Shampooing a Patient's Hair in Bed

Skill 7-7

Shampooing a Patient's Hair in Bed

Skill Variation: Shampooing a Patient's Hair With a Shampoo Cap

The easiest way to wash a patient's hair may be to assist them in the shower or the tub. If the patient's hair needs to be washed but the patient is unable or not allowed to get out of bed, a bed shampoo can be performed. Shampoo caps are available and are being used with increasing frequency. These commercially prepared, disposable caps contain a rinseless shampoo product. Refer to the accompanying Skill Variation at the end of the skill. Other hair cleansing products are also available for use at the bedside and include foams, concentrates, and dry powders. Follow product directions for use.

Delegation Considerations

The shampooing of a patient's hair may be delegated to assistive personnel (AP) as well as to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Water pitcher
Warm water
Shampoo
Conditioner (optional)
Disposable gloves
Additional PPE, as indicated
Protective pad for bed
Shampoo board or tray
Bucket
Towels
Gown
Comb or brush
Blow dryer (optional)

Assessment

Assess the patient's hygiene preferences: frequency, time of day, and type of hygiene products. Assess for any physical activity limitations. Assess the patient's ability to get out of bed to have their hair washed. If the prescribed interventions allow it and the patient is physically able to wash their hair in the shower, the patient may prefer to do so. If the patient cannot tolerate being out of bed or is not allowed to do so, perform a bed shampoo. Assess for any activity or positioning limitations. Inspect the patient's scalp for any cuts, lesions, or bumps. Note any flaking, drying, or excessive oiliness, or evidence of problems, such as pediculosis .

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate diagnosis or patient problem may include:

Impaired ability to perform hygiene
Fatigue
Impaired ability to transfer

Outcome Identification and Planning

The expected outcome to achieve is that the patient's hair will be clean. Other outcomes that may be appropriate include the following: the patient will tolerate the shampoo with little to no difficulty, the patient will demonstrate an improved body image, and the patient will verbalize an increase in comfort.

Implementation

Action	Rationale
1. Review the health record for any limitations in physical activity, or contraindications to the procedure. Confirm the presence of a prescribed intervention for shampooing the patient's hair, if required by facility policy.	Identifying limitations prevents patient discomfort and injury. In some settings, a prescribed intervention is required for shampooing a patient's hair.
2. Perform hand hygiene. Put on PPE, as indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient. Explain the procedure to the patient.	Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.
4. Assemble equipment on the overbed table or other surface within reach.	Organization facilitates performance of the task.
5. Close the curtains around the bed and close the door to the room, if possible.	This provides for patient privacy.
6. Lower the head of the bed. Raise the bed to a comfortable working height (VHACEOSH, 2016). Lower the side rail. Remove the pillow and place a protective pad under the patient's head and shoulders (Figure 1).	Proper bed height helps reduce back strain while performing the procedure. A protective pad keeps the sheets from getting wet.
7. Fill the pitcher with comfortably warm water (no more than 120°F [49°C]). Position the patient at the top of the bed, in a supine position. Have the patient lift their head and place the shampoo board underneath the patient's head (Figure 2). If necessary, pad the edge of the board with a small towel.	Warm water is comfortable and relaxing for the patient. It also stimulates circulation and provides for more effective cleaning. Adjusting the water temperature to no more than 120°F (49°C) decreases risk of burns and drying of the skin (IAFF, n.d.). Padding the edge of the shampoo board may help increase patient comfort.
8. Place a drain container underneath the drain of the shampoo board (Figure 3).	The container will catch the runoff water, preventing a mess on the floor.
9. Put on gloves. If the patient is able, have them hold a folded washcloth at the forehead. Pour a pitcher of warm water slowly over the patient's head, making sure that all hair is saturated (Figure 4). Refill pitcher, if needed.	Gloves prevent the spread of microorganisms. A washcloth prevents water from running into the patient's eyes. By pouring slowly, more hair will become wet, and it is more soothing for the patient.
10. Apply a small amount of shampoo to the patient's hair. Lather shampoo. Massage deep into the scalp, avoiding any cuts, lesions, or sore spots.	Shampoo will help to remove dirt or oil.
11. Rinse with comfortably warm water until all shampoo is out of hair (Figure 5). Repeat shampoo, if necessary.	Shampoo left in hair may cause pruritus. If hair is still dirty, another shampoo treatment may be needed.
12. If the patient has thick hair or requests it, apply a small amount of conditioner to the hair and massage throughout. Avoid any cuts, lesions, or sore spots.	Conditioner eases tangles and moisturizes hair and scalp.
13. If drain container is small, empty before rinsing hair. Rinse with comfortably warm water until all conditioner is out of hair.	Container may overflow if not emptied. Conditioner left in hair may cause pruritus.
14. Remove shampoo board. Place towel around the patient's hair.	This prevents the patient from getting cold.
15. Pat hair dry, avoiding any cuts, lesions, or sore spots (Figure 6). Remove protective padding but keep one dry protective pad under the patient's hair.	Patting dry removes any excess water without damaging hair or scalp.
16. Gently brush or comb hair, removing tangles, as needed. Apply additional hair product, such as leave-in conditioner, oil, or pomade, based on patient preferences. Style the hair according to the patient's preference.	Removing tangles helps hair to dry faster. Brushing and styling hair improves the patient's self-image.
17. Blow-dry hair on a cool setting, if allowed and if the patient wishes. If not, consider covering the patient's head with a dry towel, until hair is dry.	Blow-drying hair helps hair to dry faster and prevents the patient from becoming chilled. Keeping the head covered prevents chilling while hair is drying.
18. Change the patient's gown and remove protective pad. Replace pillow. Remove gloves. Perform hand hygiene.	If the patient's gown is damp, the patient will become chilled. Protective pad is no longer needed once hair is dry. Removing gloves properly reduces the risk for infection transmission and contamination of other items. Hand hygiene deters spread of microorganisms.
19. Remove the equipment and return the patient to a position of comfort. Raise the side rail and lower the bed.	Promotes patient comfort and safety. Removing gloves properly reduces the risk for infection transmission and contamination of other items.
20. Remove additional PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene deters spread of microorganisms.

