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Procedure For Washing Patients Hair in Bed
Procedure For Washing Patients Hair in Bed
S
upporting patients to maintain
Authors Sandra Lawton is nurse their hygiene needs while in hos-
consultant dermatology, Rotherham pital is a fundamental aspect of
Foundation Trust; Eileen Shepherd is nursing care yet there is very
clinical editor, Nursing Times. little evidence to support practice (Coyer et
al, 2011). Personal hygiene includes care of
Abstract Hair care is an essential part of the hair, skin, nails, mouth, eyes, ears, per- 2a. No-rinse shampoo cap, which does
personal hygiene and has an important ineal areas (Dougherty and Lister, 2015) not require water
role in maintaining self-esteem and and facial shaving (Ette and Gretton, 2019).
quality of life. Supporting patients to Helping patients to wash and dress is
maintain hair care when they cannot do frequently delegated to junior staff, but
this themselves is a fundamental aspect time spent attending to a patient’s hygiene
of nursing care. This article outlines the needs is a valuable opportunity for nurses
procedure for washing patients’ hair to carry out a holistic assessment (Dough-
when they are confined to bed. erty and Lister, 2015; Burns and Day, 2012).
Citation Lawton S, Shepherd E (2019) Hair care 2b. Inflatable shampoo basin
Procedure for washing patients’ hair The condition of a patients’ hair and how
in bed. Nursing Times [online]; 115: 6, it is styled is an important part of their
60-62. identity, so hair care should be carried out
– as far as possible – according to their
wishes. Washing and styling patients’ hair
can also be a valuable social activity and
help boost their self-esteem and sense of
wellbeing. 2c. Shampoo tray with a spout to allow
Caring for patients’ hair provides an water to drain away from the head
opportunity to observe the scalp for signs
of pressure damage, dandruff or dry skin
and underlying skin conditions. It is also l Drain soapy water away from the head,
important to observe for head lice (Fig 1), helping to keep the patient dry.
which must be treated immediately to Preferences for hair care products is
avoid others being affected (Dougherty individual, so patients should be invited to
and Lister, 2015). provide their own if they wish. Those with
If patients are in hospital for a long underlying skin problems may have thera-
time, it may not be possible to maintain peutic shampoos, which may need to be
their hairstyle so a referral to a hairdresser prescribed, or allergies to some of the
Fig 1. Checking the patient’s or barber may be required. Alternatively, ingredients found in washing and cos-
head some may wish to ask their regular hair- metic products. Information about aller-
dresser or barber to visit. gies should be recorded in the nursing
records.
Using appropriate equipment Before attempting to wash a patient’s
Patients who are confined to bed will be hair with water and shampoo, it is impor-
unable to wash their own hair – this can tant to check there are no contraindica-
have a negative effect on their wellbeing. tions or precautions, such as spinal or neck
However, it is possible to maintain clean injuries (Dougherty and Lister, 2015). You
hair using dry and no-rinse shampoos or should also assess how quickly the patient
no-rinse shampoo caps (Dougherty and becomes tired – for example, it may be
Lister, 2015) (Fig 2a). Devices such as inflat- appropriate to plan hair washing at a dif-
able basins (Fig 2b) and shampoo trays ferent time to bed bathing.
(Fig 2c) are also available, which: Disposable equipment should be used –
Check the head for head lice and l A llow the hair to be washed with water including bowls and jugs – to reduce the
ensure this is treated immediately and shampoo while the patient remains risk of infection (Marchaim et al, 2012).
ALAMY
Clinical Practice
Practical procedures
3b. Place a plastic sheet under the patient’s head and shoulders and wrap a towel
trays, should be washed and dried around their shoulders
according to local policy.
Hair products such as hairbrushes or
curlers should be the patient’s own or sup- l C
omb or brush; 7. Check whether the patient needs to empty
plied as single-patient use, while patients’ l C
lean clothes and bed linen; their bowel/bladder before the procedure.
own electrical items, such as hairdryers/ l Shampoo
tray;
straighteners, should undergo a safety test l D
isposable jug and basin. 8. Assemble your equipment and ensure
(PAT test) before use – check local policies. everything is to hand to minimise the
The procedure amount of time the patient is lying flat.
Glove use 1. Review the patient’s care plan for hygiene
The World Health Organization (2009) has needs and check there are no contraindica- 9. Ensure the bed is at the correct working
stated that non-sterile gloves are not rou- tions to positioning the patient flat in bed. height.
tinely required for washing and dressing
patients. Nurses need to assess individual 2. Ensure someone will be available to help 10. Decontaminate your hands and put on
patients for risk of exposure to blood and position the patient during the procedure an apron to reduce the risk of infection.
body fluids (Royal College of Nursing, if required.
