Can a nurse cut patient's hair without consent?

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I'm a nursing student and my professor was performing a bed bath, linen change, and wound care with our class on a patient who was unresponsive and obese. It was difficult cleaning and moving the patient, and the patient wasn't alert. It took 6 of us because of the patient's size. Problems with this patient: when lifting a flap of the patient's fat to clean, a bug jumped out which surprised us, and the professor immediately put us into PPE. The patient also had impaired skin integrity of the backside because of her size, inability to reposition on her own, and incontinence. The patient's hair was supposedly extremely matted and dirty and uncombable, and the professor got a bandage roll scissor and started cutting the patient's hair off, without consent of the nurses or the patient. The patient had near shoulder length hair and it ended up chopped up to about three inches in length. I did not personally see the condition of the patient's hair because there were 6 of us and I was at the end of the bed. I proceeded to ask the professor why she was cutting the patient's hair, and another student shushed me. I was confused and waited until post-conference to ask the professor. Another student said that I shouldn't say out loud next time because the patient would hear me. I felt frustrated because isn't it the right of the patient to know any treatment, regardless medical or cosmetic done to her? Isn't going behind her back violating her autonomy, despite her lack of alertness? This was a med-surg unit.

However, I do think that the professor should have told the patient that it was being done. Even if the patient seems non-responsive it is amazing what can still be taken in and understood.

I agree. I think this applies to all things that we do. And i know if I woke up with my hair (that is half way down my back) cut super short I would be mad. I would understand, but I would've thought dang you could've at least told me you were going to do it!

Specializes in SICU, trauma, neuro.

The thing with matted hair is pt can get pressure ulcers under it if it's severe. I've trimmed a couple of times, in women who had very long, thick hair that had been partially shaved to emergently place an EVD (a drain in a ventricle of the brain, to drain CSF and measure ICP). The motion of the shaver teased the hair, plus what was simply tangled from being bedridden. Neither woman was responsive, nor had family at the bedside to ask permission of. That said......

My intent wasn't to give a *haircut* or to make my job easier -- it was to preserve their hair, and protect their skin. Had I not done it, the mats would have gotten bigger and more difficult to avoid a full shear.

The first time I did it, there was a chunk about the size of a kitten that I literally couldn't even stick a pick into. She'd only been in my ICU 12 hours at the time...it wasn't like we'd neglected her hair for weeks. The moment I had her somewhat stabilized and more critical tasks complete, I set to work on her hair. I spent >2 hours with a bottle of conditioner and a pick, detangling one strand at a time, while washing the dried blood with shampoo and water. However, I only cut out what I truly couldn't save; I snipped maybe 1 cm deep at a time, and after each snip removed what was freed, and tried to comb what was left. She still had a thick mass of long hair when I was finished, and that I braided.

Same with the 2nd time I did it. This woman's hair wasn't as thick or long, but I still only cut what I physically couldn't detangle.

Like a PP said, I also told them what I was doing. I think I said "You have some matted hair that is impossible to comb. I need to clip it, but I'm only going to cut what I absolutely need to. I'll braid it when I'm finished so it doesn't get so tangled again."

I also think as a guest on the floor, she should have consulted the RN. Maybe the RN had planned to anyway but hadn't had the time yet, but maybe there was another reason it hadn't been done? Maybe the family would have raised hades, and the RN had arranged for a certified WOCN to speak to the family about skin integrity? Maybe the woman had religious objections to cutting her hair...cutting may well have been medically necessary, but maybe the RN had established a rapport with the family and wanted to talk to them about it first. Your CI shouldn't have taken it upon herself like that.

Legally this could potentially be considered a battery since the patient or a POA or a family member did not consent, IF it was not medically necessary to cut the patient's hair. This wasn't an occasion where the patient's head needed to be shaved for some kind of emergency procedure. I also wonder if the instructor consulted the patient's RN before doing this.

Specializes in Med-Surg.

Where I work in a residential facilities many of our clients have guardians and hair cutting beyond a trim is something we have to get guardian permission for. So unless medically necessary I would imagine it's not ok to cut.

Specializes in critical care.

OP, in all honesty, your professor may have been requested to take care of the matted hair by the patient's primary nurse. If there is an infestation, matted hair increases places for creepy crawlies to nest. The professor was in the right. You did well to resume questioning after direct patient care ended.

If there are bugs flying out at you from skin folds, I can't imagine what's crawling in her hair.

**wild-eyed heebie-jeebies**

**shivering**

If the hair is matted, it needs to get unmatted to prevent it from tugging on the scalp and causing skin breakdown. Pressure ulcers on the occipitus are nasty. If the hair is too matted to be combed, cutting is often necessary.

Also, you kind of came into the situation cold. The primary nurse may have asked the CI to take care of it. The family may have asked the primary nurse to have it done.

