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

[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?

[LEL]

I"m not.

I don't fault the daughter at all.

I'm being sarcastic towards management's attitude that all complaints must be the nurse's fault.

And I'm being sarcastic towards that attitude that the OP should ask the daughter's approval for things the pt already approved.

Look, I can understand that shaving a mustache can be a 'big deal'. But there are 'big deals' and there are 'BIG DEALS'. This is no big deal.

~faith,

Timothy.

I agree with your post. I understood it to be sarcastic towards management.

[GingerSue]

as I read about intentional torts - no harm need be caused for liability to exist

Battery is the willful touching of a person, or the person's clothing, or something the person is carrying, without consent.

A requirement for consent is that the client be competent to give consent.

Determination of consent is not a medical decision - it is made through court hearings.

Since this patient has dementia - who legally makes decisions for him?

The moustache will grow back - will it be shaved off again, or will it be cared for? Who is going to decide?

[NRSKarenRN, BSN, RN]

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.

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....

[nicuRN2007]

Well, I might would have some compassion for the daughter if she hadn't threatened to sue. I can't stand hearing people say "I would have sued...you should sue...I'm gonna sue...blah blah blah"...all the time.

[Tweety, BSN, RN]

Well, I might would have some compassion for the daughter if she hadn't threatened to sue. I can't stand hearing people say "I would have sued...you should sue...I'm gonna sue...blah blah blah"...all the time.

ITA. My compassion/empathy quotient for the daughter went close to zero after reading she was going to sue. I get a little weary by this attitude all the time. Like Sharon, I can see getting a lawyer over med errors, etc., but shaving of a mustache, please. Make a scene by all means, go to management, follow up, express you anger, but the old tired line "I'm going to sue" is not appropriate.

Maybe dad couldn't stand the indigity of having food products on his mustache that he took such pride in. At this point it's not about what the patient wanted and how he feels, it's how the daughter feels and how she presumes the dad to feel (with good reason, she's been his daughter all his life).

[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.

[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.

[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"

[Daytonite, BSN, RN]

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!

[Corvette Guy]

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:

[Corvette Guy]

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. :)

[sjb2005]

Would you shave pubic hair if the pt was incontinent of stool and it was a bit challenging to clean? Just wondering?