Introduction ‘Personal hygiene care is the physical act


Hair Wash is a key
part of personal hygiene health care sector.  As pointed out in the Essence of Care
Framework, ‘Personal hygiene care is the physical act of cleansing the body to
ensure that the hair, nails, ears, eyes, nose and skin are maintained
in an optimum condition (Department of Health 2010). 

Simply put, hair washing
can be described as the process of removing dirt for the prevention of
infection and infestation.  Hair washing
helps patients to maintain good personal hygiene and reduce scalp disorder like
dandruff. Hair wash is also very important as it helps patients have very
good 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 this
assignment paper is to explore hair wash as a clinical skill within the context
of personal hygiene. I will make efforts to look at the procedures and some
ethical and professional considerations. I will also make efforts to align hair
wash issues with keep biological and psychological theories. These theories
will better explain the rationale behind patients behaviour towards hair


Skills, Equipment
and Procedures for Hair Wash

The nursing and midwifery council has set standard of competency and
skills required for nurses to demonstrate while caring for patients. There are four
key area of this standard which are: professional values, communication and
interpersonal skills, nursing practice and decision marking as well as
leadership, management and team working.

In other to perform
the hair washing procedure successfully for patients, it is imperative for nurses
to maintain the professional values at all times. This can be done through effective
communication. In other words, good communication skills are required to be
able to relate well with patients and gain their consent, especially when
consent cannot be easily given.  Having
effective communication skills also facilitates relationship building and
rapport between patients and the healthcare professionals.  More often than not, when there is a good
rapport between patients and the health care professionals, there is trust and
patients 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 is
another important skill required for hair wash. One way to gain consent is to brief
the patient with all the information required. Gaining consent requires explaining
to patients the procedure required in a well-informed manner.



Equipment required
for hair wash varies from individual to individual patients, depending on the
medical conditions and state of health. Below is a list of the general equipment
required to carry out hair wash procedure:



Patients shampoo and comb


Bed-fast rinser

Incontinence pad

Disposable cloth

2 large bowls of water

Disposable apron


Bed side table

The equipment must
be 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 exhaustive
as 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 practice

The first thing to
do is to gain patient consent for reason as patients have the right to refuse irrespective
of the rationale behind the hair wash procedure. Having gained the consent of
the patient, the next thing to ensure that the immediate environment is
organised to allow free access to patient and movement of persons involved. As
pointed out earlier, equipment needed must be made readily available at the beginning
of the procedure. It is crucial for the healthcare professional to ensure that
all required equipment are in place at the beginning, otherwise the patients might
feel agitated and frustrated.

The environment also needs to be risk assessed.
This is needed to be able to identify and remove any potential hazards and
risks. It is important that the immediate
environment is free from any hazard such as table, electronic items around the
room, side bed table, bed rail, condition of brake of the bed or chair to be

The next step is to adjust the bed or
chair to the right level to maintain good posture and comply with health and
safety measures. This includes ensuring that the bed or chair height is
adjusted 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 drain

Next step will be to put on appropriate
personal 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 the
bucket on the newspaper. After that, one can move the patient to the near side
of the bed and then lower the bed to a level position.

should be followed by pulling the pillow down under the patient’s shoulders to
assisting extending the neck, then fold one bath towel around the neck. Next is
to place the narrow side of the rubber sheet under his head and over the edge
of the pillow. Roll the sides of the sheet to improvise a trough, and place the
free end in the bucket. Then give the patient a washcloth for his eyes and
face and check provisions for water drainage before pouring any water. This should
be followed by wetting his hair and apply shampoo, lather and rinse it. The
shampoo can be reapplied and rinse the hair again repeatedly until his hair is
“squeaky clean.”

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


Theoretical Framework

(Bandura or Sigmund Freud) Biological theorists have argued that due to
genetic composition, patients’ hair may be difficult to wash due to curly
nature. In Nigeria, there are people who are born with twisted hair which is
forbidden from being combed or wash. These people are called ‘Dada’. They live
with it for the rest of their life. The process of cutting the hair is
religious and certain traditional procedures have to be followed, which could
be cumbersome.

Most African-descendent women are born with fragile
hair with high chance of breakage during hair wash (McMichael, 2007). As a
result, they fear having their hair washed. The same is with Hispanic patients who
have curly or very curly hair that may weather during hair wash due to their
genetic disposition.

