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Hair Care & Combing

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By Gil Wayne BSN, R.N.

Hair care and combing are essential aspects of nursing care, often overlooked but crucial for patient comfort and dignity. How can proper hair care improve a patient’s health and prevent complications such as scalp infections or tangled hair? What techniques should nurses employ to ensure they are providing the best care for different hair types and conditions? How do these practices contribute to a patient’s emotional and psychological health during their hospital stay? Delving deeper into this subject provides a range of considerations, techniques, and interventions that nurses employ to address diverse patient needs.

Table of Contents

Hair Care & Combing

Hair care and combing in nursing involve the regular maintenance and grooming of a patient’s hair to ensure hygiene, comfort, and health. This aspect of nursing care includes washing, conditioning, detangling, and styling a patient’s hair, tailored to their individual needs and preferences. It is particularly important for patients who may be bedridden, immobilized, or otherwise unable to care for their own hair. Effective hair care can prevent scalp infections, reduce the risk of tangled or matted hair, and enhance a patient’s sense of dignity and self-esteem.

Purpose of Hair Care & Combing

Proper hair care extends beyond mere aesthetics; it confines several critical functions that contribute to a patient’s physical health and emotional state. Understanding the purposes of hair care and combing in nursing helps highlight its importance in comprehensive patient care.

1. To stimulate blood circulation to the scalp.
Combing and massaging the scalp during hair care can stimulate blood flow, promoting healthy hair growth and scalp condition. Improved circulation brings essential nutrients to hair follicles, supporting hair strength and vitality.

2. To distribute hair oils and provide a healthy sheen.
Regular combing helps distribute natural oils produced by the scalp evenly along the hair shaft. This not only gives the hair a healthy sheen but also prevents dryness and brittleness, maintaining the hair’s natural moisture balance.

3. To provide comfort to the patient.
Hair care routines can be soothing and provide a sense of normalcy and relaxation for patients, especially those confined to a bed for extended periods. This aspect of care can significantly enhance a patient’s comfort.

4. To remove tangles from the hair.
Daily combing prevents the formation of tangles and mats, which can cause discomfort and become difficult to manage if left unaddressed. This is particularly important for patients with longer hair or those who are unable to move or care for their hair themselves.

5. To preserve or keep the hair in good condition during illness.
Maintaining hair care during illness helps preserve the hair’s condition, preventing issues like excessive shedding, breakage, or scalp problems. This aspect of care is vital for patients undergoing treatments that may affect hair health.

6. To observe the presence of lice without the patient’s being aware of it.
Regular hair care provides an opportunity for nurses to discreetly check for lice or other scalp conditions, ensuring timely intervention and treatment without causing embarrassment or distress to the patient.

7. To prevent infection.
Clean and well-maintained hair reduces the risk of scalp infections and skin irritation. Regular washing and grooming can prevent the accumulation of dirt, sweat, and bacteria, which are potential sources of infection.

8. In preparation for diagnostic procedures involving the head.
Proper hair care is essential when preparing patients for diagnostic procedures such as MRI, CT scans, or surgeries involving the head. Clean and tangle-free hair ensures that these procedures can be conducted smoothly and without complications.

Equipment

Proper hair care and combing in nursing require the use of specific equipment to ensure the process is efficient, hygienic, and comfortable for the patient. Each piece of equipment plays a vital role in maintaining hair health, managing tangles, and enhancing the overall grooming experience. Below is an overview of the essential tools used in hair care and combing, along with their purposes and importance in the nursing care routine.

Here is a detailed look at the equipment commonly used in hair care and combing within a nursing context:

1. Patient’s Bath Towel. A bath towel is used to protect the patient’s clothing and bedding during hair care. It is placed around the shoulders and neck to catch any falling hair, water, or products, ensuring that the patient remains dry and comfortable.

2. Hair Comb. A hair comb is essential for detangling hair, removing knots, and distributing natural oils from the scalp along the hair shaft. Different types of combs, such as wide-tooth combs for thick hair and fine-tooth combs for delicate or thin hair, may be used depending on the patient’s hair type.

3. Hair Brush. A hairbrush helps smooth the hair, remove tangles, and distribute natural oils. Brushes with soft bristles are gentle on the scalp and can stimulate blood circulation, promoting healthy hair growth. Different brushes may be used based on the patient’s hair texture and condition.

4. Vaseline. Vaseline or petroleum jelly can be used to protect the scalp and hairline during treatments or when applying medications. It provides a barrier that can prevent irritation from hair care products or treatments.

5. Clips. Hair clips are used to section the hair, making it easier to manage and style, especially for patients with long or thick hair. They help in organizing the hair into manageable sections for thorough combing and treatment.

