6. CCA Study Notes: Client-Centred Hair Care, Grooming, and Shampooing

The Big Picture

Hair care is part of personal care. How a person’s hair looks and feels affects emotional well-being, and illness or disability sometimes makes independent hair care difficult.

Hair care should fit the individual client. Follow the care plan while considering personal choice, culture, hair and scalp condition, physical and mental health, and the client’s ability to care for their own hair. Support independence whenever the client is able to participate.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Hair Care Should Be Individualized

A client’s hair care needs belong in the care plan. Important factors include:

• culture
• personal choice
• skin and scalp condition
• physical health
• mental health
• self-care abilities

Assist with grooming when the care plan states that the client needs help.

Important Hair and Scalp Terms

Alopecia

alopecia means hair loss. The loss might be partial or complete.

Male-pattern baldness occurs with aging or heredity. Women also experience thinning hair with aging.

Other supported causes of alopecia include:

• radiation therapy to the head
• chemotherapy
• skin disease
• stress
• poor nutrition
• pregnancy
• some medications
• hormone changes

In many cases, hair grows back after the underlying issue has resolved, but this does not happen in every case.

Hirsutism

hirsutism means excessive or increased hair growth.

In women, it refers to visible, coarse hair growing in areas where little or no visible coarse hair normally appears, such as the face or neck. The pattern resembles male-pattern body hair.

Hirsutism is usually a cosmetic and psychological concern. When it develops well after puberty, it might also signal a more serious medical problem.

Dandruff

dandruff means an excessive amount of dry, white flakes on the scalp, in the hair, or on the shoulders.

Dandruff often causes scalp itching. It sometimes affects the eyebrows and ear canals.

Medicated shampoos usually help with dandruff. Regardless of shampoo type, rinse the hair thoroughly.

Lice and Pediculosis

pediculosis means an infestation with lice.

lice are small, insectlike parasites that live on the human body, especially on the skin, hair, and genital area. They feed on human blood and lay eggs on body hair and in clothing.

A parasite is an organism that lives on or in another organism and gets nutrients from that host.

Lice bites cause severe itching in the affected area. Lice do not cause dangerous infections themselves, but they sometimes carry pathogens associated with more serious diseases such as trench fever and typhus.

Lice problems occur primarily in overcrowded settings or places with inadequate bathing and laundry facilities. All humans are equally at risk for infestation, but older people are more prone to complications.

Three Types to Know

• pediculosis capitis: lice infestation of the scalp
• pediculosis pubis: lice infestation of pubic hair
• pediculosis corporis: lice infestation of body surfaces

Head lice and pubic lice attach their eggs to hair shafts.

How Lice Spread

Lice eggs are called nits. They attach to clothing and furniture as well as hair.

Lice and their eggs spread through:

• clothing
• furniture
• bed linen
• physical contact
• shared combs and brushes

Treatment involves destroying both the lice and their eggs. Supported treatment methods include medicated shampoos, lotions, and creams used according to manufacturer directions.

Several applications and manual nit removal are usually necessary. Clients and people who shared items with them need a thorough tub bath, and clothing and linens need washing in hot water.

Items that are not washable should be thoroughly vacuumed, sealed in an airtight bag, and stored for several weeks until the lice are destroyed.

Report: If you notice signs of lice, report them to your supervisor immediately and follow employer policy.

Brushing and Combing Hair

Brushing and combing usually form part of the client’s morning and bedtime routine. Hair care also takes place during the day when needed.

For example, a client might want their hair styled before visitors arrive.

CCA action: Encourage the client to perform their own hair care. Provide the amount of help the client needs.

Clients should choose how they want their hair brushed, combed, and styled.

Chemically Treated Hair

Hair treated with permanents ⓘ or chemical straightening tends to become dry, brittle, and more prone to tangling.

Handle chemically treated hair gently.

Start at the ends and brush toward the hair ends. With each stroke, gradually move higher toward the roots.

After sleep, chemically treated hair sometimes needs recombing or fluffing. A hair pick is suitable for permed hair to reduce breakage.

How to Brush or Comb Hair Safely

Before starting, place a towel over the client’s shoulders to protect clothing.

For a client who stays in bed, provide hair care before changing the pillowcase. If the linen has already been changed, protect the pillow or the client’s shoulders with a towel.

Loose hair on clothing or bedding looks untidy and, in some situations, creates a risk of inhalation or swallowing.

When brushing or combing:

1. Start near the bottom of the hair.
2. Brush or comb toward the ends.
3. Gradually work higher.
4. Handle the hair gently.
5. Brush slowly.
6. Never pull or tug.

Pulling or tugging hurts the client and might pull individual hairs from their root follicles.

Matted or Tangled Hair

If you find matted or tangled hair, discuss the problem with your supervisor.

If directed to work through the tangles:

1. Take a small section near the ends.
2. Gently comb or brush through to the ends.
3. Move gradually upward toward the scalp.
4. Continue in small sections.
5. Work toward brushing or combing smoothly from the scalp to the ends.

Avoid: Never cut hair simply to remove tangles.

