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August 8, 2017

You're Making It Weird: Opposite-Sex Physical Exams [Infographic]

By Sean Dent, ACNP

An important part of nursing is maintaining patient dignity and privacy while providing optimal care.

As nurses, we treat the person, not just the disease. This holistic approach demands attention to patient comfort during frequently uncomfortable treatments, procedures, and exams. 

The Exam

When our patients seek medical attention, they sometimes aren’t aware of the extent of their illness. There may be aspects of their health they consider very private that may need to be openly discussed. They may also need a physical exam. 

A thorough exam can (potentially) include inspection, auscultation, palpation, and percussion of whatever body part or organ that may likely be involved.

Certain aspects of our body and physical health are considered private, so when a nurse is examining a patient of the opposite sex, certain precautions should be taken, and clear lines of communication must be established between patient and nurse.

The Male Nurse and the Female Patient

Can a male nurse perform a physical examination on a female patient? Absolutely. Nurses of both genders are trained and educated equally. There is not a separate male nurse education category, and every nurse is instructed in therapeutic communication.

However, barriers to patient trust and comfort are recognized by all nurses, especially those who happen to be men. These barriers create fear and tension between the nurse and patient, and it’s every nurse's job to ease such fears. 

We are the most trusted profession for a reason -- our patients’ privacy and dignity are as important as the treatment and interventions we perform. 

Here are four topics to consider when performing physical exams on patients of the opposite sex: 

1.  The actual treatment (or exam)

Presence, approach, and communication are vitally important. The actual treatment, type of exam, or anatomical location of the exam will make little difference if you don’t have a professional presence, an endearing approach, genuinely caring touch, and open communication. 

How you do something is often more important than what you’re doing. Ask yourself these questions: 

  • How did I make my patient feel? 
  • Did I establish trust? 
  • Was I abrasive in any way? 
  • Was my body language and tone of voice congruent and reassuring? 

Your approach and mannerisms speak volumes about your nursing care. What you say -- and don’t say -- matters. 

2. Inappropriate treatment is not gender-specific

Patients will feel vulnerable. Period. 

Your gender doesn’t matter. The patient’s gender doesn’t matter. It’s the act itself that makes a patient feel this way. 

Of course, a situation involving a patient and nurse of opposite genders may influence how a patient feels. But remember that a patient can and will feel vulnerable with a nurse of the same gender if the act itself is not performed appropriately.

Compromising a patient’s dignity or privacy will not feel any less horrible if the nurse and patient share the same gender. 

3. Chaperone or an unbiased third party?

In this day and age, the fear of legal action is a real concern. 

Patients sometimes accuse their healthcare providers of misconduct, and this can influence the dynamic of your interaction with your patient during sensitive and private examinations. 

The concept of an unbiased witness or “chaperone” can eliminate this potential gray area for both the patient and the provider. 

When you know you’ll be performing a sensitive examination, you can request the presence of an unbiased professional to witness the exam. In this way, both parties can feel comfortable knowing that privacy, dignity, and professionalism are maintained.

Chaperones can sometimes be a double-edged sword. Bringing in another person can make the patient feel even more uncomfortable. As a nurse, you need to decide with the assistance of your leadership team what approach you should take when performing these type of exams. At the end of the day, maintaining your patients’ comfort should always come first. 

4. Know The Baseline

The patient and their baseline cognitive status matters. In some cases, a patient may have cognitive deficits or mood disorders that affect the exam process. And in some unfortunate cases, the patient may have been abused in the past.

If any of these scenarios present themselves, you need to be prepared to address them. No matter how detail-oriented, caring, and professional you are, the potential for misinterpretation is very high -- this is when a chaperone may help. 

You can ask yourself the following questions: 

  • What is the patient’s baseline mental status? 
  • Are they cognitively aware of the situation and the exam that needs to be performed? 
  • Do they understand and comprehend the circumstances, need, and details surrounding the sensitivity of their care?

Always obtain a detailed patient history (when appropriate and possible) and an assessment of medical needs before you perform any exam.

Comfortable and Safe Patients 

Many exams have the potential to be intrusive or embarrassing for patients.  Nurses must find a way to make patients feel comfortable and safe under any circumstances.

Nurses have the ability to lead with their hearts because our science-based care is guided by our compassionate, all-inclusive approach. We treat our patients, not their disease, and we prioritize patient dignity above all else. 

 

Sean is an Acute Care Nurse Practitioner, Freelance Blogger, Vlogger, Podcaster, Speaker and Social Media Maven.He started his career as a diploma-trained RN and now practices as a full-time Board Certified Acute Care Nurse Practitioner (ACNP-BC) in a Shock Trauma teaching hospital. When he’s not saving lives or creating content online, he’s usually drinking coffee and eating bacon.

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