Hair care, shaving, and nail and foot care are important to many residents. Like hygiene, these grooming measures prevent infection and promote comfort. They also affect love, belonging, and self-esteem needs.

People differ in their grooming measures. Some want only clean hair. Others want a certain hair style. Some want only clean hands. Others want clean, manicured, and polished nails. Many men shave and groom their beards. Likewise, many women shave their legs and underarms. Some women have facial hair. They may shave or use other hair removal methods.

See Focus on Rehabilitation: Grooming.

FOCUS ON REHABILITATION

Grooming

As with hygiene, the person should tend to grooming measures to the extent possible. This promotes the person’s independence and quality of life. The person may use adaptive devices for hair care and dressing. See Figure 21-1 for examples.

See Teamwork and Time Management: Grooming.

TEAMWORK AND TIME MANAGEMENT

Grooming

Some equipment for grooming procedures is shared among residents. Shampoo trays, electric shavers, and whirlpool foot baths are examples. Let other team members know when you need to use an item. Schedule use of the item following center policy. After the procedure, clean and promptly return the item to its proper place. Do not make your co-workers look for or clean an item.

Hair care

How the hair looks and feels affects mental well-being. Some people cannot perform hair care. You assist with hair care whenever needed.

The nursing process reflects the person’s culture, personal choice, skin and scalp condition, health history, and self-care ability. Many nursing centers have beauty and barber shops for residents (Fig. 21-2). Residents can have their hair shampooed, cut, and styled. Men also can have their mustaches and beards groomed.

Fig. 21-2 Beauty shop in a nursing center.

Skin and scalp conditions

Skin and scalp conditions include hair loss, excessive body hair, dandruff, lice, and scabies.

See Focus on Communication: Skin and Scalp Conditions.

FOCUS ON COMMUNICATION

Skin and Scalp Conditions

Some skin or scalp conditions may alarm you. Remain professional. Do not make statements that may embarrass the person.

Tell the nurse if you notice an abnormal skin or scalp condition. Describe what you saw as best as you can. For example:

• “I saw some small red spots on Mr. Martin’s right underarm when I gave him his bath. Would you please take a look at them?”

• “I was getting ready to wash Ms. Miller’s hair. I saw some small white specks. Would you please look at them before I wash her hair?”

Alopecia, hirsutism, and dandruff

Alopecia means hair loss. Hair loss may be complete or partial. Male pattern baldness occurs with aging. It results from heredity. Hair also thins in some women with aging. Cancer treatments (radiation therapy to the head and chemotherapy) often cause alopecia in males and females. Skin disease is another cause. Stress, poor nutrition, pregnancy, some drugs, and hormone changes are other causes. Except for hair loss from aging, hair usually grows back.

Hirsutism is excessive body hair. It can occur in women and children. It results from heredity and abnormal amounts of male hormones.

Dandruff is the excessive amount of dry, white flakes from the scalp. Itching often occurs. Sometimes eyebrows and ear canals are involved. Medicated shampoos correct the problem.

Lice

Pediculosis (lice) is the infestation with wingless insects (lice). See Figure 21-3. Infestation means being in or on a host. Lice attach their eggs (nits) to hair shafts. Nits are oval and yellow to white in color. They hatch in about one week.

After hatching, lice feed on blood to live. Therefore they bite the scalp or skin. Adult lice are about the size of a sesame seed. They are tan to grayish-white in color. Lice bites cause severe itching in the affected body area.

• Pediculosis capitis is the infestation of the scalp (capitis) with lice. It is commonly called “head lice.”

• Pediculosis pubis is the infestation of the pubic (pubis) hair with lice. This form of lice is also called “crabs.”

• Pediculosis corporis is the infestation of the body (corporis) with lice.

Lice easily spread to others through clothing, head coverings, furniture, beds, towels, bed linen, and sexual contact. They also are spread by sharing combs and brushes. Lice are treated with medicated shampoos, lotions, and creams. Thorough bathing is needed. So is washing clothing and linens in hot water.

Report signs and symptoms of lice to the nurse at once:

• Complaints of a tickling feeling or something moving in the hair

• Itching

• Irritability

• Sores on the head or body caused by scratching

• Rash

Scabies

Scabies is a skin disorder caused by a female mite (Fig. 21-4, p. 314). A mite is a very small spider-like organism (Fig. 21-5, p. 314). The female mite burrows into the skin and lays eggs. When the eggs hatch, the females produce more eggs. The person becomes infested with mites.

The person has a rash and intense itching. Common sites are between the fingers, around the wrists, in the underarm area, on the thighs, and in the genital area. Other sites include the breasts, waist, and buttocks.

Scabies is highly contagious. It is transmitted to others by close contact. Persons living in crowded living settings are at risk. So are persons with weakened immune systems. Special creams are ordered to kill the mites. The person’s room is cleaned. Clothing and linens are washed in hot water.

Brushing and combing hair

Brushing and combing hair are part of early morning care, morning care, and afternoon care. And they are done whenever needed. Some people also brush and comb hair at bedtime. Make sure you complete hair care before visitors arrive.