Respecting Cultural and Personal Hair-Care Practices

Hair care should respect the client’s usual practices and preferred products. These details should become part of the care plan when relevant.

The client should guide you when using their usual hair-care practices or products.

Black Textured Hair

Black textured hair requires gentle handling to reduce breakage and hair loss.

Use:

• a wide-tooth comb
• a hair pick
• a good-quality natural boar brush when available

Avoid fine-tooth combs because they tend to snag and pull curly or kinky hair.

Black textured hair tends to produce less sebum, the oily secretion made by sebaceous glands, than White hair. Moisturizing products such as leave-in conditioners and styling lotions help add oil to dry hair.

Products labelled for curly hair are not necessarily suitable for Black curly hair.

Avoid drying products such as:

• hairspray
• mousse
• holding gels

Curly, Coarse, and Dry Hair

For curly, coarse, dry hair:

1. Use a wide-tooth comb.
2. Start at the neckline.
3. Comb the hair while working higher.
4. Lift and fluff the hair outward.
5. Continue until you reach the forehead.

Wetting the hair or applying conditioner or petroleum jelly sometimes makes combing easier.

Hair Care for Clients Who Wear Hijabs

Privacy and dignity remain important during hair care.

Consult the client or family about how to respect the client’s preferences.

Supported hair-care points include:

• Do not tie the hair up while wet. Let it air-dry first when possible.
• Try to expose the hair and scalp to sunlight for at least 30 minutes each week.
• When possible, remove the hijab ⓘ, underscarf, and hair tie and run fingers through the hair and scalp to encourage circulation.
• Wash underscarves regularly.
• Regular trimming of the hair ends removes split ends. For a support worker, hair cutting still requires the specific instruction, consent, care-plan directions, and supervisor direction explained below.
• Avoid tying the hair too tightly because strain on the roots leads to hair loss.

Corn Braids

Corn braids are left intact during shampooing.

Do not do or undo corn braids without the client’s consent. Supervisor permission is also required in some situations.

Some agencies require signed permission forms for hair care. Follow agency policy.

A single large braid is different from corn braids. Undo a single braid each night because lying on it causes discomfort.

Dreadlocks

Dreadlocks are coils of hair formed by twisting, rubbing, or backcombing the hair together in a specific way.

Do not comb dreadlocks out.

Wash dreadlocks with a residue-free product. Washing frequency depends on the client.

Clients who perspire a lot need more frequent washing to reduce salt buildup on the scalp. For clients who do not perspire heavily, washing about once a week is appropriate.

Gently massaging the scalp for a few minutes each day helps release natural oils from the sebaceous glands.

Follow the care plan for the required type and frequency of care.

Who Cuts a Client’s Hair?

Routine hair cutting belongs to a professional barber or hairstylist.

Some facilities have salons or barber shops. Some hairstylists also visit homes or long-term care facilities.

In many long-term care facilities, the client or substitute decision maker ⓘ must sign a consent form before a haircut.

A limited exception exists when cutting becomes absolutely necessary, such as removing a section of matted hair.

Before a support worker cuts hair under this exception:

• the worker must receive specific instruction
• proper consent must be obtained
• the care plan must include the details
• the supervisor must specify that the cutting is necessary

If those requirements are met:

1. Do not attempt the haircut while the client is agitated or uncooperative.
2. Cut the smallest amount needed.
3. Try to leave the hair looking attractive and even.
4. Use proper hair shears.
5. Never use scissors designed for another purpose because they tear hair and cause discomfort.

What to Observe During Brushing and Combing

Report and record these observations:

• scalp sores
• flaking
• lice or nits
• patches of hair loss
• unusually dry or oily hair

Nits appear as tiny, white, oval-shaped specks in the hair.

Shampooing Frequency and Client Choice

Shampooing frequency differs from one client to another.

Some clients shampoo:

• once a week
• two or three times a week
• every day

The frequency depends on the hair and scalp condition, hairstyle, and personal choice.

Shampoo and conditioner products also involve personal choice.

When a client asks for a shampoo, check the care plan for special hair-care instructions.

Choosing the Shampooing Method

The shampooing method depends on:

• the client’s condition
• safety factors
• personal choice when permitted

Follow the care plan.

After shampooing, dry and style the hair as quickly as possible.

If a client wants curls or rollers placed before drying, consult the supervisor first. The family might prefer hairdressing services.

General Shampooing Guidelines

Follow these points when assisting with shampooing:

• Shampoo the client’s hair only when instructed by your supervisor.
• Ask your supervisor and check the care plan for the shampooing method.
• Check for position restrictions or limits.
• Remove hearing aids so they do not become wet or damaged.
• Return medicated shampoo to proper storage or give it to your supervisor.
• Do not leave medicated shampoo at the bedside unless instructed.
• Follow care-plan directions about gloves.
• Prevent shampoo from entering the client’s eyes.
• Place a face towel or washcloth over the eyes.
• Cup your hand against the forehead during rinsing to redirect soapy water away from the eyes.

The general shampooing guideline states that gloves and Standard Practices are used when the client has scalp lesions or head lice, or when certain medicated shampoos require them. Gloves sometimes pull the hair and cause discomfort.

