UPHSD-LP-CON-AII-104

01-03-2022-02
UNIVERSITY OF
PERPETUAL
SYSTEM DALTA
HELP
COLLEGE OF NURSING
CLINICAL PERFORMANCE EVALUATION CHECKLIST
SHAMPOOING THE HAIR OF A CLIENT CONFINED TO BED
Name: ________________________________ Score: ___________________
Year and Section: ______________________ Date: ____________________

Performed
Preparation Mastered Comments
Yes No

1. Address

 Determine routinely used shampoo products

 Any scalp problems

 Activity tolerance of the client

2. Determine

 Whether a primary care provider’s order is needed before a

shampoo can be given
 The type of shampoo to be used

 The best time of day for the shampoo

3. Assemble equipment

 Comb and brush

 Plastic sheet or pad

 Two bath towels

 Shampoo basin

 Washcloth or pad

 Bath blanket

 Receptacle for the shampoo water

 Pitcher of water

 Bath thermometer

 Liquid or cream shampoo

 Hair dryer

Procedure

1. Introduce yourself, and verify the client’s identity. Explain to the

client what you are going to do, why it is necessary, if appropriate,
and how the client can cooperate.
2. Perform hand hygiene, and observe other appropriate infection
control procedures as needed
3. Provide for client privacy

4. Position and prepare the client appropriately

 Assist the client to the side of the bed from which you will work

 Remove pins and ribbons from the hair, and brush and comb it to
remove any tangles.
Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632) 8871.06.39
www.perpetualdalta.edu.ph
Las Piñas Campus
 UPHSD-LP-CON-AII-104
01-03-2022-02
UNIVERSITY OF
PERPETUAL
SYSTEM DALTA
HELP
5. Arranged the equipment

 Put the plastic sheet or pad on the bed, under the head

 Remove the pillow from under the client’s head, and place it
under the shoulders, unless there is some underlying condition.
 Tuck a bath towel around the client’s shoulders.

 Place the shampoo basin under the head, putting a folded

washcloth or pad where the client’s neck rests on the edge of the
basin. If the client is on a stretcher, the neck can rest on the edge
of the sink, with the washcloth as padding.
 Fanfold the top bedding down to the waist, and cover the upper
part of the client with the bath blanket.
 Place the receiving receptacle on a table or chair at the bedside.
Put the spout of the shampoo basin over the receptacle.
6. Protect the client’s eyes.

 Place a damp washcloth over the client’s eyes

7. Shampoo the hair

 Wet the hair thoroughly with the water

 Apply shampoo to the scalp. Make a good lather with the

shampoo while massaging the scalp with the pads of your
fingertips.
 Rinse the hair briefly, and apply shampoo again

 Make a good lather, and massage the scalp as before

 Rinse the hair thoroughly this time to remove all the shampoo.

 Squeeze as much water as possible out of the hair with your

hands
8. Dry the hair thoroughly

 Rub the client’s hair with a heavy towel.

 Dry the hair with the dryer. Set the temperature at “warm”

 Continually move the dryer to prevent burning the client’s scalp.

9. Ensure client comfort

 Assist the person confined to bed to a comfortable position

 Arrange the hair using a clean brush and comb

 Document the shampoo and any assessments

Remarks:__________________________________________________________________________

Signature of Student over Printed name:______________________________ Date: ______________

Evaluated by: __________________________________________________ Date: ______________

Signature of Clinical Instructor over printed name

All information shall be used by the University for legitimate purposes and shall be processed by authorized personnel in
accordance with the Data Privacy Policies of the UPHSD Las Piñas Campus .
Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632) 8871.06.39
www.perpetualdalta.edu.ph
Las Piñas Campus
 UPHSD-LP-CON-AII-104
01-03-2022-02
UNIVERSITY OF
PERPETUAL
SYSTEM DALTA
HELP

Alabang-Zapote Road, Pamplona 3, Las Piñas City, 1740 Philippines • Tel. No.: (+632) 8871.06.39
www.perpetualdalta.edu.ph
Las Piñas Campus