I shaved off a patient's mustache. Was I wrong? - page 7
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
Oct 23, '05Just 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.
Getting the families permission doesnt always prevent a mishap.
In the end we shaved it all off so it would grow back even.
Oct 23, '05Quote from Cute_CNAI imagine it was something like this:However, I am surprised that you weren't able to keep to keep the moustache clean?
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.
Oct 23, '05I 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.
Oct 23, '05Just 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>)
Oct 23, '05This 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
Oct 23, '05I 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.
Oct 23, '05PLease, by all means when I am old with food on my mustache, by all means shave it off! Us italian woman can grow those sometimes ya know...haha
Oct 23, '05Having been a RN/BSN for 30 yrs, am familiar with your dilemma. I have worked all 3 eight hour shifts as well as 12 hour shifts in hospitals and LTC.
In your message you talked about telling 2 nurses, neither of whom mentioned the dementia. :uhoh21: You stated "the daughter said he had dementia for years". Was this your first experience with this patient? Did you have the opportunity to talk with other of his caregivers about the mustache? Does the patient actually HAVE dementia? If so, who does have POA? It sounds like you were working over the weekend, possibly with other folks not as familiar with the family members.
What a great learning experience. Having been burned by others, can empathize with your concerns. Sorry for all the upset. Again, mustache hair will grow back.
Oct 23, '05I have 3 concerns:
1. the incomplete information about this patient given to this nurse i.e. his existing dementia;
2. the poor post meal hygiene care given to him if his moustache was full of old food; and
3. the seeming lack of involvement of a dietictian to ensure he was getting food of the correct texture.
The challenge for us all is to consider the person as an individual when we are all stretched to the limit with the complex care needs of most persons in hospital in this day and age
Oct 24, '05If it were one of my CNAs, they would be written up for this simply because the patient wasn't in a state of mind to consent to that any more than they would be to consent to a mohawk- even though they probably would have nodded to THAT as well...
That being said, what's important now is to deal with the upset family member. If possible, I would sit down with her, introduce yourself, let her know that you were trying to provide the best care possible. Explain that when he nodded, you thought you were following his wishes- and you didn't know that she wouldn't appreciate it. Apologize to her sincerely, be empathetic, state what you have learned and how badly you have felt about it. Ask what you can do to make things right. Request a picture of him with mustache in full glory to keep at bedside and allow it to grow back with the picture as a reminder to staff of how proud he was of his mustache and also to use as a grooming guide- mustache wax can be at bedside and it shouldn't take any longer than cleaning and combing his hair to clean and style his 'stache. It's important to acknowledge that she has every right to be upset.
You have learned a valuable lesson from this. When I was a CNA, another CNA on my floor shaved the mustache of a patient off because "it looked itchy." This was a young patient with a head injury who had worn a thick, neatly groomed mustache for years. The family was horrifed- the mother actually burst into tears when she saw him... she stated "another part of him is gone...". Of course it would (and did) grow back over time, but it was still horribly upsetting to them. Through observing that experience, I have never allowed the same mistake to happen, neither by be nor by my CNAs, and I have told the story many times when teaching inservices about dignity and the right to individuality even when incapacitated.
Please let us know how it works out.
Oct 24, '05Sounds like a "no good deed goes unpunished" scenario to me. You probably should have checked with the family since the presence of long term facial hair is generally an identifying characteristic for men. However, stop beating yourself up!!!! If this is the worst thing that happens to you as a nurse count yourself among the blessed.
Oct 24, '05Hopefully, we have all learned that grooming issues like this involve far more than hygiene. As others have pointed out, one's appearance, including hair, is a major issue in self-image and identity.
Whether or not the family is "over-reacting", it's always best to consider their wishes and try to maintain a good relationship. I was taught that this is a good way to avoid legal problems!
Even more important, this CNA should have been aware of the mental status -dementia - of any and all of her patients. This is crucial in knowing how to interpret their behavior. Just because the patient didn't appear to object, doesn't mean that his moustache was no longer important to him.
Oct 24, '05Nebby, I think everyone's saying there are some things that are sensitive and you just plain have to be careful about them if they're not part of your ordinary skill set, the things you were taught and checked off on. In other words, some kinds of actions are special. In my state, there's separate licensing for haircutters and for nurses. Apparently, the state believes there are different skills sets here and neither falls under the other. On one floor, the unit secretary cut my pt's hair (she does this for pts who need perking up) and the pt loved it. Had I not asked, I wouldn't have known this secretary was a licensed haircutter; she was and this was a floor tradition and it was OK with the charge, so I was in the clear. So things are not always as they seem, and if an action is not clearly an ordinary action under your scope of practice, I'd kick it upstairs to see if it's OK first, especially if it doesn't constitute an emergency. For example, if you nick a pt shaving him for a procedure as ordered by a doctor and he gets MRSA, well, that's not great but it's not unheard of, however if you nick his lip while shaving off his mustache, as far as a lawyer is concerned, you'd be ripe for the picking simply because it's not an everyday nursing action with a rock-solid rationale. Unusual actions require strong rationales, so you might want to ask yourself if harm to the pt's health would result from not taking an unusual action; that's another way of looking at it.