BRUSHING AND COMBING THE PERSON’S HAIR

Quality of life

Remember to:

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure to the person before beginning and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-procedure

1 Follow Delegation Guidelines: Brushing and Combing Hair. See Promoting Safety and Comfort: Brushing and Combing Hair.

2 Practice hand hygiene.

3 Identify the person. Check the ID (identification) bracelet against the assignment sheet. Also call the person by name.

4 Ask the person how to style hair.

5 Collect the following:

• Comb and brush

• Bath towel

• Other hair care items as requested

6 Arrange items on the bedside stand.

7 Provide for privacy.

Procedure

8 Lower the bed rail if up.

9 Help the person to the chair. The person puts on a robe and non-skid footwear when up. (If the person is in bed, raise the bed for body mechanics. Bed rails are up if used. Lower the bed rail near you. Assist the person to a semi-Fowler’s position if allowed.)

10 Place a towel across the person’s back and shoulders or across the pillow.

11 Ask the person to remove eyeglasses. Put them in the eyeglass case. Put the case inside the bedside stand.

12 Brush and comb hair that is not matted or tangled:

a Use the comb to part the hair.

(1) Part hair down the middle into 2 sides (Fig. 21-6, A, p. 316).

(2) Divide one side into 2 smaller sections (Fig. 21-6, B, p. 316).

b Brush one of the small sections of hair. Start at the scalp, and brush toward the hair ends (Fig. 21-7, p. 316). Do the same for the other small section of hair.

c Repeat steps 12, a(2) and 12, b for the other side.

13 Brush and comb matted and tangled hair:

a Take a small section of hair near the ends.

b Comb or brush through to the hair ends.

c Add small sections of hair as you work up to the scalp.

d Comb or brush through each longer section to the hair ends.

e Brush or comb from the scalp to the hair ends.

14 Style the hair as the person prefers.

15 Remove the towel.

16 Let the person put on the eyeglasses.

Post-procedure

17 Provide for comfort. (See the inside of the front book cover.)

18 Place the signal light within reach.

19 Lower the bed to its lowest position.

20 Raise or lower bed rails. Follow the care plan.

21 Clean and return hair care items to their proper place.

22 Unscreen the person.

23 Complete a safety check of the room. (See the inside of the front book cover.)

24 Follow center policy for dirty linen.

25 Decontaminate your hands.

Encourage residents to do their own hair care. Assist as needed. Perform hair care for those who cannot do so. The person chooses how to brush, comb, and style hair.

Brushing increases blood flow to the scalp. And it brings scalp oils along the hair shaft. Scalp oils help keep hair soft and shiny. Brushing and combing prevent tangled and matted hair. When brushing and combing hair, start at the scalp. Then brush or comb to the hair ends.

Long hair easily mats and tangles. Daily brushing and combing prevent the problem. So does braiding. You need the person’s consent to braid hair. Never cut matted or tangled hair. Never cut hair for any reason. Tell the nurse if the person has matted or tangled hair. The nurse may have you comb or brush through the matting and tangling.

Special measures are needed for curly, coarse, and dry hair. Use a wide-tooth comb for curly hair. Start at the neckline. Working upward, lift and fluff hair outward. Continue to the forehead. Wet hair or apply conditioner or petroleum jelly as directed. This makes combing easier.

The person may have certain hair care practices and hair care products. They are part of the care plan. Also, let the person guide you when giving hair care.

See Caring About Culture: Brushing and Combing Hair.

CARING ABOUT CULTURE

Brushing and Combing Hair

Styling hair in small braids is a common practice of some cultural groups. The braids are left intact for shampooing. To undo these braids, the nurse obtains the person’s consent.

See Delegation Guidelines: Brushing and Combing Hair.

DELEGATION GUIDELINES

Brushing and Combing Hair

To brush and comb hair, you need this information from the nurse and the care plan:

• How much help the person needs

• What to do if hair is matted or tangled

• What to do for curly, coarse, or dry hair

• What hair care products to use

• The person’s preferences and routine hair care measures

• What observations to report and record:

• Scalp sores

• Flaking

• Itching

• The presence of nits or lice

• Nits (lice eggs attached to hair shafts)—oval and yellow to white in color

• Lice—about the size of a sesame seed and grayish-white in color

• Patches of hair loss

• Hair falling out in patches

• Very dry or very oily hair

• Matted or tangled hair

• When to report observations

• What specific resident concerns to report at once

See Promoting Safety and Comfort: Brushing and Combing Hair.

PROMOTING SAFETY AND COMFORT

Brushing and Combing Hair

Safety

Sharp bristles can injure the scalp. So can a comb with sharp or broken teeth. Tell the nurse if you have concerns about the person’s brush or comb.

Comfort

When giving hair care, place a towel across the person’s back and shoulders to protect garments from falling hair. If the person is in bed, give hair care before changing linens and the pillowcase. If done after a linen change, place a towel across the pillow to collect falling hair.

Shampooing

Oil gland secretion decreases with aging. Therefore older persons have dry hair. Shampooing frequency depends on the person’s needs and preferences. Usually shampooing is done weekly on the person’s bath day.

