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

SharonH, RN · Oct 16, 2005

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.

SharonH, RN · Oct 16, 2005

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.

nursemike, ASN, RN · Oct 16, 2005

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.

caroladybelle, BSN, RN · Oct 17, 2005

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.

cheleb61 · Oct 22, 2005

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.

WhiteCaps · Oct 23, 2005

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.

TexasNS · Oct 23, 2005

Just for the sake of having another story in on this....

When I was a PCA(CNA) A family member (son) asked me to shave his dad. So I did. The son told me to leave him with a nicely trimed goatee. So I did. Then the wife and daughter come in and oh my.....talk about all heck breaking loose. Daughter is screaming at the brother, wife is in tears. I'm standing there with a razor in my hand more for protection than anything else.

Come to find out that the gentelman has always worn a full beard and the son (who I might add has a goatee) just thought he would look nicer with a goatee.

Sooooo

Getting the families permission doesnt always prevent a mishap.

In the end we shaved it all off so it would grow back even.

:uhoh3: :uhoh3:

MichaelLooney · Oct 23, 2005

However, I am surprised that you weren't able to keep to keep the moustache clean?

I imagine it was something like this:

She made it sound like though he was having trouble feeding himself, he was still at least attempting it on his own. Having been in a situation like that, where people still have a limited mobility and such after strokes, and are recieving help to get it back. He probably had this food in his mustach after Breakfast one day, someone didn't bother to clean him up, or help him clean himself, it was repated at lunch and dinner, whomever assisted him to bed found it a lost cause b/c it was dried in by then, and it was all repeated again until she came along and shaved it off b/c it was just too dried and tangled and everything else. Having had a beard and mustash before, and getting stuff into them (and why I keep VERY well trimmed now!), and from the fact that his daughter said he had enough of one to curl it and stuff, he probably had a very THICK mustash, and those are always the hardest, have to be combed and trimmed just like the hair on your head (again, from personal experience) to keep them from getting all ratty anyway. I don't want to say it, but it was frankly it seems that he was recieving inproper care to begin with, and when she decided to correct that, she was the one who got in trouble instead of the ones who weren't doing their jobs before her.

DRTCBear · Oct 23, 2005

I want to take a strong position - but not a harsh position. It was inappropriate to do what you did. The very first step to take is to graciously and sincerely apologize for having done this at all. Second, a review of significant aspects of patient condition, such as long-standing 'dementia' should be part of orienting to a new patient. If 'dementia' is a correct diagnosis I would think that it should have been pretty obvious in an assessment of 'orientation'.

Altering the appearance of people, whether it would mean cutting off or unraveling dredlocks, beehive hairdos, shaving someone's pubic hair, removing jewelry, ought to be done only after considerable deliberation. It isn't just inattentive to an individual patient, it is also a question of compassionate and culturally sensitive care and interdiscioplinary practice. Asking other nurses or supevisory personnel before taking such measures is not just good defensive behavior - it is the essence of collaborative practice.

It is really easy to be culturally insensitive - just assume that what we think is ok will be okay with everyone else.

at the same time - you made a mistake - you didn't kill the patient - even if the family were to sue you - what would they be suing for? I think most attorneys would laugh them out the door...

Thinking ahead too - we should all, always be aware, that family's often disagree on care - no one person speaks for a family - not even the patient - tho the patient's wishes should be pre-eminent... but there is a very great difference between a patient initiating a request for something - like being shaved - and 'appearing' to consent to it when it is suggested by a caregiver. people often accept suggestions from caregivers even though they don't really want it.

bear

Fireguy · Oct 23, 2005

Just adding my 2-bits:

Except for a few months in boot camp, I have had a mustache for 35 years. My kids have never seen me without it (when my wife saw me without it, she freaked-out and wanted it back pronto!).

It is part of my identity, has aged along with the rest of me (from multi-colors of red, blonde and brown to pure white).

Just wanting to give some perspective from a man's point of view...

That said, I too have dealt with men with some fairly cruddy messes in their 'stache. If it was truly a pain to have to deal with, I would suggest just trimming the shaggy parts that droop over the mouth (with the appropriate permission).

Live and learn 8>)

yadda_yadda_yadda, LPN, LVN · Oct 23, 2005

This patient's daughter needs to redirect her anger. Like others have commented, the moustache WILL grow back.

The only time I've ever heard (or seen) grooming of hair to be a problem was if it held religious significance. ---- I worked with the Department of Corrections as a Nurse for many years---we had several Native Americans on the unit. These guys were NOT required to maintain regulation haircuts. Hair was a very important part of their culture.

Take a deep breath...this too shall pass :)

Really An Actress · Oct 23, 2005

I don't think it's anything to sue of either for the reasons mentioned above, but you were wrong to shave it off. I'm not buying you did it for the patient's sake either. Why didn't you take a few extra minutes to clean his mustache? You did it because it made YOUR job easier, not to benefit him.

I feel the same way about nurses who ask for an order for a urinary catheter just so they don't have to take the patient to the bathroom a couple of times a shift.

Anyway, we're all entitled to make our mistakes. This wasn't a big nor life-threatening one. And I'm one that beats myself up over every mistake I've ever made. It's taught me never to make the same one again, and hopefully I learn to take it easier on myself.