Evaluation

The expected outcomes have been met when the patient's hair has been cleaned, the patient has verbalized a positive body image, and the patient has reported an increase in comfort level.

Documentation

Guidelines

Record your assessment, significant observations, and unusual findings, such as bleeding or inflammation. Document any teaching done. Document care provided and patient response.

Sample Documentation

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Glass is found in hair: Carefully comb through hair before washing to remove as much glass as possible. Discard the glass in an appropriate container. When massaging the scalp, be alert to signs of pain from the patient; glass could be cutting the patient's head.
Nits (lice eggs) are noted on hair shafts: Consult with the health care team regarding prescribed intervention to treat pediculosis. Follow facility policy regarding implementation of transmission precautions pending treatment. Depending on the patient's circumstances, follow up with the family/caregivers regarding possible infection.

Special Considerations

If the patient has a spinal cord or neck injury, use of the shampoo board may be contraindicated. In this case, a makeshift protection area can be created to wash the patient's hair without using the board. Place a protective pad underneath the patient's head and shoulders. Roll a towel into the bottom of the protective pad and direct the roll into one area so that water will drain into the container.

Shampooing a Patient's Hair With a Shampoo Cap

Shampoo caps are available and are being used with increasing frequency. These commercially prepared, disposable caps contain a rinseless shampoo product.

Review chart for any limitations in physical activity, or contraindications to the procedure. Confirm presence of prescribed intervention for shampooing the patient's hair, if required by facility policy.
Warm the cap in the microwave, according to the manufacturer's directions, or remove it from the storage warmer.
Perform hand hygiene and put on PPE, if indicated.
Identify the patient.
Explain what you are going to do and the reason for doing it to the patient.
Assemble necessary equipment on the bedside stand, overbed table, or other surface within reach.
Close the curtains around the bed and close the door to the room, if possible.
Put on gloves. Raise bed to a comfortable working height (VHACEOSH, 2016). Place a towel across the patient's chest. Place the shampoo cap on the patient's head (Figure A).
Massage the scalp and hair through the cap to lather the shampoo. Continue to massage according to the time frame specified by the manufacturer's directions (Figure B).
Remove and discard the shampoo cap.
Dry the patient's hair with a towel.
Remove the towel from the patient's chest.
Comb and style the hair. It may be appropriate to keep the head covered with a towel until the hair dries, to help minimize chilling of the patient.
Remove gloves. Perform hand hygiene.
Lower the bed. Assist the patient to a comfortable position.
Remove additional PPE, if used. Perform hand hygiene.

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Skill 7-7