SHAMPOOING THE PERSON’S HAIR

Quality of life

Remember to:

• Knock before entering the person’s room.

• Address the person by name.

• Introduce yourself by name and title.

• Explain the procedure to the person before beginning and during the procedure.

• Protect the person’s rights during the procedure.

• Handle the person gently during the procedure.

Pre-procedure

1 Follow Delegation Guidelines: Shampooing, p. 317. See Promoting Safety and Comfort: Shampooing.

2 Practice hand hygiene.

3 Collect the following:

• Two bath towels

• Washcloth

• Shampoo

• Hair conditioner (if requested)

• Bath thermometer

• Pitcher or hand-held nozzle (if needed)

• Shampoo tray (if needed)

• Basin or pan (if needed)

• Waterproof pad (if needed)

• Gloves (if needed)

• Comb and brush

• Hair dryer

4 Arrange items nearby.

5 Identify the person. Check the ID bracelet against the assignment sheet. Also call the person by name.

6 Provide for privacy.

7 Raise the bed for body mechanics for a shampoo in bed. Bed rails are up if used.

8 Decontaminate your hands.

Procedure

9 Lower the bed rail near you if up.

10 Cover the person’s chest with a bath towel.

11 Brush and comb the hair to remove snarls and tangles.

12 Position the person for the method you will use. To shampoo the person in bed:

a Lower the head of the bed and remove the pillow.

b Place the waterproof pad and shampoo tray under the head and shoulders.

c Support the head and neck with a folded towel if necessary.

13 Raise the bed rail if used.

14 Obtain water. Water temperature is usually 105° F (40.5° C). Test water temperature according to center policy. Also ask the person to check the water. Adjust water temperature as needed. Raise the bed rail before leaving the bedside.

15 Lower the bed rail near you if up.

16 Put on gloves (if needed).

17 Ask the person to hold a washcloth over the eyes. It should not cover the nose and mouth. (Note: A damp washcloth is easier to hold. It will not slip. However, some state competency tests require a dry washcloth.)

18 Use the pitcher or nozzle to wet the hair.

19 Apply a small amount of shampoo.

20 Work up a lather with both hands. Start at the hairline. Work toward the back of the head.

21 Massage the scalp with your fingertips. Do not scratch the scalp.

22 Rinse the hair until the water runs clear.

23 Repeat steps 19 through 22.

24 Apply conditioner. Follow directions on the container.

25 Squeeze water from the person’s hair.

26 Cover the hair with a bath towel.

27 Remove the shampoo tray, basin, and waterproof pad.

28 Dry the person’s face with the towel. Use the towel on the person’s chest.

29 Help the person raise the head if appropriate. For the person in bed, raise the head of the bed.

30 Rub the hair and scalp with the towel. Use the second towel if the first one is wet.

31 Comb the hair to remove snarls and tangles.

32 Dry and style hair as quickly as possible.

33 Remove and discard the gloves (if used). Decontaminate your hands.

Post-procedure

34 Provide for comfort. (See the inside of the front book cover.)

35 Place the signal light within reach.

36 Lower the bed to its lowest position.

37 Raise or lower bed rails. Follow the care plan.

38 Unscreen the person.

39 Complete a safety check of the room. (See the inside of the front book cover.)

40 Clean, dry, and return equipment to its proper place. Remember to clean the brush and comb. Discard disposable items.

41 Follow center policy for dirty linen.

42 Decontaminate your hands.

43 Report and record your observations.

Some persons use certain shampoos and conditioners. Others used medicated products ordered by the doctor.

Residents usually need help with shampooing. If a woman’s hair is done by a hairdresser, do not shampoo her hair. She wears a shower cap during the tub bath or shower.

The shampoo method depends on the person’s condition, safety factors, and personal choice. The health team decides on the method to use.

• Shampoo during the shower or tub bath. The person shampoos in the shower. You use a hand-held nozzle for those using shower chairs or taking tub baths. You direct a spray of water at the hair.

• Shampoo at the sink. The person sits facing away from the sink. A folded towel is placed over the sink edge to protect the neck. The person’s head is tilted back over the edge of the sink. You use a water pitcher or hand-held nozzle to wet and rinse the hair.

• Shampoo on a stretcher. The stretcher is in front of the sink. A towel is placed under the neck. The head is tilted over the edge of the sink (Fig. 21-8). You use a water pitcher or hand-held nozzle to wet and rinse the hair.

• Shampoo in bed. The person’s head and shoulders are moved to the edge of the bed if possible. A shampoo tray is placed under the head to protect the linens and mattress from water. The tray drains into a basin placed on a chair by the bed (Fig. 21-9). You use a water pitcher to wet and rinse the hair. This method is used for persons who need complete bed baths. It also is used for persons who cannot use a chair, wheelchair, or stretcher.

Fig. 21-8 Shampooing while the person is on a stretcher. The stretcher is in front of the sink.

Dry and style hair as quickly as possible after the shampoo. Women may want hair curled or rolled up before drying. Check with the nurse before doing so.