Taking clothes off for a head to toe assessment

NurseSpeedy, ADN, LPN, RN · May 21, 2016

I went to LPN school 15 years ago. We practiced assessment on each other and our clothes stayed on. If the student was okay with placing the stethoscope on the skin under the shirt to listen then it was allowed, but if they did not want to be touched, this was respected and they didn't lose points for it (I think there are some laws here in the US about unwanted touching. Our patients have these rights, why would a student have these rights taken away?).

Recently I finished my RN program. They didn't even go there with practicing on each other. There were plenty of manikins to go around.

You will have so many different patients who will agree to let you listen to theirs during clinicals to learn what different sounds are. The argument that the student needs to know normal to know abnormal and this is the reason we should practice on our classmates is somewhat flawed. We are all human and even though we are not hospitalized, does not mean that we do not have any medical conditions that would cause our "normal" to not be what is textbook normal (such as someone with a heart murmur or someone who has occasional wheezing due to chronic lung problems).

FNPwannabe123 · May 27, 2016

Seems to me that doing an invasive procedure such as foley insertion or blood draws that carries risk of infection or other complications without an actual medical indication would be unethical and unwise in this day and age of litigation.

We did NG tubes on each other last quarter, as well as an IM injection and a subq injection. We also will be doing IV's on each other next quarter.

When we did our assessments we just put our stethoscope under the clothing. I don't think making students disrobe is appropriate. And I definitely draw the line at Foley insertion! :nailbiting:

Shagce1 · May 27, 2016

We were told to have shorts and sports bras to wear when we did head to toes/lung sounds/hearts sounds. But we were given a patient gown to wear as well as a sheet to cover up with. Beds were also curtained off as in a real patient room. It helped our partner to practice helping to preserve a patients privacy as well as learn those skills. We were warned on day one of orientation and again as those skills were approaching.

On another note, our cohort started out with a young woman of middle eastern descent whose culture required a head wrap, and complete body covering. She dropped out "due to family issues" shortly before we started practicing those skills. I always wondered if her modesty practices made it difficult for her to want to participate. Not sure if she ever spoke to an instructor about her beliefs or not. We did have 3 men in our class and I am sure that made it difficult for her as well.

Maevish, ASN, RN · May 28, 2016

The most we had to do was to be in swimsuits for learning how to do a bed bath. We heard horror stories from our teachers about having to practice NGs and foleys (I'm not entirely certain they weren't yanking our collective chains on that last one) on each other in school, but nothing crazy for my classes. They also had to do everything that wasn't a sterile procedure without gloves too, though, so maybe nursing labs have progressed like the glove-wearing has:wacky:

xo

Feelgood RN · May 28, 2016

You want to talk about body conscious; try being an overweight late 20's male in a cohort of 18-early 20's females!!!

I've found that most places are pretty respectful of people and their bodies, either by letting you go over clothes for practice or just go under shirts for hearing heart/lung sounds. I do have to say that people in this field are usually very professional about other peoples bodies and most just want to see something new so that they have reference for the future.

I used to joke with all twiggy girls that I was the patient of the future so they should get used to moving my big *** around

Our school didn't allow IV's or foleys or such, not because we weren't willing, but because of possible insurance claims if something happened to students...I wouldn't say that that stopped us when no one was looking, but just for hose wondering why your school doesn't allow it.

angeloublue22, BSN, RN · May 29, 2016

My school suggested we wear sports bras on the days we practice assessments because we had to take our shirt off too. We also practiced placing EKGs. We had exam curtains. We didn't see anything weird about it, since we have to get used to seeing people naked anyway. For new nurses, it makes it easy to hear breath sounds when no fabric in the way.

Valcorie34, BSN, MSN, RN · May 29, 2016

Have them just put a stethoscope under your shirt, it doesn't mean your shirt comes off. Just a stethoscope has to be against skin not clothes. Being a nurse means being able to provide privacy and make patients comfortable. So if you were in a doctors office, you do not want to get people undressed all the time. Pediatric patients are the same, they are very privacy oriented. Just find a partner you trust and let them know how you feel ahead of time and it will be fine.

You will do fine!

Mhays · May 31, 2016

I really and truly believe that with one layer of clothes, you can hear everything just fine. If your professor instructs you to use a gown and put it on so that you and your lab partner can both hear sounds, then that is fine to do so. It is hard to hear sometimes with heavy clothes; so that is why they have those paper gowns so that it becomes easier to hear with a stethoscope. Also, you might want to keep in mind of what your client's ability to do is and make sure that they can undress and do those types of things because if they need assistance, then you would have to assist them. When helping them with their clothes, you can use a bath blanket. That way, they will not be exposing their skin and they will remain covered as well. Good luck to you. Marcy CNA

domlisa82784 · Aug 25, 2016

I like being shirtless during physicals and head to toe assessment. It's better to use the stethoscope when you have no shirt on.

verene, MSN · Aug 26, 2016

In program we did practice on skin - but we had options. Students playing the patient could wear a gown, could wear a tank-top or loose fitting shirt, or could take off shirt/wear sports bra.

It was kind of awkward at first, but I think after the first practice run or two we all got pretty comfortable with it. Everyone was really professional and it made the interactions more "real world"; patients aren't always comfortable removing clothing and learning how to accommodate with gown placement or using a blanket to reveal just the skin needed for the procedure was part of our training by doing the assessments this way.