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Discussion

The significance of facial shaving as fundamental nursing care

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Being clean shaven may give many male patients feelings of dignity and identity. This article argues that facial shaving should not be an add-on but an essential aspect of nursing care

Abstract

Being clean shaven is often important for male hospital patients, who may feel more dignified, more ‘themselves’ and better cared for if they can shave – or if someone helps them with shaving. This article explores male facial shaving as an aspect of fundamental nursing care and discusses its meaning and value to patients, to families and to nurses themselves.

Citation: Ette L, Gretton M (2019) The significance of facial shaving as fundamental nursing care. Nursing Times [online]; 115: 1, 40-42.

Authors: Lizzie Ette and Mark Gretton are lecturers in nursing at the University of Hull.

  • This article has been double-blind peer reviewed
  • Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)

Introduction 

Imagine the scenario: a nurse finds 10 minutes between two urgent tasks to offer an 80-year-old male patient help with shaving his face. The patient takes up the offer and the nurse gives him a wet shave using the hospital-provided disposable razor. He is delighted with the result and tells his wife, who visits him later that day, that he is “looking like [his] old self again”. Now imagine that no one offers the same patient help. Perhaps his need for a shave has not been noticed. Perhaps shaving him is not a priority and no one finds time to do it. He feels neglected and when his wife visits she finds him unkempt and dispirited. Both scenarios may well sound familiar to many nurses.

Reflecting on one such scenario led us to conclude that shaving is far from just a ‘basic care’ task but is, in fact, significant in several ways and a fundamental aspect of nursing care. That a 10-minute care intervention can hold such rich meaning for patients speaks volumes about the nature of nursing and nursing care. The significance to patients of this seemingly mundane task led us to explore this act of care – facial shaving – and try to capture the richness of humanity taking place within it.

An elusive topic

The task of shaving the body – as opposed to the face – is widely documented in nursing texts in relation to pre-surgical preparation. For example, guidelines recommend the use of single-use clippers, rather than a razor (World Health Organization, 2016; National Institute for Health and Care Excellence, 2008). Shaving the body is also documented in relation to the care of the body after death (Hospice UK, 2015).

In contrast, day-to-day facial shaving is a relatively rare topic in the nursing literature and where it is discussed this tends to be in terms of it being a clinical procedure (Dougherty and Lister, 2015; Berman and Snyder, 2012). However, Olausson and Ferrell (2013) do start to consider the meaning attached to shaving (as an after-death care activity) and Lim (2014) goes as far as to suggest that shaving is a metaphor for nursing.

A visible aspect of care

Despite limited discussion of facial shaving in the nursing literature, it is immediately apparent, when reviewing patient feedback (for example, on the website Care Opinion), how incredibly important it actually is. Careful attention to a man’s shaving preferences is seen by family members as an extremely positive aspect of the care provided to their relative. This is particularly notable in the case of older men – especially those with dementia-related conditions – but similar feedback is also received from families of younger men, including patients in the intensive care unit.

If facial shaving is not undertaken at the patient’s preferred frequency, this can be interpreted by family members as a sign of lack of care (Richardson et al, 2008) and may even be perceived as neglectful. This is quite possibly because facial shaving is a highly visible aspect of patient care and is immediately noticeable if it has not been performed. This perhaps signifies how important those visible aspects of care are to relatives and other visitors.

The significance of shaving also highlights that nursing care extends far beyond the reaches of medical attention. It shows how small acts or omissions can influence the perception of nursing care in a broader sense, giving us more insight into care that contributes to the accomplishment of the 6Cs (Department of Health, 2012). By undertaking facial shaving, nurses attend to the dignity of the patient, but also inadvertently to the needs of the patient’s loved ones.

Undoubtedly, the need to prioritise various elements of patient care in a busy clinical environment is paramount. However, nurses who help patients to be clean and well-kempt are perhaps also showing a visible outcome of their work – facial shaving becoming a tangible way of demonstrating their own standards of care.

Proximity to patients

Many nurses and nurse managers might question whether nurses are the best placed to offer apparently basic care such as facial shaving. The demands made upon nurses’ time are considerable and it could be argued that their time is better – that is, more cost-effectively – spent in assessing care needs and subsequently managing patient care. However, this overlooks the fact that time spent attending to patients’ physical needs is also an opportunity to build rapport, trust and meaningful relationships (Ribeiro et al, 2017; Lim, 2014).

Time spent in close contact with patients also offers the opportunity to assess their physical and emotional needs. Peate (2010) suggests that the “routines and rituals associated with personal cleansing”, often thought of as “basic or even menial”, bring nurses into close and even intimate physical proximity with patients. Peate considers these activities as being “fundamental to the patient’s sense of wellbeing, thus transforming the act of cleansing [into] an essential aspect of nursing care”. This is certainly reflected in the feedback of patients and relatives, who clearly associate facial shaving with a higher level of care.

Sense of self

Essentially, the main aim of helping a male patient to shave, or do it for him, is to meet his hygiene and care needs. From the patients’ perspective, however, the desire to shave, or be shaved, is likely to be more complex. This will depend largely on the individual, but it is reasonable to assume that socialisation and psychology, as well as the dictates of routine, all play a part.

Older men in particular, who grew up in the middle of the 20th century, may have been socialised when they were boys into believing that being ‘clean shaven’ is to be prepared to go into the world. According to Sherrow (2006), the trend in Western cultures in the 1940s and 50s, partly driven by the advertising of shaving products, was towards daily shaving; unlike today, beards were not fashionable.