6. Rubber Bands or Tapes. Rubber bands or hair ties are used to secure sections of hair, especially after styling or when keeping hair out of the way during other medical procedures. They should be gentle and non-damaging to avoid hair breakage or scalp irritation.

Assessment

By taking these considerations into account, nurses can provide personalized and effective hair care that respects the patient’s health, preferences, and comfort. Understanding the impact of medical conditions, routine practices, and hair types ensures that hair care is both therapeutic and supportive of the patient.

1. Determine history of the following conditions or therapies.
When performing hair care and combing, it’s crucial to assess the patient’s medical history for specific conditions or therapies that can affect hair health and scalp condition. Understanding these factors can help tailor hair care practices to the patient’s needs.

  • Recent Chemotherapy. Chemotherapy often causes hair thinning or complete hair loss (alopecia). The scalp can become sensitive, so gentle handling is necessary. Special care products designed for sensitive scalps may be recommended.
  • Hypothyroidism. Hypothyroidism can lead to dry, brittle hair and hair loss. Using gentle, moisturizing hair products can help manage these symptoms. The nurse should be aware of these issues to avoid causing further damage during hair care.
  • Radiation of the Head. Radiation therapy to the head can result in hair loss and scalp sensitivity. Extra care should be taken to handle the hair and scalp gently, avoiding any harsh treatments or products that could irritate the skin.
  • Unexplained Hair Loss. Unexplained hair loss can be a sign of underlying health issues or stress. A thorough assessment and gentle care are essential to avoid exacerbating the condition. Referrals to a dermatologist or other specialists might be necessary.
  • Growth of Excessive Body Hair. Conditions like polycystic ovary syndrome (PCOS) or certain medications can cause excessive hair growth (hirsutism). Understanding this can help nurses provide appropriate advice and care, including safe hair removal options if desired by the patient.

2. Determine usual hair care practices and routinely used hair care products.
Knowing the patient’s usual hair care routine and the products they use can help in providing consistent and familiar care, which can be comforting for the patient.

  • Hair Spray, Shampoo, Conditioners. These products can affect hair texture and manageability. Using the patient’s preferred or similar products can ensure continuity in hair care and reduce the risk of allergic reactions or irritation.
  • Hair Oil Preparation. Some patients use oils to moisturize their hair and scalp. Understanding their use can guide the nurse in maintaining the patient’s usual care routine and ensuring that their hair remains well-nourished and manageable.
  • Hair Dye. Patients who dye their hair might have specific needs regarding color maintenance and scalp sensitivity. Awareness of this practice can help in selecting gentle products and avoiding procedures that might strip the color or cause irritation.
  • Curling or Straightening Preparations. These products can impact hair health and texture. Knowing about their use can guide the nurse in providing appropriate hair care, avoiding damage from harsh chemicals, and understanding the patient’s styling preferences.

3. Determine whether wetting the hair will make it difficult to comb.
Different hair types react differently to water, and understanding this can prevent discomfort and damage during hair care.

  • Kinky Hair. Kinky or tightly curled hair is often easier to comb when wet because water can help soften the hair and reduce tangles. However, once dry, this hair type can become more challenging to manage and prone to breakage. Wetting the hair before combing can make the process smoother and less painful.

4. Determine if the hair is straight, curly, or kinky. Each hair type requires different care techniques and products to manage effectively.
Understanding the hair type helps in selecting the appropriate combs, brushes, and hair care products. For example, kinky hair may need more moisturizing products and gentle handling compared to straight hair.

5. Check if the hair is matted or tangled. Note the overall health of the hair, including signs of dryness, brittleness, or excessive oiliness.
Matted or tangled hair requires careful and gentle detangling to prevent breakage and discomfort. Dry or brittle hair may need moisturizing treatments, while oily hair might benefit from regular washing with appropriate shampoos.

6. Examine the scalp for dryness, flakiness, redness, or irritation.
A dry or flaky scalp may indicate conditions like dandruff or eczema, requiring specific shampoos or treatments. Redness or irritation could suggest infections or allergic reactions needing medical attention.

7. Look for evenness in hair growth across the scalp, noting any areas with patchy hair loss.
Patchy hair loss can be a sign of conditions such as alopecia areata, fungal infections, or other underlying health issues. Identifying this can prompt further medical evaluation and treatment.

8. Evaluate the texture (coarse or fine), oiliness, and overall thickness or thinness of the hair.
Coarse or fine hair types have different care needs. Oily hair might need more frequent washing, while thin hair might require gentle handling to avoid breakage. This information guides the selection of hair care products and techniques.

