I shaved off a patient's mustache. Was I wrong? - page 6

I was written up yesterday for shaving off a patient's mustache. I don't understand what I did wrong. The man has had a stroke and has trouble feeding himself. He was getting food all over his... Read More

  1. by   bellcollector
    Though I would not raise a ruckus Iwould be just sick if while hospitalized someone shaved my hubbies muutach unless medically necessary. We have descovered that if he is clean shaven it triggers a PTSD flashback in me. I realize it will be temporary but I would have trouble being with him while it grows back. I know that sounds rediculous to most but it could be a big deal to plenty of folks. Live and learn.
  2. by   sjb2005
    My opinion...leave the mustache alone and clean it off. And I'm not particularly fond of them. Was it for him or for you? Just wondering.
    Last edit by sjb2005 on Oct 16, '05
  3. by   jsteine1
    Consider the source of the daughters anger. This gentleman has dementia, ie, he is no longer the man this lady grew up with. How very painful a situation like that is. The change in his appearance simply fueled her fire about her dad. Personally, I would sit down privately with her and talk aout those issues a bit. I believe the daughter would ease up once she knew somebody "gets it"
  4. by   Daytonite
    Quote from NRSKarenRN
    Nurses and assistive personal need to be aware of "flash point" issues that can occur with families who are overly stressed and do what they can to minimize families reaction. Learning what to say and how to say it should be part of role playing exercises in nursing school and initial orientation to a facility as first time nurse.

    What we say and the manner in which message delivered can extinguish situation or turn up the flame.


    The following are flash point issues I've come across in 30 years in healthcare:

    1. Grooming issues
    a. Shaving off beard or mustache, especially elderly without family aware
    b. Not shaving female whiskers
    c. Hair care: not washing hair or inappropriate hair styling
    (pigtails on a women who was former weekly salon visitor, etc)
    d. Not bathing clients/clients who refuse to bathe
    e. Dirty clothes/hospital gown or soiled linens
    f. Incontinence management: use of adult diapers/foley catheter

    2. Nutrition issues
    a. Hot food cold, cold food warm
    b. Not following diet or food preferences
    c. Lack of menu choices, especially in long term care facilities
    d. Withholding food terminally ill client
    c. Peg tube insertion/feed/withdrawal

    3. Lab work
    a. Waking clients up at during night for labs
    b. Repetitive venipunctures for labs
    c. Not knowing critical lab results/failure to followup
    d. Failure to obtain written lab orders

    4. Waiting to be taken to tests/waiting for test results

    5. IV Therapy
    a. Multiple restarts
    b. Difficult stick
    c. Not offering long term access device (PICC/PORT/HICKMAN) sooner
    d. Long term IV therapy needed at home but insurance doesn't cover

    6. Discharge Planning
    a. RN's/Docs not realizing planning starts DAY OF ADMISSION not 1 hour before discharge orders written
    b. Discharge home without needed supplies ordered or prescriptions written
    c. Expectation that "Visiting nurse will bring syringes/supplies" (so NOT TRUE with managed care these days)
    d. Placement issues: refusing LTC placement, lack of caregiver
    f. Caregiver ill prepared to take care of patient once home as no teaching started in hospital: insulin administration/tube feeding/wound care
    g. Visiting nurse will come every day and stay several hours


    These are the most common areas I've had to smooth over with families, patients, nurses and doctors over the years. Role playing responses ahead of time really helps you to prepare for these situation for they are everyday occurrences.

    Worse thing to say is "I don't know why", turn and leave. Better comment is "Let me look into that, and I will get back to you"

    Looking forward to seeing other comments....
    Wow! I looked at your list since I've been supervising awhile and you've pretty much listed most of it! I think I've come across every single one of those issues. I keep copies of every administrative report I write (the equivalent of incident reports except they go up the management line) for my own records just to be on the safe side. I have quite a pile of them. I should go through them and see what's there.

    With regard to the original OP. . .I clearly recall it being emphasized when I was in nursing school years ago that you don't cut hair or cut off beards or mustaches. Taking off a mustache is not part of daily grooming and nurses are only supposed to be performing ADLs--sorry. Just don't do again. The daughter can't sue you over this. It would get laughed out of the court. Anyway, I can't believe any lawyer would take a case like that!
  5. by   Corvette Guy
    Quote from TypicalFish
    I don't mean to flame you, but I find your "shrug" a bit insensitive. The daughter likely did over-react; but it was more likely a response to everything that was going on-in this case 'a little bit more' of her father had been taken away from her, her control over the situation had been taken away and maybe it was the final straw in her ability to cope that day; seeing her father EVEN MORE changed and decreased was just too much. To wag your finger at her and say "Well. It COULD of been SO much worse" is insensitive and not what the holistic approach that nursing is supposed to be.

