I had one clinical day (my first clinical day) with an instructor that just started working at my college recently and I just can't stop thinking about an incident that occurred with her. I'm in my first semester.
In the incident she didn't obtain clear consent from a patient when she asked if we could watch a catheter insertion. The patient was elderly, but she was very forceful about us watching and he seemed very uncomfortable, attempting to cover up and never said "yes they can". She just rushed in, got too excited and forgot their was a human being? I'm not sure.
When we were walking to the elevator, one of my classmates mentioned to her how uncomfortable he looked and she actually said "well I asked and he didn't say no. He didn't say yes either, but he didn't say no when he could have". But honestly I don't feel she gave him much of a choice to say no.
Her response made me cringe. The whole incident just makes me feel not so great. She used a lot of phrases like "this is how nursing is", and "this is the real world" when referring to other sloppy incidents.
I don't know any nurses, besides other professors/classmates and I feel I can't go to them. This is my first and only clinical day so far and all I'm thinking is maybe I just don't understand nursing.
And then I'm cringing inside that she gets to be the influence on students, because realistically some students will follow that example.
I'm just not sure what to do. I don't want to create drama, I'm worried that as a student I either won't be believed or told I don't understand nursing? And maybe I don't?
As nurses, we should be promoting and protecting the dignity of our patients. Urinary catheterization can indeed be a personal and uncomfortable experience. And so can other intrusive nursing procedures, even ones we don't necessarily deem so. I always ask my patients ahead of time if a student can even chat with them (in a psych setting). No means no, yes means yes; there are no "maybes." It is up to us to obtain the informed consent of our patients -- especially so in a geriatric population, but any population really.
You are in a difficult position as you are a student. Hopefully she was having that "off" day. However, of it does become a pattern, it needs to be addressed.
Every single one of the TEN of us were told to file in to an elderly man's room to witness a straight cath recently. Add to that two nurses, a CNA, and our clinical instructor = 14 people in one half of a nursing home room, watching. This went on for awhile, too, as they were having problems actually reaching his bladder. They tried multiple different kinds of catheters. And we were all there watching the entire time.
Why didn't this patient's nurse speak up? I for one as the patient's nurse would have told all of those people to get the heck out of the room. One or two students, maybe. But 14? That's just not okay at all. Poor guy.
That really shouldn't have happened. You'll have so many more opportunities and meet patients who don't care if all the students are in there but the patient who is uncomfortable with even one extra student should be protected. Patient advocacy is huge in my book and sounds like it will be in yours. You'll see a lot of bad practice but I'd just keep an eye out for it at the moment and make note of what you don't want to be. If it happens again, walking out of the room because you know a patient is uncomfortable will be your way of advocating for the patient. When your instructor talks to you about it, that's your chance to explain you standing up for the patient and while you're there to learn, you're not there to break privacy rules.
I agree that it is an uncomfortable situation. You are stuck between a rock and a hard place with this one. It's not appropriate to all barge in there and watch a procedure, especially if the patient looked really uncomfortable. It's important to be able to read body language and keep the patients best interest at heart. Most people wouldn't want everyone staring at them while getting a catheter placed. I would keep notice of this and if it keeps happening it would probably be best to go to a higher up and let them know. Good luck!
That really shouldn't have happened. You'll have so many more opportunities and meet patients who don't care if all the students are in there but the patient who is uncomfortable with even one extra student should be protected. Patient advocacy is huge in my book and sounds like it will be in yours. You'll see a lot of bad practice but I'd just keep an eye out for it at the moment and make note of what you don't want to be. If it happens again, walking out of the room because you know a patient is uncomfortable will be your way of advocating for the patient. When your instructor talks to you about it, that's your chance to explain you standing up for the patient and while you're there to learn, you're not there to break privacy rules.
Patient advocacy is probably one of the main reasons I went into nursing. I have a really big thing with vulnerable populations that can't stand up for themselves being taken advantage of. Children, elderly, those with mental illnesses. I will definitely walk out in the future, and did walk out before everyone else this time, but after the insertion. A classmate mentioned it in our meeting afterwards and I mentioned in front of the instructor that the patient looked very uncomfortable and that's why I left. This was after she defined consent as him not saying no.
I agree that it is an uncomfortable situation. You are stuck between a rock and a hard place with this one. It's not appropriate to all barge in there and watch a procedure, especially if the patient looked really uncomfortable. It's important to be able to read body language and keep the patients best interest at heart. Most people wouldn't want everyone staring at them while getting a catheter placed. I would keep notice of this and if it keeps happening it would probably be best to go to a higher up and let them know. Good luck!
I really hope it was just an off day for her. I don't know if I'll have her as an instructor moving forward, but if it becomes a pattern I'll definitely approach it at that point.
At some, if not most, University/teaching hospitals the patients give consent to being observed for educational purposes when they sign consent for admission to the hospital. However, if the patient is clearly uncomfortable, a better educational experience is obtained by students NOT being present for the procedure.
I, as a patient, may withdraw that consent at any time, and don't have to count on the students picking up on the fact that I'm uncomfortable with their presence.
pixierose, BSN, RN
882 Posts
As nurses, we should be promoting and protecting the dignity of our patients. Urinary catheterization can indeed be a personal and uncomfortable experience. And so can other intrusive nursing procedures, even ones we don't necessarily deem so. I always ask my patients ahead of time if a student can even chat with them (in a psych setting). No means no, yes means yes; there are no "maybes." It is up to us to obtain the informed consent of our patients -- especially so in a geriatric population, but any population really.
You are in a difficult position as you are a student. Hopefully she was having that "off" day. However, of it does become a pattern, it needs to be addressed.