To cut or not to cut?

[ICURN3020]

Just wondering everyone's thoughts on whether we as nurses and other direct care staff (CNA's, STNA's, etc) have the right to groom a patient without their or their families expressed consent/request.

Now, by grooming, I don't mean combing/braiding the hair, cleaning/cutting the nails or shaving the patient's face to maintain the usual appearance of the patient or for hygiene purposes.

I'm talking cutting a male patient's shoulder length hair into a very short style. Or completely shaving the face of a male patient who normally wears a full beard (unless of course it was necessary due to interference with medical treatment).

I'm talking doing these "makeovers" based soley on the fact that staff feels the patient appears unkempt and not pleasant to look at. Personally, I'd be upset to come in for a visit with a loved one and find them appearing drastically different looking than how I knew them and how I know they preferred to look.

We had a patient recently (the shoulder length to short hair cut mentioned above) who ended up passing away and I remember thinking, "Geez, no one's even going to recognize him at his funeral."

We have no policy that I am aware of at my hospital regarding this, other than it is of course expected that the patient's personal care needs and hygiene related grooming are attended to.

Any thoughts?

[dudette10, MSN, RN]

I don't even need to read all the responses. The answer is NO!

[dudette10, MSN, RN]

The only exception to this that I make is when the beard is on a woman. Before sending a female patient back to a nursing home, I usually ask the CNA to make a good shave part of that morning's clean up routine.

[idialyze, BSN, RN]

A very elderly woman was admitted to my unit once. She had a doctor's orders to cut her hair due to a severe lice infestation, I still itch thinking about it many years after!

[amoLucia]

I DO NOT like chin-ney-chin chin hairs on the elderly LOLs faces. And I have shaved them off. But this must be done PRIVATELY (a woman with shaving crème on her face is quite a sight)! And I did ask their permission when I could.

Only one time in my whole career many years ago did I ever cut a woman's hair. There was no family to ask and the pt was a SEVERLY demented resident in my LTC. We tried the hairdresser/beautician but she bit her.

That was the problem - she had the most severe end-stage dementia I have ever seen. Animalistic behavior. She was being followed by psych and medicated as best as poss but she was pitiful to watch. Her all-over-the-place hair was long and stringy; she looked like a "wild woman". It was pitiful!

I cut her hair just enough to remove some long stringy locks; no big inches, no short new 'bob' cut. Just a few snips to improve her looks.

I am thankful I have never had another pt as severe as she and I would hope that if I or any of mine were to be so affected that someone would do their kindest to help preserve some dignity.

[suanna]

I can't imagine doing a "makeover" medical center style with or without the patient/familys consent. I'm lucky to get my meds passed, dressings changed, and required paperwork done. I was a bit trepidatious about opening the thread- I was afraid it was going to be a circumcision debate. Hair styling is a better topic.

[ICURN3020]

I can't imagine doing a "makeover" medical center style with or without the patient/familys consent. I'm lucky to get my meds passed, dressings changed, and required paperwork done. I was a bit trepidatious about opening the thread- I was afraid it was going to be a circumcision debate. Hair styling is a better topic.

You're right about time constraints and all the things we have to do in any given shift. The times I have been able to spend the hour or so washing, combing and usually braiding a female pt's long hair were on really slow nights. It felt good to be able to give them the extra attention and I hope their families were happy to see them looking a little nicer.

For men, I always include a hair combing after their bath and if time allows, a shave (if the pt/family requests or if the pt obviously shaves at home).

I've even cut the hair poking out of one elderly man's ears per his family's request.....they said that he didn't like it and usually cut it himself. Now, some of my co-workers looked at me like "are you serious?" but I look at it like this...if that was my father/husband I would hope that someone would do anything they could (within reason) to help him preserve his dignity and meet his wishes. Yes, we are primarily a medical center and health issues come first, but why not spend the few extra minutes if you have it doing something a little extra for the pt? The family will never know that you hung the antibiotic on time or called those test results to the doctor promptly but they will notice that the their family member's hair is combed or that they appear comfortable.

What I have observed is that a lot of my co-workers choose to frequently use that extra available time to chit chat or gossip. Nothing wrong with a little socialization at work, but remember why you're there in the first place.

[JBudd, MSN]

There were a few times I borrowed one of the units' shampoo boards, and cleaned out long hair in the ED, on trauma pts. Only way to get rid of enough dried blood to see if the scalp was intact. I've found additional lacerations that needed stitching, that were missed initially (weren't bleeding at the time because of the matted blood). I used half strength peroxide to get some of it out, trying to be sure not to accidentally change the hair color!) and those cheap little combs to pull the clots out.

But I would not cut it off! Except for the one time the poor homeless guy had such a matted beard we couldn't get to his face, I did cut a few chunks out.

[anon456, BSN, RN]

Our nurses actually donate hair stuff for our patients. Like good shampoo, hair bows, rubber bands, and such. I WISH we had proper brushes! Maybe if I find some on sale for $1 I'll buy some for the long-haired patients in the future.

We had a patient with long, thick hair that came in with a very bad case of head lice. This was a peds ICU patient who needed life-saving treatment and her hair was the last thing on anyone's mind. They covered the hair with a cap and everyone wore PPE in the room. No one ever mentioned or considered cutting it. After she stabilized, various treatments were attempted on the lice but nothing really worked. She and the critters were sent home with instructions not only for her physical care but for further treatment for the lice including prescriptions for the lice shampoo.

I have never heard of anyone ever cutting a patient's hair for grooming reasons. Sometimes it gets long and unruly, and the parents will cut it, or one family hired a haircutter to come and do it for them. As others have mentioned, it can sometimes be of religious significance. Even the kids who get brain surgery, the surgeons only shave just where the incision goes, and they always send the hair back in a bag for the parents.