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?

[Lisa CCU RN, RN]

your supervisor should have stuck up for you.

yet another nurse bites the dust to appease pt/family satisfaction surveys.

I don't think that you don't need a lawyer - the standard of negligence requires that the plaintiff prove that 1. you had a duty and failed to uphold it - in fact, you were attempting to uphold your duty to this pt. and 2. plaintiff must prove 'harm' as a result of your action/inaction regarding your duty to your patient.. I doubt, given your understanding of expressed consent on the part of the patient, that a family member could prove 'harm'. In addition, there is a discconect between duty and harm in this case - it would be very difficult to prove that your actions breached your professional duty.

And again, your boss should have taken your side. Your management team let you down. But it's altogether common for management to summarily decide all complaints against nursing these days.

Good luck. I wouldn't apologize for your actions, if anything, just express regret that the daughter doesn't 'agree' with you.

~faith,

Timothy.

I agree with this. We had a DON who would cuss out family members if they said anything against us techs. I didn't reallly agree with her language she used at times, but at least she stood up for us.

[angelladyclaire]

When my dad was in the ICU his last time before he died, they had to shave the sides of his beard off in order to keep his NG and trach tubing secured properly. While we didn't get mad that they did it (it was medically necessary) it was very strange at his funeral to see him with just a goatee... it was like looking at a completely different person. The nurses left all that they could of his facial hair because they understood it was part of who he was.

I do think this particular family member overreacted a bit, but in the same situation I would've been peeved not to have been asked or informed. If the famly had been asked, they might have consented... the point is that they weren't asked.

I understand that the OP did what she honestly felt was in the patients best interest BUT unless something like that is medically necessary it shouldn't be done without the permission of the DPOA/Family. (I'm assuming this patient had a DPOA as he had dementia and his family was around).

[SmilingBluEyes]

that is what I feel, too angel. The family is upset perhaps, cause that is part of who he is. I think they have over-reacted, yes----but maybe like Karen said, this is a lesson-learned. To ask FAMILY MEMBERS of such patients before altering their entire appearance for non-medical necessity.

[Jo Dirt]

Well, the mustache *will* grow back, but as the wife of a husband who has had a full beard and mustache for over 10 yrs. I do not think it was appropriate for the OP to take it upon herself to make such a drastic change. I am surprised she didn't know the man was a dementia patient. I assume the daughter is the POA and yes, she should have been called and asked first.

I understand the OP had good intentions, unfortunately this isn't always good enough.

[Hellllllo Nurse, BSN, RN]

This just goes to show what a pain-in-butt being a nurse can be sometimes.

This nurse does the simplest thing, for the benefit of the pt, with his permission, and it is now a huge deal.

And of course, mgmt and family say the nurse is in the wrong!

I understand the change in pt appearance can be unsettling for family, and the religious/psych/social considerations- blah blah blah!

They need to get over it and be thankful he has a good nurse!blah blah blah!

I always say that when you get your license, they should print "No good deed goes unpunished" right across the top!

Nsg DX- alteration in body image (perceived, family)

Family coping- ineffective

Managment, nursing ineffective

Caregiver role-strain (nurse)

Secondary to shaving off a pt's moustache, for Pete's sake.

[wooh, BSN, RN]

Yep, the lesson learned here is it will never be the mistake that almost kills someone that you get called in to the principal's office for. It will be the little things that get you, usually the little things like this that were in the patient's best interest.

As for funerals without facial hair, quite honestly, they need a better funeral home. I would think they could put a little fake mustache/extra beard on for a funeral viewing.

[SandraJean]

It's obvious that you meant well and were trying to help the situation.

The family is already grieving a loss of the person they know and love, they are powerless to do much to change the situation. As small as something like a mustache is, it's probably feels like a big thing to them as they can't control much else in the situation. I guess I would ask the family first before changing their loved one's appearance. I hope they settle down for you. You didn't mean any harm.

[Cute_CNA, CNA]

An additional fact to consider: Some religions REQUIRE that the men not be clean-shaven. We can not assume that "no harm will be done" if we shave someone without their persmission.

llg

Hmm, I had already considered the "loss of identity issue" (however, many men grow back moustaches very quickly; we're not talking about a full beard here, which takes longer), I didn't consider that. That is true, some religions require men to have beards. I forgot about that. I don't know of religions that have the bare minimum requirement of only a moustache, though.

At the psychiatric hospital I work at, we were not told to never shave someone for reasons like that while in training. I have never heard of it being an issue.

What galls me is that the family member was threatening to use legal action in this case. I just think that that was a nasty, impulsive scare tactic for the hospital and the OP. I think it was uncalled for. I would understand maybe being a bit angry for not contacting the family, but to threaten someone's livelihood over something that's not even permanent is just being over-the-top.

[grannynurse FNP student]

Hmm, I had already considered the "loss of identity issue" (however, many men grow back moustaches very quickly; we're not talking about a full beard here, which takes longer), I didn't consider that. That is true, some religions require men to have beards. I forgot about that. I don't know of religions that have the bare minimum requirement of only a moustache, though.

At the psychiatric hospital I work at, we were not told to never shave someone for reasons like that while in training. I have never heard of it being an issue.

What galls me is that the family member was threatening to use legal action in this case. I just think that that was a nasty, impulsive scare tactic for the hospital and the OP. I think it was uncalled for. I would understand maybe being a bit angry for not contacting the family, but to threaten someone's livelihood over something that's not even permanent is just being over-the-top.

The daughter was upset and perhaps spoke in haste. Or perhaps she was serious. My SO had a moustache since I have known him. He recently shaved it off. The change was a big surprise, to me. As for the threat, the OP errored in not getting a complete report on the patient, especially regarding the dementia.

Grannynurse:balloons:

[grentea]

I whole-heartedly agree with CRNASOMEDAY. It sounds like the whole situation got blown out of proportion. I think that sometimes when family members are upset they express alot of anger about things seemingly unrelated to their relative's problems. I don't think you did anything wrong. And I realize this is an arguable point, but having dementia doesn't mean that you don't know what you want anymore. Perhaps he really did want his moustache shaved off, in which case you may have been the only one to listen to him. Well, anyways even if that wasn't the case, you did no harm because it was after all just hair. Don't stress about it. :)

[Marie_LPN, RN, LPN, RN]

She demanded to talk with the supervisor and told her she was going to sue the hospital!

I could completely see why she was bent out of shape, however, suing is NOT going to make her feel all better.

[Celia M, ASN, RN]

The problem here is although the OP asked the patient and he said yes, if he has dementia he might not have fully understood the question. The OP should have consulted the DPOAHC or NOK. Now if the patient was A+O x3 and gave his permission for his mustache to be shaved off then thats fine. I have been married for 17 years and known my husband for 21, and I've never seen him without a mustache. If he was unable to make the decision, unless it was immediately medically necessary for the mustache to go I would like to be consulted. I'm sure that the dgt was over reacting when she threatened to sue.