For another thing, you shouldn't have questioned the instructor in front of the other students and the patient. The correct thing to do is to ask her to step outside. Confronting and possibly being argumentative with the instructor in front of other people is rude and unprofessional.

Advocating for your patient is good, just make sure you do it the right way. A few of the new grads I have worked with think that advocating for a patient gives them a license to be inappropriately aggressive. You still have to be polite and professional.

Specializes in Psych, Addictions, SOL (Student of Life).

It depends on the setting in nursing homes and long term care a nurse or caregiver cannot legally cut a clients hair. At least not in California. It would be considered assault and battery and you could face legal consequences. In the long term care settings that I have worked at hair cuts must be done by a licensed cosmetologist. There are exceptions to Title 22 in this matter where cutting of the hair can be done when cleary medically necessary but that necessity needs to be documentd b the physician and the patient's recognized decision maker must be notified either before the haircut or immediately after if the haircut was done emergently. In other words "So and so had a fall and hod to get sutures - the ER shaved off half her hair etc..."

The situation you describe is clearly negligence on the part of the facility where the patient was being housed and a good advocate would have placed a call the state licensing agency to report a patient with multiple bed sores, lying in their own filth. Just my take on the matter. Of course you school might not be invited back for future clinicals but so be it.

Specializes in Psychiatry, Community, Nurse Manager, hospice.

I was specifically told by my clinical instructor that cutting hair and shaving beards without consent is considered assault and to never do that outside of emergency. So I'm surprised by this.

Specializes in Reproductive & Public Health.
Consider if it were pubic hair that kept wrapping around a Foley. Would you bust out a quick trim?

....yes, of course. If a patient had pubic hair that was unruly to the extent that it was interfering with maintaining her foley, then why wouldn't you trim it? I do agree that OF COURSE consent should be obtained when possible, and even an unresponsive patient should be told what you are doing, because you don't know what level of brain activity might actually be occurring.

I must say, though, that I have seem waaayyyy more than my fair share of vulvas over the years, and have yet to see pubic hair that was, um, exuberant enough to wrap around and/or obstruct a foley. And now that I've stated that fact for the record, I am sure one of my patients will helpfully prove me wrong on Monday. lol :)

1 Votes
Specializes in Pediatric Hematology/Oncology.
....yes, of course. If a patient had pubic hair that was unruly to the extent that it was interfering with maintaining her foley, then why wouldn't you trim it? I do agree that OF COURSE consent should be obtained when possible, and even an unresponsive patient should be told what you are doing, because you don't know what level of brain activity might actually be occurring.

I must say, though, that I have seem waaayyyy more than my fair share of vulvas over the years, and have yet to see pubic hair that was, um, exuberant enough to wrap around and/or obstruct a foley. And now that I've stated that fact for the record, I am sure one of my patients will helpfully prove me wrong on Monday. lol :)

This actually recently happened to a buddy of mine. The patient was so frustrated with it that she finally just said, "Eff it, please just cut it off!" So, yes, this does happen and pubic hair definitely can get tangled. I have seen a couple wraparounds myself. Ouch :dead:

Specializes in Ortho.

I feel like in the cases most of the other posters are talking about they had pretty significant reasons to cut the hair. But in your case I can't understand why other measures were not taken before cutting it. Why not try washing it and see if it can be untangled? Before you said it was a med surg floor I was imagining LTC and thinking that it sounded like neglect from the staff got her in that situation. Not knowing how long she had been there I really don't know about that, though I do feel that the staff should have done something pretty quickly after her admission if she was stable. I would love to know more details, I'm interested in the surrounding circumstances- how she got that way, how long she had been there, your instructor's reasoning. I do feel that someone should have at least tried washing it first, especially since she was being bathed at the time already. And the person who hushed you needs to hush herself. If you have a concern you have the right, and really an ethical obligation to question it. And if she was concerned about the instructor's response, that's not her problem. You're the one asking, you're the one dealing with the response, if you are prepared to take whatever attitude she responds with it has nothing to do with the other person. I had a similar situation in preconference just two weeks ago, though it wasn't related to patient care, it was about a clinical paper, but I was asking because I wanted to know, I was not being disrespectful and I know that the instructor didn't take it that way, she was just trying to explain why her thoughts were different from mine, and I was trying to listen, and the other student was sitting behind her giving me the "shut up" face when it had nothing to do with her. I don't question something without being prepared for the response. And truly her response was nothing to be scared of, she wasn't irritated that I asked nor did she have any other problem with my question, she was simply trying to answer it for me. But the other student thought I should shut up because she would have been too intimidated by the instructor to bother to ask. I'm sure the student who tried to stop you from asking was intimidated too. You can't do that. To be a good nurse you can't refrain from trying to understand your situation just because you're scared of authority figures. And you don't have to "rock the boat" to get an answer. If you question situations respectfully, out of genuine concern for the patient, and in a sincere effort to gain better understanding, no good nurse will be upset with you for that.

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