Grooming
Objectives
Key Terms
Hair care, shaving, nail and foot care, and clean garments prevent infection and promote comfort. Such measures affect love, belonging, and self-esteem needs.
People differ in their grooming measures. Some want only clean hair. Others want a certain hairstyle. Some want only clean hands. Others want polished nails. Men may shave and groom their beards. Likewise, women may shave their legs and underarms. Some women use hair removal methods for facial hair.
As with hygiene, the person performs grooming measures to the extent possible. This promotes independence and quality of life. The person may use adaptive devices (Fig. 23-1).
See Focus on Surveys: Grooming.
See Teamwork and Time Management: Grooming.
Hair Care
The look and feel of hair affect mental well-being. The nursing process reflects the person’s culture, personal choice, skin and scalp conditions, health history, and self-care ability. You assist with hair care as needed.
See Focus on Long-Term Care and Home Care: Hair Care.
Focus on Long-Term Care and Home Care
Hair Care
Long-Term Care
Beauty and barber shops are common in nursing centers (Fig. 23-2). Residents can have their hair shampooed, cut, and styled. Men can have their mustaches and beards groomed.
Skin and Scalp Conditions
Skin and scalp conditions include hair loss, excessive body hair, dandruff, lice, and scabies.
• Alopecia means hair loss. Hair loss may be complete or partial. A result of heredity, male pattern baldness occurs with aging. Hair thins in some women with aging. Cancer treatments (radiation therapy to the head and chemotherapy) may cause alopecia in all age-groups. Skin disease, 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 men, 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 is common. Sometimes eyebrows and ear canals are involved. Medicated shampoos correct the problem.
• Pediculosis (lice) is the infestation with wingless insects (Fig. 23-3). 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 1 week. After hatching, they bite the scalp or skin to feed on blood. About the size of a sesame seed, adult lice are tan to gray-ish white in color. Lice easily spread to others through clothing, head coverings, furniture, beds, towels, bed linens, and sexual contact. They also are spread by sharing combs and brushes. Lice are treated with medicated shampoos, lotions, and creams specific for lice. Thorough bathing is needed. So is washing clothing and linens in hot water. 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.
• Scabies is a skin disorder caused by a female mite (Fig. 23-4). A mite is a very small spider-like organism. The female mite burrows into the skin and lays eggs. After hatching, the females produce more eggs. Infested with mites, the person has a rash and intense itching. Common sites are between the fingers, the wrists, underarm areas, thighs, and genital area. Other sites include the breasts, waist, and buttocks. Highly contagious, scabies is transmitted to others by close contact. Persons 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.
See Focus on Communication: Skin and Scalp Conditions.
Brushing and Combing Hair
Brushing and combing hair are part of early morning care, morning care, and afternoon care. Some people also do so at bedtime. Provide hair care when needed and before visitors arrive.
Encourage patients and residents to do their own hair care. The person chooses how to brush, comb, and style hair. Assist as needed. Provide hair care for those who cannot do so.
Brushing increases blood flow to the scalp. And it brings scalp oils along the hair shaft to help keep hair soft and shiny. Daily brushing and combing prevent tangled and matted hair. To brush and comb hair, start at the scalp. Then brush or comb to the hair ends.
Braiding prevents long hair from matting and tangling. You need the person’s consent to braid hair. Report matted or tangled hair to the nurse. The nurse may have you comb or brush through the matting and tangling from the hair ends to the scalp. Never cut the person’s hair.
Special measures are needed for curly, coarse, and dry hair. For curly hair, use a wide-tooth comb. Start at the neckline. Working upward, lift and fluff hair outward. Continue to the forehead. Wet hair or apply conditioner, petroleum jelly, or other hair care product as directed. This makes combing easier. Follow the care plan for coarse and dry hair.
The person may have certain hair care practices and 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.
See Focus on Children and Older Persons: Brushing and Combing Hair.
See Delegation Guidelines: Brushing and Combing Hair.
See Promoting Safety and Comfort: Brushing and Combing Hair.
See procedure: Brushing and Combing Hair, p. 370.
Caring About Culture
Brushing and Combing Hair
Small braids (cornrows) are common in some cultural groups. The braids are left intact for shampooing. To undo these braids, the nurse obtains the person’s consent.
