Mrs Instructor, how do I do my teaching? I guess I'll say "Hi Bobby and Mrs Jones! I'm Jane your student nurse. I just need to look in your shorts so I can document how big you are and how much hair you have. I'm going to use this Enfamil measuring tape that you can take home with you Mrs Jones, to add to your son's scrapbook" If that doesn't make an instructor realize she's on the wrong planet, nothing will! (and, yes, I know that measuring tape has nothing to do with it!)
missjo, i knew you weren't saying that taking a peak was always the way to go, i just wanted to mention my experience as a patient in a similar situation, and just caution folks to be careful and always ALWAYS say why you need to do something and have a second person of equal or higher knowledge with you to validate and put the patient at ease if something like that HAS to be done.
I guess that's where my ealry AM sarcasm came in... when you're telling the pt and family what you're doing, how do you possibly explain this without looking like a whacko? I can preface a lot of things with "I'm sorry if you feel this is personal, but this is a routine question and gives us some info that may help you..." but this isn't one of them!! I can't end it with my usual "If you change your mind about your answer or just want to talk some more or ask questions, any of the nurses would be glad to talk to you in confidence" b/c by that time, the pt will never trust me with anything!
ditto to what everyone else said, and one more thing...patients are not our guinea pigs or dolls to practice with, especially in a pediatric hospital, taking care of akward teenagers. just because we learn about tanner assessments does not mean we have to do it just because we are given the chance...it was not pertinent to this patients focused assessment. and yes, asking if there are any concerns, 'anything i should take a look at?' is an apropriate assessment.
Specializes in med/surg/tele/neuro/rehab/corrections.
My son had an appendectomy at age four and it was his nurse that gave me his undies after surgery and asked me put them on him so he would feel more comfortable.
I was going to say even before reading all these replies that someone taking a peek under those undies sounds like a molester and I would be really mad and report such an incident.
I have a 11 year old son and in nursing school, if some nurse or nursing student took a look at his privates I would be wondering myself about it. I also work in postpartum and I tell my young ladies when I have to look at their lochia and if they have an episotomy I look but I always explain what I looking at and for, also when I am checking their breast for fullness or have a mother breastfeeding I tell them I'm fixing to touch your breast. I would feel very uncomfortable if some nurse just looked in my underwear and I didn't know why, male or female. When I had to do my OB assessment with my instructor she had us defer the breast exam and lady partsl exam and just talked about what we would be looking for.
Did you ask the instructor if you were a MALE nursing student and you "peeked" into a 13 yr old FEMALE patients panties pot appendectomy if that would be appropriate? I am disgusted with the lack of real life skills some instructors have. I have NEVER done that on any patient unless they had a Foley and then I explain why I am peeking.
My guess is that the OP's description of this instructor's behavior is probably rooted in the all too common "power trip". Any excuse to find fault or pull the rug out from under a student makes a passive/aggressive nursing instructor feel superior. I imagine that the student must be really competent, and the intstuctor is pulling out some obscure reason to try to restore his/her preferred "balance" of power.
Makes me wanna puke.
But, kudos to you OP! Very impressive and well done!
Devil's advocate here. Perhaps instructor wants you to verbalize why you didn't do it. Did you not do it because you didn't think to, or did you not do it because it wasn't pertinent to your focused assessment and you wanted to respect your patient's privacy?
Wasn't there, but looking back there were times that instructor would hit me up with stuff like that, and if I could just verbalize why I did or didn't do something, that's what they wanted to hear. I consider it training for sticking up for yourself against holier than though MDs.
[Originally posted by wooh: "Wasn't there, but looking back there were times that instructors would hit me up with stuff like that, and if I could just verbalize why I did or didn't do something, that's what they wanted to hear. I consider it training for sticking up for yourself against holier than though MDs."]
I like your take on things, wooh (devil's advocate). Before reading the four pages of responses to my original post, I could not have been nearly as eloquent in explaining my reasons for not "going there."
In the very detailed care plan we are required to submit, we must comment on eleven functional areas, the ninth being sexuality/reproductive. For this patient I wrote, "This area was not assessed," going on to discuss the norms of pubertal development for males of my patient's age.
The instructor makes notations in red pen and we are then required to address all of her comments. She wrote "Why?" above my "This area was not assessed." I submitted my revisions last Thursday, and my answer was informed by this forum: "I took underwear to be a declination. Due to psychosocial developmental issues, I did not feel this was appropriate for the kind of focused assessment I was doing. Doctors would have been able to assess this at the time of surgery."
Regardless of my instructor's response, I have really learned a lot by her challenge and your responses. I look forward to continued learning about the nursing process!
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MissJoRN, RN
414 Posts
I hope I didn't give the impression that anyone should be peeking in undies. I just wanted to remember that we do a lot of assessments "out of the corner of our brains" without even realizing it, for instance during a bath (although I wanted to keep my post age appropriate) Like I said, I don't think that would have been an age appropriate nursing assessment. I understand that the instructor wants her students to understand Tanner Staging, but lets keep it on a theoretical level because until you care for a pt with Klinefelters or some other unsual endocrine syndrome or even the precocious (sp?) puberty that often accompanies CP, Tanner's is just theoretical. Even then, it's assessed and noted by the MD, you'll see it more often on a consult form than an H&P, and nobody expects a nurse to address the stage itse'f, just the implications of the pt being in an age-inapproriate stage... early menses, developmental delay, hormonal instability that may affect blood glucose
And one more thing (from my warped mind, please stop reading if you are among the nurses that have never made an inappropriate joke!!) next time an instructor asks a student for this I want the student to smile that "I'm enthusiastic about nursing and learning new skills" smile and say sure! Now Mrs Instructor, how do I do my teaching? I guess I'll say "Hi Bobby and Mrs Jones! I'm Jane your student nurse. I just need to look in your shorts so I can document how big you are and how much hair you have. I'm going to use this Enfamil measuring tape that you can take home with you Mrs Jones, to add to your son's scrapbook" If that doesn't make an instructor realize she's on the wrong planet, nothing will! (and, yes, I know that measuring tape has nothing to do with it!)