Introduction ‘Personal hygiene care is the physical act

IntroductionHair Wash is a keypart of personal hygiene health care sector.  As pointed out in the Essence of CareFramework, ‘Personal hygiene care is the physical act of cleansing the body toensure that the hair, nails, ears, eyes, nose and skin are maintainedin an optimum condition (Department of Health 2010).  Simply put, hair washingcan be described as the process of removing dirt for the prevention ofinfection and infestation.  Hair washinghelps patients to maintain good personal hygiene and reduce scalp disorder likedandruff. Hair wash is also very important as it helps patients have verygood circulation of the scalp and ensure that patients’ hair is not tangled.Hair wash also ensures hair is easily combed and well maintained.

The aim of thisassignment paper is to explore hair wash as a clinical skill within the contextof personal hygiene. I will make efforts to look at the procedures and someethical and professional considerations. I will also make efforts to align hairwash issues with keep biological and psychological theories. These theorieswill better explain the rationale behind patients behaviour towards hairwashing.  Skills, Equipmentand Procedures for Hair WashThe nursing and midwifery council has set standard of competency andskills required for nurses to demonstrate while caring for patients. There are fourkey area of this standard which are: professional values, communication andinterpersonal skills, nursing practice and decision marking as well asleadership, management and team working.

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In other to performthe hair washing procedure successfully for patients, it is imperative for nursesto maintain the professional values at all times. This can be done through effectivecommunication. In other words, good communication skills are required to beable to relate well with patients and gain their consent, especially whenconsent cannot be easily given.

  Havingeffective communication skills also facilitates relationship building andrapport between patients and the healthcare professionals.  More often than not, when there is a goodrapport between patients and the health care professionals, there is trust andpatients will be willing to relate freely with the healthcare professionals.The implication of this is that it will make delivery of care more effective.Gaining consent isanother important skill required for hair wash.

One way to gain consent is to briefthe patient with all the information required. Gaining consent requires explainingto patients the procedure required in a well-informed manner.   Equipmentrequired. Equipment requiredfor hair wash varies from individual to individual patients, depending on themedical conditions and state of health. Below is a list of the general equipmentrequired to carry out hair wash procedure: ·        Trolley ·        Towels ·        Patients shampoo and comb·        Jug ·        Bed-fast rinser·        Incontinence pad·        Disposable cloth ·        2 large bowls of water·        Disposable apron·        Newspaper·        Bed side tableThe equipment mustbe made available at the start of the procedure.

This is to protect patients’dignity and ensures a smooth procedure. As mentioned above, the list is not exhaustiveas there may be more depending on patients’ circumstances. For clarity sake,this assignment will assume that the procedure is being carried out on the bed.The Procedure: How the skill is used in practiceThe first thing todo is to gain patient consent for reason as patients have the right to refuse irrespectiveof the rationale behind the hair wash procedure. Having gained the consent ofthe patient, the next thing to ensure that the immediate environment isorganised to allow free access to patient and movement of persons involved.

Aspointed out earlier, equipment needed must be made readily available at the beginningof the procedure. It is crucial for the healthcare professional to ensure thatall required equipment are in place at the beginning, otherwise the patients mightfeel agitated and frustrated. The environment also needs to be risk assessed.This is needed to be able to identify and remove any potential hazards andrisks. It is important that the immediateenvironment is free from any hazard such as table, electronic items around theroom, side bed table, bed rail, condition of brake of the bed or chair to beused.

The next step is to adjust the bed orchair to the right level to maintain good posture and comply with health andsafety measures. This includes ensuring that the bed or chair height isadjusted appropriately with the aid of the remote control or any other tool. Sometimes,the head rest need to be adjusted to ensure free flow of water into the drainpipe.  Next step will be to put on appropriatepersonal protective equipment (PPE).

This may include the glove, apron etc.Before putting on the hand glove, it may be necessary to use hand sanitiser.Having worn appropriate PPE, one can place a newspaper on the chair and thebucket on the newspaper. After that, one can move the patient to the near sideof the bed and then lower the bed to a level position.Thisshould be followed by pulling the pillow down under the patient’s shoulders toassisting extending the neck, then fold one bath towel around the neck.

Next isto place the narrow side of the rubber sheet under his head and over the edgeof the pillow. Roll the sides of the sheet to improvise a trough, and place thefree end in the bucket. Then give the patient a washcloth for his eyes andface and check provisions for water drainage before pouring any water. This shouldbe followed by wetting his hair and apply shampoo, lather and rinse it. Theshampoo can be reapplied and rinse the hair again repeatedly until his hair is”squeaky clean.

“This will then be followed by drying thehair by slipping a dry towel under the patient’s bed. Then roll and remove therubber sheet. Pull the pillow up into its normal place. Dry the hair by gentlyrubbing it with a clean towel. Remove the equipment and wipe up any waterspilled on the floor. Assist the patient to comb and brush his hair with aclean comb and brush.

 Theoretical Framework(Bandura or Sigmund Freud) Biological theorists have argued that due togenetic composition, patients’ hair may be difficult to wash due to curlynature. In Nigeria, there are people who are born with twisted hair which isforbidden from being combed or wash. These people are called ‘Dada’. They livewith it for the rest of their life.

