Hair Care and Combing

Hair care is easy to overlook, but it matters for patient comfort and dignity. Done well, it prevents scalp infections and matting, gives you a discreet look at the scalp, and supports a patient's sense of self during a hospital stay. The technique varies by hair type and condition, so know your tools and your patient.

Hair Care and Combing

Hair care and combing maintain and groom a patient's hair for hygiene, comfort, and health: washing, conditioning, detangling, and styling, tailored to the patient. It matters most for the bedridden, immobilized, or anyone who cannot manage their own hair. Good care prevents scalp infections and matting and supports dignity and self-esteem.

Purpose of Hair Care and Combing

• Stimulate scalp circulation. Combing and massaging promote blood flow, bringing nutrients to the follicles and supporting hair strength.
• Distribute hair oils. Combing spreads natural oils along the shaft for a healthy sheen and to prevent dryness and brittleness.
• Provide comfort. The routine is soothing and brings a sense of normalcy, especially for long-term bed patients.
• Remove tangles. Daily combing prevents tangles and mats that cause discomfort and become hard to manage, especially with long hair.
• Preserve hair condition during illness, preventing excessive shedding, breakage, and scalp problems, especially during treatments that affect hair.
• Check for lice discreetly, allowing timely treatment without embarrassing the patient.
• Prevent infection. Clean hair reduces dirt, sweat, and bacteria that cause scalp infection and irritation.
• Prepare for head procedures like MRI, CT, or surgery, where clean, tangle-free hair lets the procedure go smoothly.

Equipment

• Bath towel around the shoulders and neck to catch falling hair, water, or products.
• Hair comb for detangling and distributing oils. Use wide-tooth combs for thick hair, fine-tooth for delicate or thin hair.
• Hair brush to smooth hair, remove tangles, and distribute oils. Soft bristles are gentle and stimulate circulation.
• Vaseline (petroleum jelly) to protect the scalp and hairline during treatments and medications.
• Clips to section hair for easier management, especially long or thick hair.
• Rubber bands or ties to secure sections, gentle enough to avoid breakage or scalp irritation.

Assessment

1. Determine a history of conditions or therapies that affect hair and scalp:

• Recent chemotherapy. Causes thinning or alopecia and a sensitive scalp; handle gently and use products for sensitive scalps.
• Hypothyroidism. Causes dry, brittle hair and hair loss; use gentle, moisturizing products.
• Radiation of the head. Causes hair loss and scalp sensitivity; avoid harsh treatments or products.
• Unexplained hair loss. May signal underlying illness or stress; assess gently and refer to a dermatologist if needed.
• Excessive body hair growth. PCOS (polycystic ovary syndrome) or certain medications cause hirsutism; advise on safe hair removal if the patient wants it.

2. Determine usual hair care practices and products, which provides familiar, comforting care:

• Hair spray, shampoo, conditioner, which affect texture and manageability; match the patient's preferences to reduce irritation.
• Hair oil, to keep the usual routine and keep hair nourished.
• Hair dye, which means scalp sensitivity and color-maintenance needs; choose gentle products.
• Curling or straightening preparations, which affect hair health; avoid further chemical damage.

3. Determine whether wetting the hair will make it hard to comb. Kinky or tightly curled hair is often easier to comb wet, since water softens it and reduces tangles, though it can be harder to manage and prone to breakage once dry.

4. Determine if the hair is straight, curly, or kinky, to pick the right combs, brushes, and products. Kinky hair needs more moisturizing products and gentler handling than straight hair.

5. Check whether the hair is matted or tangled and note overall health (dryness, brittleness, oiliness). Matted hair needs careful detangling; dry hair needs moisturizing; oily hair needs regular washing.

6. Examine the scalp for dryness, flakiness, redness, or irritation, which may indicate dandruff, eczema, infection, or allergic reaction.

7. Look for even hair growth, noting patchy loss, which can signal alopecia areata, fungal infection, or other issues warranting evaluation.

8. Evaluate texture, oiliness, and thickness. Oily hair needs more frequent washing; thin hair needs gentle handling.

9. Check for lesions, sores, signs of infection, or lice, which need prompt treatment to prevent spread and discomfort.

10. Look for excessive growth where hair is usually minimal, such as the face in women, which can indicate hormonal imbalance or PCOS.

11. Determine the patient's ability to manage their own hair care. Limited mobility, strength, or coordination means more support or adaptive tools.

12. Identify the patient's regular tools and products and their hair-care knowledge, providing continuity and educating where needed.

Delegation

Routine hair care, brushing, combing, shampooing, and shaving facial hair, can often go to unlicensed assistive personnel (UAP), with conditions.

• Delegation to UAP. These tasks maintain hygiene, comfort, and dignity and do not require advanced clinical skills.
• Contraindications. Reconsider delegation for patients who need careful handling, such as those with cervical spinal injury or trauma.
• Nurse's responsibility. Assess case by case. For complex needs or contraindications, perform the task yourself or give detailed instructions and supervision.
• Cultural competence. Hair care practices vary across cultures. Confirm the UAP knows different hair textures, products, and styles patients may prefer.
• Training and education. Train UAPs who lack experience with different hair textures, including managing kinky or tightly curled hair and using culturally important oils and products.
• Supervision and feedback. Monitor technique and give constructive feedback to build skill and cultural competence.

Procedure for Hair Care and Combing

1. Introduce yourself and verify the patient's identity per agency protocol.

2. Explain the procedure, why it is needed, and how the patient can participate.

3. Perform hand hygiene to prevent transmission and cross-contamination.

4. Provide privacy by drawing the curtain or closing the door.

5. Move the patient's head near the edge of the bed, face turned away from you, for better access and to keep products and loose hair off the face.

6. Place a towel under the head, extending over the chest and shoulders, to protect clothing and bedding.

7. Loosen the hair and part it in the middle to organize it into manageable sections.

8. Brush thoroughly to remove superficial tangles and distribute natural oils.

9. Comb small strands at a time, wrapping a strand around your forefinger and holding it above the part being combed so the pull is on your hand, not the roots, and comb tangles from the ends first.

10. Comb gently, especially through tangles. For badly tangled hair, apply Vaseline, oil, or wet it with alcohol; it takes time, patience, and skill.

11. For long hair, part it down the middle and braid into two braids toward the front so a patient lying on her back is not bothered by a coronet across the head, or let it down and secure the ends with ribbon, tape, or rubber bands.

12. Gather used articles, clean and disinfect the brush and comb, and return them to maintain hygiene and prevent the spread of infection.

Additional Information

• Never let an ill patient comb her own hair. They may lack the strength, coordination, or dexterity, risking fatigue, discomfort, or injury. The nurse should do it, gently and thoroughly.
• Use Vaseline for severe tangles. It loosens knots so you can comb through without breakage or pain, with patience and care.
• Never cut a patient's hair without permission. Doing so violates their autonomy and dignity. If the patient cannot consent, consult family or caregivers and respect their preferences and cultural considerations.

Shampooing the Hair

Tailor washing frequency to keep the hair clean. Method depends on health, strength, and age: patients who can shower independently shampoo in the shower; those who cannot shower can be shampooed seated at a sink; patients who can transfer to a stretcher can be shampooed at a sink with the stretcher wheeled in; and bedridden patients can be shampooed with water brought to the bedside.

Beard and Mustache Care

Facial hair needs consistent attention, since beards and mustaches trap food and debris. Regular washing and combing prevent buildup and maintain hygiene, and patients often want periodic trimming for a well-groomed look. Cleansing, combing, and occasional trimming keep facial hair hygienic and presentable.