Brushing and Combing Hair 
Pre-Procedure
1. Follow Delegation Guidelines: Brushing and Combing Hair, p. 369. See Promoting Safety and Comfort: Brushing and Combing Hair, p. 369.
3. Identify the person. Check the ID (identification) bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
4. Ask the person how to style hair.
• Other hair care items as requested
6. Arrange items on the bedside stand.
Procedure
a In a chair—Help the person to the chair. The person puts on a robe and non-skid footwear when up.
10. Place a towel across the person’s back and shoulders or across the pillow.
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. 23-5, A).
2) Divide 1 side into 2 smaller sections (Fig. 23-5, B).
b Brush 1 of the small sections of hair. Start at the scalp and brush toward the hair ends (Fig. 23-6). Do the same for the other small section of hair.
c Repeat steps 12, a(2) and b for the other side.
13. Brush or comb matted or 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.
14. Style the hair as the person prefers.
Post-Procedure
17. Provide for comfort. (See the inside of the front cover.)
18. Place the call light and other needed items within reach.
19. Lower the bed to a safe and comfortable level for the person. Follow the care plan.
20. Raise or lower bed rails. Follow the care plan.
23. Complete a safety check of the room. (See the inside of the front cover.)
24. Follow agency policy for used linens.
Shampooing
People vary in shampoo frequency—1, 2, or 3 times a week or daily. Factors affecting frequency include hair and scalp condition, hairstyle, and personal choice.
Some persons use certain shampoos and conditioners. Others use medicated products ordered by the doctor.
The person may need help shampooing. The nurse tells you what method to use. The shampoo method depends on the person’s condition, safety factors, and personal choice.
• Shampoo at the sink. The person sits or lies facing away from the sink. A folded towel placed over the sink edge protects the neck. The person’s head is tilted back over the sink edge (Fig. 23-7). Use a water pitcher or hand-held nozzle to wet and rinse the hair.
• Shampoo in bed. The person’s head and shoulders are at the edge of the bed if possible. A shampoo tray is under the head to protect the linens and mattress from water. The tray drains into a basin on a chair by the bed (Fig. 23-8). Use a water pitcher to wet and rinse the hair. This method is used for persons:
• Who cannot use a chair, wheelchair, or stretcher
Some agencies have commercial shampoo caps. The cap has a cleaning agent that does not need rinsing. Some caps also have a conditioner. To use a shampoo cap:
• Check the temperature. The cap should be warm. Do not use a cap that is too hot.
• Apply the cap to the person’s head.
• Remove the cap. You do not need to rinse the hair. Dry the hair with a towel if needed.
Dry and style hair as soon as possible after the shampoo. Women may want hair curled or rolled up before drying. Check with the nurse before doing so.
See Focus on Children and Older Persons: Shampooing.
See Focus on Long-Term Care and Home Care: Shampooing, p. 372.
See Delegation Guidelines: Shampooing, p. 372.
See Promoting Safety and Comfort: Shampooing, p. 372.
See procedure: Shampooing the Person’s Hair, p. 373.
Shampooing the Person’s Hair 
Pre-Procedure
1. Follow Delegation Guidelines: Shampooing. See Promoting Safety and Comfort: Shampooing.
• Shampoo
• Hair conditioner (if requested)
• Pitcher or hand-held nozzle (if needed)
5. Identify the person. Check the ID bracelet against the assignment sheet. Use 2 identifiers (Chapter 13). Also call the person by name.
7. Raise the bed for body mechanics for a shampoo in bed. Bed rails are up if used.
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 used. For a shampoo 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.
15. Lower the bed rail near you if up.
16. Put on gloves (if needed).
18. Use the water 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 with your fingernails.
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 a 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. Rub gently. Use the second towel if the first one is wet.
31. Comb the hair to remove snarls and tangles.
33. Remove and discard the gloves (if used). Practice hand hygiene.
Post-Procedure
34. Provide for comfort. (See the inside of the front cover.)
35. Place the call light and other needed items within reach.
36. Lower the bed to a safe and comfortable level for the person. Follow the care plan.
37. Raise or lower bed rails. Follow the care plan.
39. Complete a safety check of the room. (See the inside of the front cover.)
41. Follow agency policy for used linens.
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