    Also, if the daughter was POA, if the father really had dementia issues, then legally she should have been consulted prior to having the beard shaved, unless it was a well-documented emergent situation.
    :yeahthat:
  6. by   Corvette Guy
    Quote from nrskarenrn
    bingo!!

    typical fish more clearly stated issue than i did.

    nurses and assistive personal need to be aware of "flash point" issues that can occur with families who are overly stressed and do what they can to minimize families reaction. learning what to say and how to say it should be part of role playing exercises in nursing school and initial orientation to a facility as first time nurse.

    what we say and the manner in which message delivered can extinguish situation or turn up the flame.


    the following are flash point issues i've come across in 30 years in healthcare:

    1. grooming issues
    a. shaving off beard or mustache, especially elderly without family aware
    b. not shaving female whiskers
    c. hair care: not washing hair or inappropriate hair styling
    (pigtails on a women who was former weekly salon visitor, etc)
    d. not bathing clients/clients who refuse to bathe
    e. dirty clothes/hospital gown or soiled linens
    f. incontinence management: use of adult diapers/foley catheter

    2. nutrition issues
    a. hot food cold, cold food warm
    b. not following diet or food preferences
    c. lack of menu choices, especially in long term care facilities
    d. withholding food terminally ill client
    c. peg tube insertion/feed/withdrawal

    3. lab work
    a. waking clients up at during night for labs
    b. repetitive venipunctures for labs
    c. not knowing critical lab results/failure to followup
    d. failure to obtain written lab orders

    4. waiting to be taken to tests/waiting for test results

    5. iv therapy
    a. multiple restarts
    b. difficult stick
    c. not offering long term access device (picc/port/hickman) sooner
    d. long term iv therapy needed at home but insurance doesn't cover

    6. discharge planning
    a. rn's/docs not realizing planning starts day of admission not 1 hour before discharge orders written
    b. discharge home without needed supplies ordered or prescriptions written
    c. expectation that "visiting nurse will bring syringes/supplies" (so not true with managed care these days)
    d. placement issues: refusing ltc placement, lack of caregiver
    f. caregiver ill prepared to take care of patient once home as no teaching started in hospital: insulin administration/tube feeding/wound care
    g. visiting nurse will come every day and stay several hours


    these are the most common areas i've had to smooth over with families, patients, nurses and doctors over the years. role playing responses ahead of time really helps you to prepare for these situation for they are everyday occurrences.

    worse thing to say is "i don't know why", turn and leave. better comment is "let me look into that, and i will get back to you"

    looking forward to seeing other comments....
    very impressive and true, list. :bowingpur

    btw, nice to meet you on the chat board last night.
  7. by   sjb2005
    Would you shave pubic hair if the pt was incontinent of stool and it was a bit challenging to clean? Just wondering?
  8. by   SharonH, RN
    Quote from nrskarenrn
    bingo!!

    typical fish more clearly stated issue than i did.

    nurses and assistive personal need to be aware of "flash point" issues that can occur with families who are overly stressed and do what they can to minimize families reaction. learning what to say and how to say it should be part of role playing exercises in nursing school and initial orientation to a facility as first time nurse.

    what we say and the manner in which message delivered can extinguish situation or turn up the flame.


    the following are flash point issues i've come across in 30 years in healthcare:

    1. grooming issues
    a. shaving off beard or mustache, especially elderly without family aware
    b. not shaving female whiskers
    c. hair care: not washing hair or inappropriate hair styling
    (pigtails on a women who was former weekly salon visitor, etc)
    d. not bathing clients/clients who refuse to bathe
    e. dirty clothes/hospital gown or soiled linens
    f. incontinence management: use of adult diapers/foley catheter

    2. nutrition issues
    a. hot food cold, cold food warm
    b. not following diet or food preferences
    c. lack of menu choices, especially in long term care facilities
    d. withholding food terminally ill client
    c. peg tube insertion/feed/withdrawal

    3. lab work
    a. waking clients up at during night for labs
    b. repetitive venipunctures for labs
    c. not knowing critical lab results/failure to followup
    d. failure to obtain written lab orders

    4. waiting to be taken to tests/waiting for test results

    5. iv therapy
    a. multiple restarts
    b. difficult stick
    c. not offering long term access device (picc/port/hickman) sooner
    d. long term iv therapy needed at home but insurance doesn't cover

    6. discharge planning
    a. rn's/docs not realizing planning starts day of admission not 1 hour before discharge orders written
    b. discharge home without needed supplies ordered or prescriptions written
    c. expectation that "visiting nurse will bring syringes/supplies" (so not true with managed care these days)
    d. placement issues: refusing ltc placement, lack of caregiver
    f. caregiver ill prepared to take care of patient once home as no teaching started in hospital: insulin administration/tube feeding/wound care
    g. visiting nurse will come every day and stay several hours


    these are the most common areas i've had to smooth over with families, patients, nurses and doctors over the years. role playing responses ahead of time really helps you to prepare for these situation for they are everyday occurrences.

    worse thing to say is "i don't know why", turn and leave. better comment is "let me look into that, and i will get back to you"

    looking forward to seeing other comments....

