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?

[steelcityrn, RN]

PLease, 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

[wtkid53]

Having 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.

[sdre]

I 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

[LoriAlabamaRN]

If 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.

Lori

[MTK]

Sounds 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.

[MCF]

Hopefully, 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.

[anonymurse]

Nebby, 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.

[madore57]

I thought it was considered assault if you shaved off a patient's moustache, cut their hair ect. Of course you can shave a man who normally shaves but to remove a fully grown moustache, beard or hair is considered assault - or so I thought. That's why we take the patient's hair after surgery and give it back to him if he/she wants it - in some hospitals - whether they want it or not.

madore57

[Q.]

And she didn't assume, she asked him.

And how would you know if a dementia/stroke patient knew what she was asking?

[wooh, BSN, RN]

And how would you know if a dementia/stroke patient knew what she was asking?

Yes, in the name of patient dignity, let's always assume that they don't know what they're saying. Excuse me Mr. Stroke Patient, I know that you asked for spaghetti for dinner, but first I must call your daughter and ask her, because obviously, you don't know what you're talking about! And what if she walks in a sees you eating spaghetti? The horror!!

[marsern05]

I work on a cardiovascular surgical floor and I live in an area where there are alot of Amish families. You DO NOT shave off an Amish man's beard, no matter how long, how disgusting or how much it is in the way of the healing incision. I have seen several of these men back in with sternal infections and there they are in the ICU, still with their beards, but now braided and pulled to one side....perhaps we should start out doing that.

[BittyBabyGrower, MSN, RN]

Unless medically necessary, we aren't allowed to cut hair, nails, mustaches, etc. If baby's nails need done, then the parents have to do it because if one of their fingers got infected we would be at fault.

Also with the shaving, you could have run a risk of bleeding...esp if he was a stroke patient and on anti-coags.

Now, from a personal aspect....the day my dad died, before we got there, a nurse shaved my dad's moustache...the guy was in end stages of COPD and she said his cannula wouldn't stay on???? That man laying in that bed was NOT the dad I knew...nor none of the family...he always had a nice moustache and that was part of who he was! I was so upset because the last time I saw him he didn't look like himself. As for the funeral people putting on fake facial hair...you have to be kidding me.