The process of cutting the hair isreligious and certain traditional procedures have to be followed, which couldbe cumbersome.Most African-descendent women are born with fragilehair with high chance of breakage during hair wash (McMichael, 2007). As aresult, they fear having their hair washed. The same is with Hispanic patients whohave curly or very curly hair that may weather during hair wash due to theirgenetic disposition. This biological composition can be betterunderstood by the three main regional components of peoples’ hair shaft whichare: Cuticle, cortex and medulla. ‘There is more medulla in the coarser hair ofAsians than Caucasians.

The medulla may be involved in the splitting of hairssince it provides an area of weakness as a pathway for the propagation ofcracks along the axis of the fiber’ (Kamath & , Weigmann 1982 & Dawber1996, as cited in Gavazzoni ,2015). From the psychological perspective, the way people interprets hair washis a matter of personal construct. Some people construe the hair wash ashealthy while some see it as a violation of cultural ethics and norms.

This iswhat George Kelly refers to as the Personal constructstheory. Personal constructs is a branch of psychodynamic traditionin psychology. Personal constructs theory suggests that people developpersonal constructs about how the world works. People then use these constructsto make sense of their observations, experiences and way of life. (Neimeyer  & Neimeyer 2002). In other words, we canchoose to re-programme our beliefs or thoughts to choose what to believe,either positive construct or negative constructs.According to a proponent of this theory, Constructs may be expanded(dilated) to accommodate new ideas or constricted tobecome more specific (Fransella, 1996). Usingthe African Dada example above, those (Dadas) who want to accommodate new ideasmay want to get their hairwashed or cut by offering special sacrifice and rituals to appease the gods ofhair.

 When do you need to carry out hair wash? The procedure forwashing patient’s hair in bed at the hospital is generally performed when apatient has serious illness or when a patient has a disability that makes thepatient to be bed bound for a period of time. There are different situationswhen the hair of the patient needs washing in bed due to the state of theirhealth. Hence they depend on the health care professionals to help them carryout this task. Sometime the patient might need little assistance to carry outthe personal hygiene but sometime they are solely dependent on the healthcareprofessionals to care for their personal hygiene needs.Patients in suchsituation s are unable to perform their daily hygiene care as often as they useto due to the fact that they are bedridden. Due to their bedridden medical conditionand ill-health, washing patients’ hair in the bed may be challenging andsomewhat difficult for health care professionals. This idea is supported bysome scholars who argued that ‘If the patient is bedbound, washing the hair maybe challenging, but if appropriate and with the patient’s consent, they can bemoved to the top of the bed so that their head is supported over the end'(Dougherty and Lister, 2012). Depending on individualpatients, the frequency of hair wash may vary from weekly to monthly.

 Ethical andProfessional issuesThe patients in the hospital have adiverse religious and cultural background which has to be put intoconsideration when caring for patients. The understanding of individual’spatients religious believe and cultural background helps in careful planning,assessment in performing hair washing of patient. It is very crucial to supportpatients whilst considering their religious belief system. That was why (Collinsand Hampton, 2003) believes that personal care functions operates at both thephysical and the psychological/spiritual levels.The culture and way of life of certainpatients reflects on how they would like to be supported personally. Most patientsstrongly believe in societal practices of where they live or grow up and wantto be treated according to these practices.

In the words of Holland (2008) ‘the way people maintain their personal cleanliness is very closely linked tothe society and culture in which they live. It is a key requirement that HCAsand APs respect a patient’s personal choice, even if this conflicts with theHCA or AP’s own personal belief systems’. The African Caribbean community is said to payattention to the care of skin, and hair, some wash their hair once a week andmostly use special ointment and cocoa butter for the care of their hair. TheRastafarians hair are wore in dreadlock and never cut their hair, the hair arewash but not comb. While the Hinduism hair are said to be consecrated based on theirreligious believe. This cannot be touched without consents.The Muslims as well covers their haira woman and will need consent and privacy when washing the hair. In situationlike this is important that the heath care profession give the individualchoice of how they will like procedure to be performed and how their personalcare hygiene is delivered.

It is also important to use the patient hair productwhere available to give them the opportunity to makes choice based on their preference.This was highlighted in the NMC code as part of the guide to Nurses  2:2.3 which states ‘Listen to people andrespond to their preferences and concerns by encouraging and empower people toshare decisions about their treatment and care’Maintaining patient’s dignity during hair wash Nursing and Midwifery Council Code is very clear about maintain the patient dignity at all times nomatter the type of procedure that you are performing which was identified inthe NMC code of Prioritise people.

As part of thepreparation for the hair wash, healthcare professional have to maintain thedignity of the patient by using the curtain where application to maintainprivacy and dignity according the code of practice. This is required to treatpeople as individuals and uphold their dignity at all times. It is crucial to seek patients consent at all times before and duringthe hair washing procedures. Due to cultural, religious and other reason,patients may change their mind and refuse hair wash despite medical advice. Ifthis happens, healthcare professional must understand that they cannot forcepatients to do hair wash. They can also persuade and sell the benefits to them.

Even when patients have earlier agreed and later changed their minds, they mustnot be taken for granted and patients’ decisions must be respected at alltimes. Conclusion This paper hasunderscored the importance of hair wash as a clinical skill within the contextof personal hygiene. The paper has made considerable efforts at explaining theprocedures and some ethical and professional considerations. I have also beenable to use this paper to do an application of relevant biological andpsychological theories to in the explanation of patients behaviour towards hairwashing. 

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