Black patients' hair is often neglected in the hospital due to a lack of appropriate products and a predominantly non-Black health care staff unfamiliar with caring for hair different from their own. Maintaining the patient's hair usually falls to the patient or a family member. If the patient is unable to provide self-care and is unaccompanied, the staff are responsible. But they may not feel confident about or know how to provide hair care. Improper hair maintenance can lead to hair loss due to friction and matting; it also reflects poorly on the quality of the nursing care provided.
Nurses aspire to provide holistic care. Personal grooming maintains a patient's dignity and helps keep their spirits up during the challenges of hospitalization. We recently implemented a project at our hospital to address this disparity in nursing care. It is our hope that our project will inspire other hospitals to diversify their hair care offerings and ensure that staff are comfortable caring for patients with all hair textures.
In response to the national dialogue on race and racism, our hospital formed a nursing diversity, equity, and inclusion (DEI) council. This Magnet core council allows for collaboration among nurses from all areas of the health system to address myriad patient care inequities. In addition to challenging explicit and implicit bias, the council sought to identify and update or eliminate policies, procedures, and practices that may have historically seemed equitable but actually resulted in disparate patient outcomes. With these goals in mind, nurses began to appraise their work environments.
One day, when offering personal care items to a Black patient, a nurse realized the patient would be unable to do her hair due to inadequate supplies. The hospital's hair care options included shampoo, shower caps, baby shampoo, and a fine-toothed comb. When a nurse brought this to the attention of the DEI council, a nurse manager mentioned that she had arranged for a special order of coconut oil for her unit for use as a hair oil. This meant there was already a hair oil vetted for hospital use. In addition, the council found that a wide-toothed comb that would work with more hair types was available from an already contracted hospital supplier. One of the clinical nurse specialists on the council presented the need, obtained the approval, and began the ordering process.
Material services provided the option of stocking these hair supplies on all units or distributing them by special request. We felt it was important to have supplies stocked on all units, except for the intensive care nursery. Because nurses and clinical care partners are busy, having to special order supplies and pick them up from central supply every time could make staff less likely to use them. Most important, we wanted to change the cultural message: not stocking products suitable for different textures of hair presents fine hair as “normal” or “baseline.”
To encourage use of the new products, the council prepared educational materials for nursing staff. We wanted staff to know the historical significance of hair discrimination as well as empower them to take better care of their patients' hair. The council distributed a tip sheet with QR code links to videos to instruct staff on how to care for textured hair. These educational resources were meant to convey the expectation that caring for a patient's hair, regardless of texture, is a standard of care.
The announcement of the project's rollout in October 2021 received positive responses from hospital staff. To evaluate the new policy, and to determine the need for supplementary products or additional staff education, the council will be soliciting feedback from patients and staff. Inequitable hair care in hospitals should no longer be the norm. It is a small step in addressing systemic racism in health care to use a clear and inexpensive solution that can be easily reproduced in other health care settings.