Practice Tip of the Week | Comprehensive Hair Care Training to Improve Patient Outcomes

By Adrienne Davis, MBA, MSN, RN, CPN, NPD-BC; Adrienne Johnson, MSW, LCSW-S; and Afra Evans, MSN, RN, NPD-BC, CCM 

An increase in hospital-acquired pressure injuries (HAPIs) among patients with textured hair, combined with limited staff training, lack of awareness, and family concerns, prompted the launch of a new education initiative. As awareness grew around the importance of caring for all hair types in a respectful and appropriate way, our pediatric hospital selected new haircare products and developed updated guidelines, including a scalp assessment tool. However, a review of clinical areas revealed that while some products were available, staff lacked the training and resources needed to use them effectively. 

Problem 

A survey of 133 staff members, 86% clinical, revealed significant gaps in knowledge and confidence regarding diverse haircare practices. Results showed that 69% had never received training, 23% said the survey itself was their only information source, and 51% did not feel equipped to provide appropriate care. Additionally, 33% did not understand different hair types, 50% were not confident using products, and 43% did not know who to ask for help. Overall, 36% reported feeling nervous or intimidated when caring for hair types different from their own. 

Literature Review 

An interdisciplinary clinical education committee, comprising clinical nurse specialists, nurses, and social workers, created training that addressed knowledge gaps in diverse hair and scalp assessment, product and accessory use, and patient and family support. The education subcommittee developed a multi-modal learning strategy aligned with the organization’s mission. This included a flyer on culturally considerate haircare practices and appropriate product use to address immediate safety concerns and training needs. 

Methods 

A total of 41 Haircare Champions, representing seven clinical roles and over 20 practice areas, were identified to participate in training development, delivery, and ongoing peer-to-peer support. Online courses were created for both clinical and non-clinical audiences, tailored to their specific needs. In-person “roadshows” offered low-fidelity simulations, where champions engaged staff, reinforced online learning, and provided opportunities to practice scalp assessment and product use.  

Implementation 

Implementation of this comprehensive training and resource program significantly advanced health equity, achieving 0% HAPI to the scalp and head in the pediatric organization. By closing knowledge and confidence gaps, the initiative fostered a more competent and empowered workforce. The engagement of Haircare Champions and the use of multi-modal strategies ensured sustained improvements in patient safety and outcomes.  

Results 

The initiative of comprehensive training and resources for equitable haircare practices has significantly advanced health equity, achieving 0% hospital-acquired pressure injuries (HAPI) to the scalp and head in a pediatric organization. By closing gaps in clinical staff knowledge and confidence, the initiative cultivated a more competent and empowered workforce. The engagement of dedicated Haircare Champions, paired with multi-modal learning strategies, has driven sustained improvements in patient safety and outcomes. 

Recommendations 

Involve patients and families in creating education materials, including illustrated scalp assessment guides and product use instructions. Incorporate hands-on training sessions and scalp assessments into routine care and discharge planning, providing take-home kits and clear instructions to support patients with complex needs or extended stays. To ensure ongoing success, conduct staff surveys to assess confidence and cultural competence, regularly monitor HAPI rates, and gather patient feedback. 

REFERENCES

Jubaedah, L., & Arum, A. P. (2021). Empowerment of PKK mothers in caring for hair through teaching videos of traditional haircare. Journal Pemberdayaan Masyarakat Madani, 5(1), 160–170. https://doi.org/10.21009/10.21009/JPMM.005.1.12 

Koch, S. L., Tridico, S. R., Bernard, B. A., Shriver, M. D., & Jablonski, N. G. (2020). The biology of human hair: A multidisciplinary review. American Journal of Human Biology, 32(2), e23316-n/a. https://doi.org/10.1002/ajhb.23316  

Sinclair, R. D. (2007). Healthy Hair: What Is it? The Journal of Investigative Dermatology Symposium Proceedings, 12(2), 2–5. https://doi.org/10.1038/sj.jidsymp.5650046 

CHA More than Just Hair: Improving Hair Care Equity in Health Care (October 2022). More Than Just Hair: Improving Hair Care Equity in Health Care (childrenshospitals.org) 

Sara Asbeck, Chelsi Riley-Prescot, Ella Glaser & Antonella Tosti (2022). Afro-Ethnic hairstyling trends, risk, and recommendations. Cosmetics (9) 17. pp 2-11. 

S. Aslan, T. A. Evans, J. Wares, K. Norwood, Y. Idelcaid & D. Velkow. (2019). Physical characterization of the hair of Mexican woman. International Journal of Cosmetic Science. 41 36-45.  

Wang, T., Nelson, Y. M., Alexander, F., & Dolansky, M. A. (2022). Future direction of quality and safety competency-based education: Quality and Safety Education for Nurses teaching strategies. The Journal of Nursing Education, 61(6), 287–288. https://doi.org/10.3928/01484834-20220510-01