This biological composition can be better
understood by the three main regional components of peoples’ hair shaft which
are: Cuticle, cortex and medulla. ‘There is more medulla in the coarser hair of
Asians than Caucasians. The medulla may be involved in the splitting of hairs
since it provides an area of weakness as a pathway for the propagation of
cracks along the axis of the fiber’ (Kamath & , Weigmann 1982 & Dawber
1996, as cited in Gavazzoni ,2015).

From the psychological perspective, the way people interprets hair wash
is a matter of personal construct. Some people construe the hair wash as
healthy while some see it as a violation of cultural ethics and norms. This is
what George Kelly refers to as the Personal constructs
theory. Personal constructs is a branch of psychodynamic tradition
in psychology.

Personal constructs theory suggests that people develop
personal constructs about how the world works. People then use these constructs
to make sense of their observations, experiences and way of life. (Neimeyer  & Neimeyer 2002). In other words, we can
choose 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 to
become more specific (Fransella, 1996). Using
the African Dada example above, those (Dadas) who want to accommodate new ideas
may want to get their hair
washed or cut by offering special sacrifice and rituals to appease the gods of


When do you need to carry out hair wash?

The procedure for
washing patient’s hair in bed at the hospital is generally performed when a
patient has serious illness or when a patient has a disability that makes the
patient to be bed bound for a period of time. There are different situations
when the hair of the patient needs washing in bed due to the state of their
health. Hence they depend on the health care professionals to help them carry
out this task. Sometime the patient might need little assistance to carry out
the personal hygiene but sometime they are solely dependent on the healthcare
professionals to care for their personal hygiene needs.

Patients in such
situation s are unable to perform their daily hygiene care as often as they use
to due to the fact that they are bedridden. Due to their bedridden medical condition
and ill-health, washing patients’ hair in the bed may be challenging and
somewhat difficult for health care professionals. This idea is supported by
some scholars who argued that ‘If the patient is bedbound, washing the hair may
be challenging, but if appropriate and with the patient’s consent, they can be
moved to the top of the bed so that their head is supported over the end’
(Dougherty and Lister, 2012).

Depending on individual
patients, the frequency of hair wash may vary from weekly to monthly.


Ethical and
Professional issues

The patients in the hospital have a
diverse religious and cultural background which has to be put into
consideration when caring for patients. The understanding of individual’s
patients religious believe and cultural background helps in careful planning,
assessment in performing hair washing of patient. It is very crucial to support
patients whilst considering their religious belief system. That was why (Collins
and Hampton, 2003) believes that personal care functions operates at both the
physical and the psychological/spiritual levels.

The culture and way of life of certain
patients reflects on how they would like to be supported personally. Most patients
strongly believe in societal practices of where they live or grow up and want
to be treated according to these practices. In the words of Holland (2008) ‘
the way people maintain their personal cleanliness is very closely linked to
the society and culture in which they live. It is a key requirement that HCAs
and APs respect a patient’s personal choice, even if this conflicts with the
HCA or AP’s own personal belief systems’.

 The African Caribbean community is said to pay
attention to the care of skin, and hair, some wash their hair once a week and
mostly use special ointment and cocoa butter for the care of their hair. The
Rastafarians hair are wore in dreadlock and never cut their hair, the hair are
wash but not comb. While the Hinduism hair are said to be consecrated based on their
religious believe. This cannot be touched without consents.

The Muslims as well covers their hair
a woman and will need consent and privacy when washing the hair. In situation
like this is important that the heath care profession give the individual
choice of how they will like procedure to be performed and how their personal
care hygiene is delivered. It is also important to use the patient hair product
where 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 and
respond to their preferences and concerns by encouraging and empower people to
share 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 no
matter the type of procedure that you are performing which was identified in
the NMC code of Prioritise people.

As part of the
preparation for the hair wash, healthcare professional have to maintain the
dignity of the patient by using the curtain where application to maintain
privacy and dignity according the code of practice. This is required to treat
people as individuals and uphold their dignity at all times.

It is crucial to seek patients consent at all times before and during
the hair washing procedures. Due to cultural, religious and other reason,
patients may change their mind and refuse hair wash despite medical advice. If
this happens, healthcare professional must understand that they cannot force
patients 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 must
not be taken for granted and patients’ decisions must be respected at all



 This paper has
underscored the importance of hair wash as a clinical skill within the context
of personal hygiene. The paper has made considerable efforts at explaining the
procedures and some ethical and professional considerations. I have also been
able to use this paper to do an application of relevant biological and
psychological theories to in the explanation of patients behaviour towards hair