    karen, you and typicalfish both stated it well. believe it or not, i agree with you on all these points. being sensitive to the issues you mentioned above can make the difference between a smooth hospital stay and a hostile, uncomfortable stay in which every move and action by nursing personnel is scrutinized and criticized. and it takes only one person and one incident for it all to go down the tubes. after more than 15 years in the biz, i am well aware of these "flash points" as you call them.


    it was wrong to shave the mustache. my dad has always had one and if it had been me, i would have been quite annoyed maybe even angry. but let's be honest here; it's facial hair and it will grow back. that's the bottom line. as a daughter, as a healthcare consumer, and as a nurse i cannot sympathize greatly with someone who threatens to sue over a mustache. i just can't do it.
  9. by   SharonH, RN
    Quote from TypicalFish
    I don't mean to flame you, but I find your "shrug" a bit insensitive. The daughter likely did over-react; but it was more likely a response to everything that was going on-in this case 'a little bit more' of her father had been taken away from her, her control over the situation had been taken away and maybe it was the final straw in her ability to cope that day; seeing her father EVEN MORE changed and decreased was just too much. To wag your finger at her and say "Well. It COULD of been SO much worse" is insensitive and not what the holistic approach that nursing is supposed to be.

    Also, if the daughter was POA, if the father really had dementia issues, then legally she should have been consulted prior to having the beard shaved, unless it was a well-documented emergent situation.

    Let me be clear: I would have never expressed that attitude to the daughter, I'm certainly more sophisticated than that in my dealings with patients and family. The shrug is my personal take on the situation. And as a daughter, the thought of my father getting older and sicker is always in the back of my mind; the fate of his mustache is not. As a nurse, I know that it could be worse especially in today's healthcare environment, those are just the facts of the situation. I wouldn't lose any sleep over it.
  10. by   nursemike
    Quote from NebbyLPN
    I was written up yesterday for shaving off a patient's mustache. I don't understand what I did wrong. The man has had a stroke and has trouble feeding himself. He was getting food all over his mustache and face because of weakness in his right hand and arm. I come in to work the last two days and find all kinds of food particles in the hair and it just looked horrible. I couldn't clean the food particles out. I told two different charge nurses about this. I finally got so disgusted with it that I asked the man if it was OK if we shaved the mustache off. He nodded it was OK. Then, his daughter came in and raised the roof about it. I hadn't seen her visiting him the two previous days. She demanded to talk with the supervisor and told her she was going to sue the hospital! She said her father had this mustache for years--years! and was known among his family for his pride about the mustache. She said he would wax it up into elaborate curls. She told me that I should have called her first before doing this because the man's had dementia for some years. Well, no one told me that. I told the daughter that I had gotten her father's permission to shave the mustache off and he was very cooperative about it. I haven't been able to sleep at all tonight I've been so worried about this. I think I'm in big trouble and scared to go back to work today. What should I do? Should I call a lawyer?
    I'm 49. I started growing my moustache in the 8th grade. By the time I was a junior in high school, other people could tell I was growing a moustache. I wouldn't want it shaved off without my permission, and I would not easily give my permission.

    I thought the point about preserving self-image after a stroke was a good one. I think it's true that there are probably other ways to groom a moustache than shaving it off. But, as others have said, it's a shave, not an amputation.

    I've only been a nurse a short while, but I've been around nursing for a bit longer. One thing is clear: for some families, busting a nurse's chops is their preferred method of dealing with the stress of a loved one's illness (I never did see all of Terms of Endearment, but in the part I saw, I wanted to smack Shirley McClain upside the head. I'm all for effective pain management, but crap!)
    On the flip side, I've already been the beneficiary of a few families who wanted so desperately to believe that their loved one was getting the best possible care that they've gone on about what a wonderful job I was doing. As much as I appreciate the support, I try to be realistic. I'm a caring nurse, gaining competence daily, but I have far to go. My patients' impression of the care they've been given is one important piece of feedback among several, but the patient's family's opinion just isn't very useful data.
  11. by   caroladybelle
    Quote from DusktilDawn
    There was an incident at a facility I worked for over TRIMMING a beard. Apparently it was against custom/religion for men to cut the beard (including trimming) in this situation.
    Orthodox/Hasidic Judaism have specific regulations on men's facial hair. In addition, many religious groups regulate women'shair.
  12. by   cheleb61
    I recently had the same issue at work. A CNA shaved the mustache of a confused long-term resident completely off. The daughter hasn't been in to see the resident since it happened so she was not a factor. It became a big issue because it is a resident's rights/dignity issue. They have the right to have a mustache no matter how caked with food and whatnot that it gets. Some men have had their mustaches for years and shaving them off would be like shaving their heads. Getting permission from a family member to shave someone's mustache may seem silly but it is necessary to avoid problems like this one.
  13. by   WhiteCaps
    My husband shaved his moustache once. He looked just like his brother.
    Eeeeeeuuuuuhhh! He hasn't shaved it since!
    Yes, the daughter over-reacted, but it really is a big deal to a person's identity.

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