9. Check for lesions, sores, signs of infection, or infestations like lice on the scalp.
Lesions or infections may require medical treatment and specific care routines to avoid exacerbation. Infestations need immediate treatment to prevent spreading and discomfort.

10. Look for excessive hair growth in areas where it is typically minimal, such as the face in women.
Hirsutism can indicate hormonal imbalances or conditions like polycystic ovary syndrome (PCOS). This assessment can lead to further investigation and appropriate interventions.

11. Determine the patient’s ability to manage their own hair care. Ask if they have any difficulties with tasks like brushing, washing, or styling their hair.
Understanding self-care abilities helps in planning assistance levels. Patients with limited mobility, strength, or coordination might need more support or adaptive tools to manage their hair care effectively.

12. Identify any specific tools or products the patient uses regularly and their knowledge of hair care.
Providing continuity in the use of familiar products and tools can enhance the patient’s comfort and satisfaction with care. Educating the patient on proper hair care techniques and the use of new products might be necessary.

Delegation

In a healthcare setting, various hair care tasks such as brushing, combing, shampooing hair, and shaving facial hair can often be delegated to Unlicensed Assistive Personnel (UAP). However, this delegation comes with specific considerations to ensure patient safety and culturally competent care.

1. Delegation to UAP. Routine hair care tasks like brushing, combing, shampooing, and shaving can be performed by UAPs to efficiently manage the workload of the healthcare team. These tasks are essential for maintaining hygiene, comfort, and dignity for patients but do not require advanced clinical skills.

2. Contraindications. Delegation should be reconsidered if the patient has specific medical conditions that make these procedures risky. For example, patients with cervical spinal injuries or trauma require careful handling to avoid exacerbating their condition. Such patients need specialized care to ensure their safety and comfort.

3. Nurse’s Responsibility. The nurse must assess the appropriateness of delegating these tasks on a case-by-case basis. This includes evaluating the patient’s health status and any potential contraindications. For patients with complex medical needs or conditions that affect hair care, the nurse should either perform the task themselves or provide detailed instructions and supervision to the UAP.

4. Cultural Competence. Hair care practices and preferences can vary significantly across different cultures. The nurse needs to assess the UAP’s knowledge and experience with cultural hair care practices to ensure respectful and appropriate care. This includes understanding different hair textures, products, and styles that may be preferred or required by patients from various cultural backgrounds.

5. Training and Education. If the UAP lacks experience or knowledge in caring for hair of different textures and styles, the nurse should provide training and guidance. This education can help prevent damage to the patient’s hair and ensure that the UAP can provide culturally sensitive care. For instance, knowing how to manage kinky or tightly curled hair, or understanding the importance of specific hair oils and products in some cultures, is crucial for effective and respectful hair care.

6. Supervision and Feedback. Continuous supervision and feedback are necessary to ensure that the UAP is performing hair care tasks correctly and sensitively. The nurse should monitor the UAP’s technique and provide constructive feedback to improve their skills and cultural competence.

Procedure for Hair Care & Combing

Below is a detailed guide outlining the steps involved in providing effective hair care and combing in a healthcare setting.

1. Introduce self and verify the patient’s Identity using agency protocol.
Introducing self establishes rapport and trust with the patient, making them feel more comfortable and respected. Verifying the patient’s identity using agency protocol ensures that the right care is provided to the right person, reducing the risk of errors and enhancing patient safety.

2. Explain to the patient the procedure, why it is necessary, and how he or she can participate.
Providing a clear explanation of the procedure helps alleviate any anxiety or uncertainty the patient might have. Understanding the purpose of the procedure and how it benefits them fosters cooperation and engagement.

3. Perform hand hygiene.
and hygiene is crucial in preventing the transmission of infections. By washing hands or using hand sanitizer before the procedure, the nurse reduces the risk of introducing pathogens to the patient’s environment and minimizes the chance of cross-contamination.

4. Provide patient privacy.
Respecting the patient’s privacy is essential for maintaining dignity and promoting a therapeutic environment. Drawing curtains around the bed or closing the door to the room ensures that the patient feels comfortable and secure during the procedure. This fosters trust and encourages open communication between the patient and the healthcare provider.

5. Move the patient’s head near the edge of the bed with their face turned away from you.
This position provides better access to the patient’s hair, allowing the nurse to work more effectively. It also ensures that any hair care products or loose hairs do not fall onto the patient’s face, enhancing comfort and hygiene.

6. Place towel under the head of the patient extending down the chest and shoulders.
Placing a towel protects the patient’s clothing and bedding from getting wet or soiled by hair care products, hair, or water. It helps maintain a clean and dry environment, preventing discomfort and the need for additional linen changes.

