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Sexually harassed by your patients? Advance for Nurses posed this question to us:

Q: A patient routinely makes rude, sexually charged comments as I provide basic hygiene and attend to his catheter. How should I respond, given that patients are not like peers or subordinates where reprimands, demotions and firings, can be enacted?

A: Vulnerability is probably underlying your patient's demeaning and disrespectful behavior. His body and his healthcare providers are doing things to him that he doesn't like and can’t really control. He may fear that in providing healthcare to his genital area, you will do something painful to him. He may even fear castration on some level. For regressive men attached to their dominance over women, this fear may be even more acute.

So to adapt in perhaps the only way he knows how, your patient transforms his fear into dominance. The last time someone cleansed his genitals, his parents were probably toilet training him. So when you cleanse his penis he might mentally revert to boyhood--a demeaning feeling. But he can feel man-like again by imagining that your interest in his penis is purely a sexual one--an arena where someone like him probably dominates. Feelings of domination and vulnerability probably can't simultaneously exist, so his vulnerability fades with the increase of his sexual suggestions.

So you might address his fear and inappropriate reaction to it directly, by saying something like (or printing it out and giving it to him):

"Joe, I want to talk to you about my role here as your nurse. To become a nurse I went through ___ years of college where I learned how to identify health problems and appropriately treat them. It must be unpleasant to have nurses assist you with your health care in the sensitive genital area. I will do my best not to hurt you and I'm certainly not here to demean or threaten you when I provide this care. I am solely interested in your health and well-being. I am not interested in you sexually and it is not part of my job to provide sexual services to you, despite the inaccurate messages and images that the media sends society. I want you to stop making sexually suggestive remarks. I cannot provide you with the kind of quality healthcare that you need to recover when you do that. So if you want to survive your ordeal here and get the best health care possible from me or any other nurse, it would be in your best interest to speak to me and other nurses in an appropriate, non-sexual way, with the understanding that the only service we are here to provide you relates to your health. (Optional: "If you can't deal with these guidelines, we can get the hospital's attorneys involved.") Any questions?"

modified version above originally printed in Advance for Nurses April 24, 2006.

Supporter Alison Chase, RNC, MS, ANP, adds:

As a VD nurse for many years, I have encountered sexual comments more often than some and out of necessity found my own ways of dealing with this.

I have found sexual comments a good introduction to doing some therapy for the patient. Asking if the need for my treatment or examination makes him uncomfortable often opens the door to allow the patient to express his true feelings about pain, feeling out of control, infantilized... to which I can then make some reassuring or just sympathizing comments. Telling him it's normal to feel uncomfortable about it--everyone does--helps. Also responding that I have seen hundreds of genitals and our nursing education leads us to not see genitals--we simply see skin that is abraded or infected or healthy. This helps immensely.

Continuing the conversation in a clinical manner--"Have you had any pain on urination or discharge, or a history of these? Or giving instruction about proper cleansing techniques, birth control, symptoms of disease...seems to display professionalism and change the tenor of the conversation without having to give a lecture, while implying that the patient cannot shock or scare me away. As you pointed out, the underlying cause of such behavior is usually the patient feeling his manhood is threatened so reassurance that the nurse will stay and respectully care for the patient is important, while sending the message that the care will be on a professional basis only.

If the above does not succeed, then the question "Would you have said that to a physician?" Sometimes with a listing of my education years often gains an apology from the patient.

With continued offense or physical assault of any degree I would report the behavior.

Also see our page on research about sexual harassment of nurses.

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