Mr. Harry the Excessive Hair Patient

[Barbie8808]

Yup you guess it, this post is all about pubic hair. I've been in the game for almost 10 years and I have no idea why CNA's or nurses ignore pubic hair or excessive hair in general! I had a nurse ask me to get an IV on a patient once who literally resembled Chewbacca. Fortunately I had success in his hand which is frowned upon at my institution but heck what else was I going to do? Oh but thats not the half.... What about when I have a patient whose on golytely or diarrhea??? The last thing I'm tryna do is fidget with 7 inch longs hair. I'm wondering if its OK to provide lil snip snip?

[canigraduate]

I work in an extremely busy unit and our CNAs are being trained to place and remove saline locks and foleys. It takes some tasks away from the nurse and gives us a smidge more time to do the things only nurses can do. The ED techs, who are also CNAs, were already trained that way.

It doesn't matter if I think it's appropriate or not, it's what is happening. It is also legal in this state. So, you can get offended all you want, but it is something that exists and, at least in this case, is designed to help the nurses, not take away from them.

I'm sure that nurses decried the loss of the personal care touch when aides first began taking care of ADLs. Things change. Your choices are to adapt or get left behind.

I never trim hair without permission, unless it's on a dementia patient who is actually in pain from them getting tangled or caught. Shaving cream and warm, soapy water can take care of a lot of problems. I know a lot of hospitals are moving away from soap to rinseless periwash, but the detergent in soap and shaving cream works better to release the poop from the hair. If you have nothing else, you can use lotion to loosen it up, but it doesn't work as well.

[HouTx, BSN, MSN, EdD]

Wow - very interesting thread.

FWIW, my state's NPA explicitly prohibits some tasks from being delegated to Unlicensed Assistive Personnel.... IV's are on that list.

[Dogen]

Good lord, people. CNA scope is defined by the state, just like RN practice, so there are bound to be differences from state to state. OP was pretty accurate when they said everyone responds essentially the same: "in MY state/facility/whatever that would never be allowed." This same topic has come up at least a half dozen times, and it blows people away every time. Just because you've never seen or heard of something doesn't mean it doesn't exist or can't happen. Mind your own practice and assume that OP's facility and coworkers who are licensed in the same state probably know more about what's legal for OP to do than you do. Get over it. Please. Just let it go.

Further, regarding the "you can't control how people respond" thing... This is true, but isn't there some rule - applied kind of unevenly - about keeping threads on topic? The thread is about OP wanting to shave their patients' pubic hair. How is that not rife for conversation?

On that topic... you probably shouldn't shave a patient for your convenience. You could ask the patient, "Listen, Mr. Bear, you have a blackberry thicket down there that I'd like to trim back to more of a grassy knoll. Awkward, I know, but in the long run it'll mean my hand is in your butt crack less, which seems like a win-win, am I right?" If there's an infection risk (skin break down, wound, etc), then it may be indicated... send it up the chain. Also, for the love of god, as a PP said, go get the clippers from the cath lab. They shave groins on the regular. I don't want to shave some dude's forearm with clippers that were just down your patient's pants.

[Irish_Mist, BSN, RN]

Absolutely. Shaving someone's genitals without their permission can be considered sexual assault. Shaving someone's beard or other body part without their permission can be considered assault.

Get permission or don't do it. If you do it without permission (unconscious patient or what have you) there had better be a very, very good reason. I was specifically instructed that lice is does not count as a good reason.

This is what I was taught.

I thought it was standard until I saw the stuff people post here.

Straight from the Department of Justice: "Sexual assault is any type of sexual contact or behavior that occurs without the explicit consent of the recipient. Falling under the definition of sexual assault are sexual activities as forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, and attempted rape."

There is no mention of shaving pubic hair without consent. You could argue that it is battery since this was done without her consent but the sexual assault argument does not hold weight at all.

[Dany102]

... And here I thought this was a not-so-serious thread topic. Guess I'm wrong.

Aesthetic considerations aside, I'd certainly urge caution to anyone wanting to offer to trim any hair from a patient's body. Certainly make sure you have their consent first (with only a few limited exceptions).

Hey, I'm all for grooming in hospitals but you better be prepared to offer to trim my facial hair, wax my back AND offer me a pedi/mani as well. Otherwise... Hands off my pheromone generator.

Dany

[NotAllWhoWandeRN, ASN, RN]

Straight from the Department of Justice: "Sexual assault is any type of sexual contact or behavior that occurs without the explicit consent of the recipient. Falling under the definition of sexual assault are sexual activities as forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, and attempted rape."

There is no mention of shaving pubic hair without consent. You could argue that it is battery since this was done without her consent but the sexual assault argument does not hold weight at all.

"The term "sexual fondling" means the touching of the private body parts of another person (including the genitalia, orifice, groin, breast, inner thigh, or buttocks) for the purpose of sexual gratification."

Since when is it ok to handle patients' genitals when it is not required for medical care?

If that were me, I would feel utterly violated. I would raise heck. If that were my patient, I would raise heck. I would document and file an incident report and report to however many managers I needed for an intervention to take place. How do you define what is uncceptable to do to an unconscious patient outside medical necessity, if you think touching and shaving a vulva is ok?

On the note of hair in general, 99% of the time it is NOT a hygiene issue. If it wraps around a Foley (which was recently discussed), get permission to trim it. If it's literally caking with feces, maybe get permission to trim it. As someone pointed out, shaving is likely to compromise skin integrity in an area that - esp with bowel incontinence - is saturated with unfriendly bacteria. In four years, I have never once had a patient that needed their pubic hair removed for the sake of hygiene.