7. Loosen the hair and part it in the middle.
Loosening the hair and parting it in the middle organizes the hair into manageable sections. This initial step makes the subsequent brushing and combing more efficient and reduces the risk of tangling or causing discomfort.

8. Brush hair thoroughly.
Thorough brushing removes superficial tangles and distributes natural oils from the scalp along the hair shafts. This process promotes healthy hair and scalp by enhancing natural lubrication and shine, while also making the hair easier to manage.

9. In combing or brushing, comb small strands at a time. Hold the strand at a time wrapping around the forefinger. Hold the strand above the part being combed so that the pull comes on hand, not on the hair roots, and comb the tangles from the end first.
Working with small strands and holding the hair correctly minimizes tension on the hair roots, reducing the risk of pain and hair breakage. Starting at the ends and working upwards gently removes tangles without pulling on the scalp, preventing discomfort and potential damage to the hair.

10. Comb gently, especially when removing tangles. If the hair is badly tangled, apply Vaseline or oil or wet hair with alcohol but time, patience, and skill are required.
Gentle combing reduces the risk of hair breakage and scalp irritation. Using Vaseline, oil, or alcohol to ease out tangles ensures the process is less painful and more effective, particularly for severely tangled hair. This approach requires patience and skill to protect the hair and scalp.

11. If the hair is long, part down the middle and braid into two braids starting towards the front so that a patient lying on her back will not be conscious of this coronet across the front of the head or let them freely down, holding the ends with ribbon, tape, or rubber bands.
Parting and braiding long hair helps keep it neat and prevents it from tangling while the patient is lying down. Positioning the braids towards the front avoids discomfort for the patient when lying on their back. Securing the ends with ribbons, tape, or rubber bands ensures the hair stays tidy and manageable.

12. Gather all used articles. Clean and disinfect brush and comb and return them to their proper places.
Cleaning and disinfecting hair care tools after use maintain hygiene and prevent the spread of infections. Proper storage of the equipment ensures that they are ready for future use and prolongs their lifespan, supporting overall patient care and safety.

Additional Information

Additional information and guidelines are essential to ensure that the procedure is carried out with sensitivity and attention to the patient’s needs and condition. This includes respecting the patient’s autonomy, ensuring comfort, and addressing specific challenges that may arise.

1. Never allow an ill patient to comb her hair.
Ill patients may not have the strength, coordination, or dexterity required to comb their own hair effectively. Allowing them to attempt this task could lead to increased fatigue, discomfort, or even injury. It is safer and more efficient for a nurse to perform hair care, ensuring that the procedure is gentle and thorough.

2. If the hair is too tangled, vaseline may be used to remove the tangles.
Severely tangled hair can be difficult and painful to manage. Applying Vaseline or another lubricant helps to loosen the knots, making it easier to comb through the hair without causing breakage or pain. This method requires patience and care, ensuring that the hair is detangled gently and effectively.

3. The nurse should never cut the patient’s hair without the patient’s permission.
Rationale: Cutting a patient’s hair without their consent is a violation of their personal autonomy and can significantly impact their sense of identity and dignity. Always seek the patient’s permission before making any alterations to their hair. If the patient is unable to give consent, consult with their family or caregivers and respect their preferences and cultural considerations.

Shampooing the Hair

Hair washing frequency should be tailored to maintain cleanliness, depending on individual needs. Various methods exist for shampooing patient’s hair, taking into account their health, strength, and age. For patients capable of showering independently, shampooing in the shower is suitable. Those unable to shower may receive shampooing while seated in front of a sink. Patients lying on their backs who can transition to a stretcher can receive shampooing at a sink with a stretcher wheeled in. Bedridden patients can undergo shampooing with water brought directly to their bedside. These approaches ensure effective hair care while accommodating the patient’s mobility and comfort level.

Beard and Mustache Care

Facial hair, including beards and mustaches, demands consistent attention to maintain cleanliness and grooming standards. A key priority in beard and mustache care revolves around ensuring cleanliness, as these areas can easily trap food particles and debris. Regular washing and combing are essential to prevent accumulation and maintain hygiene. Patients often seek periodic trimming of their beard or mustache to uphold a polished and well-groomed appearance. This combination of cleansing, combing, and occasional trimming contributes to the overall upkeep and presentation of facial hair, enhancing both hygiene and aesthetics.

References

  • Berman, A., Snyder, S. J., & Frandsen, G. (2015). Kozier & Erb’s fundamentals of nursing: Concepts, process, and practice (10th ed.). Pearson.
Gil Wayne ignites the minds of future nurses through his work as a part-time nurse instructor, writer, and contributor for Nurseslabs, striving to inspire the next generation to reach their full potential and elevate the nursing profession.

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