Many young men whose shaving stories were collected by Kirkendall (1945) viewed shaving as an important step into manhood and physical maturity, something they had craved for a long time, and a number of them spoke of their satisfaction when they finally reached ‘manhood’ in the eyes of their parents and friends. Additionally, writers at the time would allude to ‘clean-shaven’ heroes (for example, the author William Earl Johns in his Biggles books), adding to expectations relating to men’s physical appearance. While for some men being clean shaven is of little or no significance, for others it defines their sense of self, their very sense of maleness.

Furthermore, daily shaving of the face may be rooted in habit. If a man has shaved since he was a teenager, he may well feel that he does not need to give reasons: this is just what he does. This means it is not good enough to see shaving as an ‘optional extra’, when for many men being clean shaven may be just as important as having combed hair.

Cultural preferences

Healthcare is provided in culturally diverse settings, which requires nurses to respect and accommodate patients’ cultural and religious needs (Greengross, 1999). Cultural sensitivity and awareness of patients’ lifestyle, habits, routines and background enable nurses to determine their patients’ shaving preferences. Once again this highlights the value of skilled assessment and care planning, and the importance of prioritising people, as recommended by nurses’ professional code of practice (Nursing and Midwifery Council, 2015).

It is important to consider that many men do not completely shave their faces daily, whether due to personal preference, culture or other reasons. Needs and preferences may instead dictate that facial hair needs washing or grooming. These needs and preferences should be attended to diligently and respectfully.

Challenges in practice

Why does male facial shaving sometimes present challenges in clinical settings?

One challenge is perhaps about technique. It is generally easy to comb a man’s hair, and combs are usually available in the hospital environment. At one time there would perhaps also have been a communal electric shaver to hand, but rigorous infection prevention and control policies rightly mean this is not an option.

A man may own an electric razor but not have it with him in hospital if admitted as an emergency, and his relatives may be discouraged from bringing it later due to concerns about valuables going missing. This means the only option is the wet shave, but nurses may not feel comfortable doing this for reasons of safety, lack of expertise and lack of confidence.

Another challenge might relate to gender. One reason why male nurses feel able to shave male patients in their care is that they are likely to shave their own face or to have done so in the past. This gives them more confidence for undertaking the task on another person. However, a male patient is quite likely to be surrounded by female nurses only, as 80% of all Agenda for Change staff are women (NHS Employers, 2018).

Although women will not have had the same opportunity to learn this skill personally, they have ample opportunity to learn it in clinical practice. Facial shaving should be taught to nurses early in their careers to ensure a consistently confident skill base across the nursing workforce.

Finally, the challenge may also lie in the detail of the clinical scenario, which clearly influences how nursing care is planned and delivered. As already stated, little is documented on how to manage male facial shaving in difficult situations, and nurses are reminded that their responsibility is to focus on priorities for the patient. It can be helpful to acknowledge that one has not been able to shave a patient despite the fact that this could have reasonably been expected, and record evidence-based decisions not to shave the patient.

What is the solution?

By taking a problem-solving approach (Barrett et al, 2012) to planning patient-centred care, it is possible to find creative solutions to the challenges posed by clinical circumstances.

As often, better and more patient-focused education may be needed. If nurses, and all other members of the nursing team, appreciate the importance of male facial shaving – the routine, the sense of self and maleness, the impact on how a patient sees himself and how he is perceived by others – they are much more likely to regard it as a ‘must-do’, rather than a ‘might-do’. Box 1 features further reading recommendations.

There are many nurses who do appreciate the importance of facial shaving and have the skills to do so, and it is good practice to seek them out and learn from them. Networking with other clinicians who are managing similar challenges remains one of the most powerful tools used in evidence-based practice, as is patient-centred collaboration with family members where necessary. Nurses must do this, if they are serious about fulfilling a male patient’s desire to “look like [their] old self again”.

Box 1. Further reading

Nurses who wish to consider the skills needed for male facial shaving may find a good starting point in the suggestions made by Mackie (2009), who also acknowledges that some female patients may need help with this fundamental care. To encourage nurses to transcend the procedural element of facial shaving, we suggest that they read, for example, the work of Lawler (1991) and the Essence of Care guidance from the Department of Health (2010a; 2010b).

Key points

  • There is very little nursing literature on facial shaving of male patients
  • Male patients of any age may attach particular importance to shaving
  • A clean shave may make men feel dignified and ‘themselves again’
  • Helping a male patient shave is an opportunity to get to know him and assess his other needs
  • Nurses should not overlook the importance of basic nursing care interventions such as shaving
  • 3 Comments

Readers' comments (3)

  • As a nurse, I always find time to shave patients or assist where necessary. I often cut men’s hair as well, as some patients are on the ward for several months.
    The problem I find on the wards is not lack of time as I do the task as part of the hygiene needs, it’s a lack of motivation from other staff and health care staff. It’s not a priority, but I know if the patient was their relative they would be shocked.
    It’s so frustrating it’s difficult to see these patients looking unkempt as in the article suggests and I would like more formal training and accountability with health care staff

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  • Hello Sammy, thank you for reading and commenting. Your thoughts do rather match up with ours, which led us to write the article!

    best wishes,

    Mark

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  • I am a recently retired nurse,and was fortunate to work in a ward environment that included male shaves as an integral part of meeting our patients hygiene needs. This basic requirement has a real positive effect on the whole person .I think it's important to remember that the time spent with a patient is an opportunity to assess and observe and allow the patient to express how they are feeling. Back to basics and reconnect with your patient.

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