2018) and be aware of local policies for 11. Remove the patient’s clothes from their
glove use. 3. Decontaminate your hands in line with upper body and cover them with a sheet to
When gloves are required, they must be the WHO’s 5 moments for hand hygiene maintain dignity.
single-use and disposed of in line with (Bit.ly/WHOCleanYourHands).
local policy (Loveday et al, 2014). 12. Remove the pillows from behind the
4. Discuss the procedure with the patient, patient’s head so they are lying flat. This
Undertaking hair washing in bed ask about their usual hair routine and gain allows water to drain away from the eyes
General principles for hair washing are their informed consent for the procedure. and ears during the procedure (Dougherty
outlined in Box 1. and Lister, 2015). Ask the patient to let
5. Check whether the patient has any pain. you know if they feel uncomfortable in this
Equipment Administer analgesia if necessary and position at any time.
The following equipment will be required: ensure it has taken effect before starting
l A
pron; the procedure, to help relieve any pain 13. Remove the head of the bed so you can
l T
owels; associated with moving the patient. access the patient’s hair easily (Fig 3a).
l L
aundry skip;
l D
isposable wash cloths; 6. Ensure the patient’s privacy and check 14. Place a plastic sheet under the patient’s
l P
lastic sheet; that the environment is warm and free of head and shoulders, and wrap a towel
l P
referred shampoo and conditioner; draughts. around their shoulders (Fig 3b).
Clinical Practice
Practical procedures
Fig 9: show
patient sitting
up in a hospital
bed with a
towel wrapped
round their
head
3c. Place the patient’s head on the shampoo tray ensuring you follow manufacturer’s
instructions carefully
15. Position the patient’s head on the 22. Apply conditioner, if required by the 33. Remove and dispose of your apron and
shampoo tray, ensuring you follow manu- patient, and rinse the hair again. decontaminate your hands.
facturer’s instructions carefully (Fig 3c).
A towel can be placed under the neck for 23. Check, regularly, the patient is com- 34. Record care that has been given, record
support (Dougherty and Lister, 2015). fortable and can maintain their position. and report any abnormal findings and
update the patient’s care plan if required. NT
16. Following manufacturer’s instruc- 24. Pat the hair with a towel to remove the
tions, ensure the receptacle that will col- excess water – avoid pulling on the hair as References
Burns S, Day T (2012) A return to basics:
lect the water from the shampoo tray is this can be uncomfortable. ‘interventional patient hygiene’ (a call for papers).
positioned under the drainage spout. Intensive and Critical Care Nursing; 28: 4, 193-196.
25. Remove the shampoo tray and wrap a Coyer FM et al (2011) The provision of patient
personal hygiene in the intensive care unit: a
17. Fill a disposable wash bowl with warm towel around the patient’s head to dry the descriptive exploratory study of bed-bathing
water and allow the patient to check the hair and ensure they do not feel cold. practice. Australian Critical Care; 24: 3, 198-209.
temperature. Dougherty L, Lister S (2015) The Royal Marsden
Manual of Clinical Nursing Procedures. Chichester:
26. Dry the surrounding skin, paying par-
John Wiley & Sons.
18. If required, cover the patient’s eyes ticular attention to skin folds in the neck. Ette L, Gretton M (2019) The significance of facial
with a disposable washcloth to protect shaving as fundamental nursing care. Nursing
them from water and shampoo. 27. Change any wet bed linen. Dispose of Times; 115: 1, 40-42.
Loveday HP et al (2014) epic3: National
soiled bedlinen directly into the linen skip. evidence-based guidelines for preventing
19. Using a disposable jug, take water from healthcare-associated infections in NHS hospitals
the disposable bowl and wet the patient’s 28. Replace the bedhead and reposition the in England. Journal of Hospital Infection; 86: S1,
S1-S70.
hair. Start at the front hairline and allow patient so they are comfortable (Fig 4). Marchaim D et al (2012) Hospital bath basins are
the water to drain down and away from the frequently contaminated with multidrug-resistant
face, avoiding the eyes and ears (Fig 3d). 29. Help the patient get dressed. human pathogens. American Journal of Infection
Control; 40: 6, 562-564.
Royal College of Nursing (2018) Tools of the
20. Apply the shampoo and massage it into 30. Style the patient’s hair according to Trade: Guidance for Health Care Staff on Glove
the hair. their preferences. If possible, try to make Use and the Prevention of Contact Dermatitis.
Bit.ly/RCNGloves
this a social situation – offer them a drink
World Health Organization (2009) WHO
21. Using the jug, rinse the patient’s hair and a mirror so they can advise you about Guidelines on Hand Hygiene in Health Care.
with water. the style and participate in their care. Bit.ly/WHOHands2009