To cut or not to cut?

[ICURN3020]

Just wondering everyone's thoughts on whether we as nurses and other direct care staff (CNA's, STNA's, etc) have the right to groom a patient without their or their families expressed consent/request.

Now, by grooming, I don't mean combing/braiding the hair, cleaning/cutting the nails or shaving the patient's face to maintain the usual appearance of the patient or for hygiene purposes.

I'm talking cutting a male patient's shoulder length hair into a very short style. Or completely shaving the face of a male patient who normally wears a full beard (unless of course it was necessary due to interference with medical treatment).

I'm talking doing these "makeovers" based soley on the fact that staff feels the patient appears unkempt and not pleasant to look at. Personally, I'd be upset to come in for a visit with a loved one and find them appearing drastically different looking than how I knew them and how I know they preferred to look.

We had a patient recently (the shoulder length to short hair cut mentioned above) who ended up passing away and I remember thinking, "Geez, no one's even going to recognize him at his funeral."

We have no policy that I am aware of at my hospital regarding this, other than it is of course expected that the patient's personal care needs and hygiene related grooming are attended to.

Any thoughts?

[Nonyvole, BSN, RN]

Unless it's required for medical treatment or housing things best left outside, the personal grooming habits of my patients are nobody's business but their own. And even if they're covered in bugs/dirt/whatever, I'm still not coming close to them with a pair of scissors or a razor without their permission.

Think about the religious requirements out there that prohibit people from cutting their hair, or require them to have a beard. It's not always because of personal preference or an inability to perform ADLs.

If I was the subject of a haircut or my family member was, you can be darn sure that I'd be raising a fuss.

[RN403, BSN, RN]

I believe that patients have the right to be groomed just to keep their appearance nice and of course they have the right to have their hygiene needs met, but, I do not think that it is necessary to give our patient's a make-over just because we feel that they are not pleasant to look at.

If the patient normally has a beard or has long locks as a male, it is not up to me to shave it all off or cut their hair simply because I disagree with the way they choose to look. Unless somehow their appearance/hair is interfering with their safety, or, medically there is some reason to make drastic changes, then, I would just let it be.

I agree with you, I would be upset to visit a loved one in the hospital and find that they look drastically different. I would be even more upset to hear that this make-over was done simply because they were ''unpleasant'' to look at.

[VivaLasViejas, ASN, RN]

I would never in a million years consider it OK to cut a resident's hair or shave off a beard without permission from the resident and/or family. It doesn't matter if food gets into the beard or the hair gets matted; the staff is supposed to be paying attention to residents' cleanliness and grooming anyway. We may not like it, but it's part of the job!

[richardgecko]

Absolutely not. Men grow their hair long in my religion. We'd have a serious issue if someone took scissors to my son or husbands locks because it displeased them.

Smh.

[ICURN3020]

Good point.....I didn't even think of the religious aspect. I work in the ICU and some patients stay with us for quite a while, unfortunately. I have spent literally one to two hours multiple times painstakingly combing out the long hair of a few female patients.

Sometimes no matter what you do, from them lying on their hair for days, weeks, even months, it becomes a matted mess. I honestly have seen hair so bad after an extended stay, I imagine their only option would have been to cut it off because there was no getting a comb/brush through it. Most of our staff (esp. the females) are pretty good about trying anything we can to save someone's hair. But we have our few who take it upon themselves to choose how their patient should look.

Yeah, I must agree..I would be pretty p'd off to learn that my hair was chopped.

[ICURN3020]

Side note.....do any hospitals provide brushes? All we have are those crappy, flimsy 10 cent combs that a lot of the time are useless.

[Here.I.Stand, BSN, RN]

I don't ever cut w/o the family's permission. I've seen vent-head where it appears the only option would be to shear off the mat, but is it that vitally important that it can't wait until the day shift when the family shows up? "I see he had long hair when he came in, and the past few days he's been so unstable that honestly we weren't able to devote any attention to his hair. Now it's so matted I can't stick a finger through it. I am concerned that lying on that mat of hair will put him at risk for a pressure ulcer--a bedsore--on his head. I will try my best to comb his hair, but if we can't, what would you like us to do?" I feel bad enough for families who are distraught anyway, and then come in to find their family with a crani or EVD haircut.

For some people, the hair has religious significance. Some Pentacostal women don't cut their hair. Married Amish men grow a beard.

For bad vent head, what I've done was give the hair a good rub-down w/ a shampoo cap. I'd love to bring a bottle of spray conditioner, but somehow I think that would violate infection control policy. But anyway, get the hair good and wet w/ the shampoo. Then take a pick to it, one strand at a time.

[Here.I.Stand, BSN, RN]

No brushes, but decent picks along w/ the useless combs.

Side note.....do any hospitals provide brushes? All we have are those crappy, flimsy 10 cent combs that a lot of the time are useless.

[chare]

I believe the legal definition of this act is battery, although I am unsure whether an incident of the type described in the OP would result in either civil or criminal proceedings.

[Nonyvole, BSN, RN]

I have long hair. It's part of my identity, both personal and religious. At work I pull it back into a single bun, and at night it goes into a different bun on the top of my head. I have thought about what I would do if I did end up in the hospital - twin buns on the top of my head with plastic pins to hold everything together. I'd rather look like a Dalek than risk my hair getting badly matted, and really, it takes less than a minute to swirl everything around and pin it down for that. Significantly longer for my day-to-day styles...

I've used Coban on patients before to get their hair out of the way. Or some two-inch roller gauze. Similar deal as before, but gently wrap the entire ponytail and you can skip putting it into a bun. Being a patient in the hospital doesn't require high fashion, and if the patient or family doesn't like it, then hey, they can take care of their own hair, right?

Now, my only ICU experience was a single day in school, and the nurse I was shadowing that day was essentially acting as a med-surg nurse since her patients were waiting for beds on that unit, so my knowledge of how much spare time an ICU nurse has is very limited. But do you have the time to quickly run a comb through your patient's hair each shift? Or suggest that the family do it?

[Meriwhen, ASN, BSN, MSN, RN]

Unless it seriously interferes with treatment (such as surgery) or has become a health and/or safety hazard, I'd leave the patient and their hygiene habits be.