Who establishes the rules

[quizzical]

I am completely new to this forum. Maybe a lot of you would think I don't belong here. I actually am currently studying to be a Medical Assistant but might eventually go on to become an RN.

However in the Medical Assisting program I am in, there were several nurses who needed to learn phlebotamy , and there was even one doctor from Russia who's Russian MD was somehow insufficient for the US and was studying to be an MA or phlebotamist.

I would have some stories to tell about my Medical Assistant training but I

just want to begin by saying that I was taught quite a bit about medical ethics and it left me with a lot more questions than I ever had. Of course my experience as a patient (whenever I had to go to a doctor or the hospital) already had left me with a lot of questions that my enrolling in Medical Assisting training hardly answered.

There is a "closed" forum on this site about how nurses ought to deal with female patients when applying EKG leads on them. At MA training I was taught that it is appropriate to touch the female's breast using the back of the hand because this is considered less intrusive and if you use your palm it can be considered "groping" thus sexual harassment or assault.

(By the way, I was also told that the same technique would apply when you are dealing with a man who has gynecomastia ; and this is not mentioned much).

What I wonder about is who established such a rule and had it become a "universal" technique to be taught to all nurses, or medical assistants or EKG technicians, ( etc)?

Anyone know?

This will be my first question on this forum. I will probably have more of different kinds.

[NICU Guy, BSN, RN]

I used to be an EKG tech many years ago and when it came to females with large breasts, I asked them to lift or move the breast themselves. Usually, that was sufficient to place the leads in the proper position. On the medium sized women, I would use my finger tips of my right hand to move the breast tissue out of the way and use my left hand to apply the leads. As long as you are professional, it shouldn't be an issue how you go about moving the breast.

[VivaLaVespaGirl, BSN, MSN]

We are taught in our program to inform the patient of our intent, then to use the back of our hand to move breast tissue. Alternatively, we may ask the patient to do so if appropriate.

[bagladyrn, RN]

One time I was attempting to place EKG leads on a lady with very large pendulous breasts. As I tried to find a polite way to move the mass of tissue she looked at me and said: "honey-do you want me to fling my tit out of the way?" Gave us both a laugh!

[klone, MSN, RN]

I don't apply EKG leads, but I am a lactation consultant which requires me to get up-close and personal with women's breasts on a regular basis. If I have to touch, lift or hold her breast, I simply say "Is it okay if I touch your breast?" and ask for their permission, then go about my business.

[kidzcare]

You can easily cover yourself (legally speaking) by stating your intent and asking permission before touching your patient. It's a habit now to do it for every patient, every time.

Something as simple as assessing bowel sounds can feel invasive if you don't say what your intention is.

[quizzical]

Hi all.

I am the one who created this post. I have yet to fully learn how to utilize this forum.

I appreciate the replies but none really answers the question, who made the "back of the hand" rule?

It seems to be taught to every medical worker who will have to deal with the matter. Therefore, some "medical authority" must have thought it up and made it a standard to teach to all students of EKG or Medical Assisting ( etc). Was it the American Medical Association? ( It seems that they are very politically powerful and can make rules for a lot of medical personnel to follow).

Thanks to anyone who can provide info. Maybe some of you can ask a teacher or professor whom had taught it to you.

[klone, MSN, RN]

Did you ask your instructor?

I can say it certainly wasn't taught to us when I was in nursing school. I have never heard "back of the hand" until this thread.

[quizzical]

I am almost done with dealing with the instructor who told me about the "rule." I may not get a chance to ask him. However I can also try to put two and two together.

So, let me ask you "klone" how long ago were you in nursing school? Maybe it is some relatively new rule or standard that came about since the 1970s when society began to realize that sexual harassment happens regularly in common situations, such as in the workplace; and even when doctors deal with patients.

Perhaps the "rule" did not exist anytime before the 1960s.

[klone, MSN, RN]

So, let me ask you "klone" how long ago were you in nursing school? Maybe it is some relatively new rule or standard that came about since the 1970s when society began to realize that sexual harassment happens regularly in common situations, such as in the workplace; and even when doctors deal with patients.

Perhaps the "rule" did not exist anytime before the 1960s.

I graduated from my RN school in 2006. I'm 40, so I was not born yet in the '60s.

[nurseprnRN, BSN, RN]

Hi all.

I am the one who created this post. I have yet to fully learn how to utilize this forum.

I appreciate the replies but none really answers the question, who made the "back of the hand" rule?

It seems to be taught to every medical worker who will have to deal with the matter. Therefore, some "medical authority" must have thought it up and made it a standard to teach to all students of EKG or Medical Assisting ( etc). Was it the American Medical Association? ( It seems that they are very politically powerful and can make rules for a lot of medical personnel to follow).

Thanks to anyone who can provide info. Maybe some of you can ask a teacher or professor whom had taught it to you.

You may be quite surprised to know that the AMA is a membership organization that does not include all physicians any more than the ANA includes all nurses, that the AMA does not make practice rules, standards of practice, or laws, and that for some odd reason physicians very rarely learn patient handling techniques other than doing exams and procedures because, well, they don't actually handle patients very much in the way that nurses and techs often do. Your conclusion that some medical authority must have thought of this and made it a standard is therefore flawed because it is based on erroneous assumptions.

Many such practice-based ideas are passed along in various communications media such as this one, through schools where instructors learned it once, from peers or preceptors, or just from someone's aha! moment, and the origins of a particular practice may be lost in the mists of time. Why does it matter, anyway?

Note that this is different from the, "We've always done it this way" meme that frequently initiates some inquisitive person's foray into nursing research.Those tend to be practices in things like getting vital signs, giving meds, or other patient care procedures that can be more culturally-based in a particular hospital or nursing program, perhaps based on local resources, systems, or equipment.

The generalizable concept is not, "What's the rule about moving a breast?" but rather, "How could I use my knowledge of good manners and preventing patient embarrassment in a situation where I have to contact an intimate area?" In my opinion, "What's the best way to move a breast (politely)" seems to fall under the "good manners" part of interpersonal relations, not a "how to do it for accurate results"' thing. Asking a patient to hold her own breast up would work, too.

And hoping you're not one of our occasional trolls....

PS. It's phlebotomist, and MA is not on the same ladder as either physician or nurse or EMS. All separate paths. If you want to be a nurse, don't waste your time in MA school.

[Altra, BSN, RN]

I suspect you're looking for a reference to a "rule" established by some governing body, and there is none.

Firstly, the American Medical Assn. is a professional association for physicians. It would not regulate the practice of clinicians who, for example, perform EKGs.

The back of the hand technique you describe is commonly, but not universally, taught. If it works for you - great. If you develop an alternative way of working with patients' personal boundaries - that's great too.