[Irish_Mist, BSN, RN]

Does sexual fondling not mean grabbing, groping or touching genitalia for the purpose of sexual gratification? One does not have to "fondle" another to shave their public hair. I totally can understand why someone would be upset about their pubic hair being shaved without their permission. But calling it sexual assault is exaggeration. Arguing about the semantics of shaved pubic hair is ridiculous especially when there are multiple cases of rape, child molestation and trafficking happening EVERY DAY. Should her pubic hair been shaved without her consent? No. But it is not sexual assault. Calling it that is a mockery to real cases of sexual assault.

[RiskManager]

I can honestly say in my 30+ years of being a risk manager that I have never had a complaint regarding trimming/shaving pubic hair, but this thread has made me think about the concept. If I were to be working up such a complaint, I would be asking my nursing staff about three primary issues: was the patient/surrogate able to give consent to the procedure, and did they do so; were there objective clinical indications to do the procedure; and did we chart all of this. What would make the situation a real sticky wicket, so to speak, is the lack of consent or clinical indications, and if the patient/family made any sort of allegation that this was done by the nursing staff for purposes of the staff's sexual gratification. This is not dissimilar to the complaints I get when a male provider is listening to cardiac and breath sounds of a female patient or has to reposition the breast for an exam. As a provider, you never want to get tagged with even the accusation that you were doing something ostensibly for a clinical purpose, but was really for your sexual gratification. By the time you go through the investigation wringer, you will do a lot to avoid these situations again.

And let me also point out that this is not limited to male providers/female patients, but I have seen complaints with every permutation of gender and sexual orientation of the provider and patient.

[Boomer MS, RN]

Wow. Interesting comments. Although we all know that sexual assault does occur to patients in many forms, I have faith that most RNs and MDs do not do that. For the few times that I felt the need cut some pubic hair, it was because the person was covered in feces, mud or both. My patients were most often poor and disenfranchised and needed that extra care. Always sad. We could not allow those people to remain in that condition, much less send the patient up to floor or ICU like that. I have not shaved anyone's hair in the congenital area because of the risk of migrating bacteria. We always explained and asked permission first, unless it was an emergency. Then it was considered implied consent. Isn't it just common courtesy to ask someone first? And never shave eyebrows!!!

Responses here demonstrate that you all are the good guys, looking out for what's best for the patient.

[NotAllWhoWandeRN, ASN, RN]

Does sexual fondling not mean grabbing, groping or touching genitalia for the purpose of sexual gratification? One does not have to "fondle" another to shave their public hair. I totally can understand why someone would be upset about their pubic hair being shaved without their permission. But calling it sexual assault is exaggeration. Arguing about the semantics of shaved pubic hair is ridiculous especially when there are multiple cases of rape, child molestation and trafficking happening EVERY DAY. Should her pubic hair been shaved without her consent? No. But it is not sexual assault. Calling it that is a mockery to real cases of sexual assault.

Sexual violence survivor here, so don't tell me I'm trivializing myself by advocating for someone else's right to not have their genitals handled and altered without consent. You cannot put sexual violations on a hierarchy of who's allowed to be hurt and how much.

Whether it is sexual assault to handle someone's genitals and shave them, legally, depends on the motive of the person who did it. The motive in this case was clearly not to provide medical care, and the patient was unconscious and unable to consent/refuse, discuss, or even observe the procedure. If you have touched a patients genitals with no valid reason, it IS valid to ask what the motive actually was.

Even if you don't view it as sexual assault, there is no reason to laugh at a patient who has had their intimate body parts handled and altered without consent. Even if you don't believe it's sexual, it's deeply personal. It should never have happened, and dismissing a patient who had that experience and was horrified by it is just plain wrong.

Edited to add: I'd also like to note that to a survivor, having your bodily autonomy violated in nonsexual ways still evokes the fear and helplessness that "real" sexual assault created. Hearing other people tell you "It's not a big deal" is damaging. Hearing that healthcare professionals think it's funny turns my stomach.

[Boomer MS, RN]

Sexual violence survivor here, so don't tell me I'm trivializing myself by advocating for someone else's right to not have their genitals handled and altered without consent. You cannot put sexual violations on a hierarchy of who's allowed to be hurt and how much.

Whether it is sexual assault to handle someone's genitals and shave them, legally, depends on the motive of the person who did it. The motive in this case was clearly not to provide medical care, and the patient was unconscious and unable to consent/refuse, discuss, or even observe the procedure. If you have touched a patients genitals with no valid reason, I it IS valid to ask what the motive actually was.

Even if you don't view it as sexual assault, there is no reason to laugh at a patient who has had their intimate body parts handled and altered without consent. Even if you don't believe it's sexual, it's deeply personal. It should never have happened, and dismissing a patient who had that experience and was horrified by it is just plain wrong.

I am so sorry to hear this.

Of course it is wrong to dismiss a patient's concerns. Patients are vulnerable and scared.

[Farawyn]

Straight from the Department of Justice: "Sexual assault is any type of sexual contact or behavior that occurs without the explicit consent of the recipient. Falling under the definition of sexual assault are sexual activities as forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, and attempted rape."

There is no mention of shaving pubic hair without consent. You could argue that it is battery since this was done without her consent but the sexual assault argument does not hold weight at all.

Okay, but it's still icky. Especially since the patient was getting a tonsillectomy!