Water Temperature

Number to remember: Shampoo water is usually about 40.5°C (105°F).

Measure the water temperature according to employer policy.

Retest it frequently because water in some facilities cools quickly.

Shampooing During a Shower or Tub Bath

A handheld shower nozzle is suitable for clients shampooed during a shower or tub bath.

If the client is able to tip their head back:

1. Ask the client to tip their head back to keep water and shampoo away from the eyes.
2. Support the back of the head with one hand.
3. Shampoo with the other hand.

If the client is unable to tip their head back:

1. Help the client lean forward.
2. Give the client a folded washcloth to hold over the eyes.
3. Support the forehead with one hand.
4. Shampoo with the other hand.
5. Make sure the client breathes easily.

Shampooing at a Sink

A client who sits upright and tilts the head forward or backward might use a sink for shampooing.

Some older adults and people with disabilities have limited movement in the neck or upper back. The sink method is not suitable when those limitations prevent safe positioning.

Follow the care plan.

If the client uses a wheelchair, lock the wheels securely.

Facing the Sink

If the client faces a low sink:

1. Help the client lean forward over the sink.
2. Place a towel over the shoulders.
3. Give the client a folded washcloth for the eyes.
4. Wet and rinse the hair with a water pitcher or handheld nozzle.

Leaning Back Over the Sink

If the client prefers to lean backward:

1. Position the chair or wheelchair facing away from the sink.
2. Put a folded towel over the sink edge to protect the neck.
3. Help the client carefully tilt the head back over the sink edge.
4. Give the client a folded washcloth for the eyes.
5. Wet and rinse the hair with a pitcher or handheld nozzle.

Safety: Use extreme care when bending the head backward. The supported risk includes artery dissection and other life-threatening consequences.

Shampooing on a Stretcher at the Sink

A client with a recent spinal injury or surgery might need shampooing on a stretcher at the sink rather than in bed.

Follow this sequence:

1. Place the stretcher in front of the sink.
2. Lock the stretcher wheels.
3. Apply safety straps to prevent rolling.
4. Follow the care plan for side-rail use.
5. Place a waterproof plastic bag under the client and drape its edge into the sink.
6. Place a folded towel over the sink edge.
7. Put a folded washcloth over the client’s eyes.
8. Wet and rinse the hair with a water pitcher or handheld nozzle.

Assistive Devices for Shampooing

A plastic cape draped over the shoulders and into the sink helps direct water.

A wheelchair shampoo rinse tray attaches to the back of the wheelchair and extends over the sink. The client rests the head on the tray. Water travels down the tray into the sink, while raised edges help keep water off the floor.

Shampooing in Bed

A client who does not tolerate sitting long enough for sink shampooing might have their hair washed in bed.

Move the client close to the bed edge. This supports body alignment and reduces the amount of stretching required by the worker.

Place a folded cloth over the client’s eyes. Ask the client to help keep the cloth comfortably positioned.

Place a shampoo tray under the head. The tray protects the linen and mattress and drains water into a basin beside the bed. Use a pitcher to wet and rinse the hair.

Home-Care Shampoo Trays

A shampoo tray is sometimes made from:

• a plastic shower curtain
• a plastic tablecloth
• a plastic painting drop cloth

Avoid plastic garbage bags because they slip easily and lack enough sturdiness.

To make the tray:

1. Place the plastic beneath the client’s head.
2. Roll the edges upward to form raised sides.
3. Direct the ends into a basin so water drains into it.
4. Check the care plan and consult the supervisor before using this method.

Children and Grooming Preferences

Hairstyles matter to adolescents and other school-aged children.

Do not judge a child’s hairstyle or impose your own hairstyle preferences.

Style the hair in a way that pleases both the child and the parents.

Adolescents and Shampooing

Oil gland secretion increases during puberty. Adolescents therefore tend to have oily hair and require frequent shampooing.

Shampooing in Long-Term Care

Shampooing is usually performed once or twice weekly on the client’s bath or shower day.

If the client recently had their hair done at a salon, do not shampoo it. Protect the hairstyle with a shower cap during the bath or shower.

Shampooing a Client’s Hair in Bed

This procedure supports the client’s dignity, independence, individualized care, preferences, privacy, and safety.

Pre-Procedure

1. Identify the client according to employer policy.
2. Explain the procedure.
3. Perform proper hand hygiene.
4. Gather two bath towels, a face towel or washcloth, shampoo, requested conditioner, bath thermometer, pitcher or nozzle if needed, shampoo tray if needed, basin or pail if needed, waterproof pad if needed, gloves if needed, comb and brush, and hair dryer.
5. Arrange the supplies within easy reach.
6. Provide privacy and perform proper hand hygiene again.

Collecting supplies before starting reduces unnecessary trips away from the client and avoids wasted time and effort.

Procedure

7. Position the client as close to the bed edge as possible for the chosen method. Place the waterproof pad and shampoo tray beneath the head and shoulders when needed.
8. Put a bath towel over the shoulders or pillow.
9. Brush or comb the hair to remove tangles while the hair is dry.
10. Raise the bed rail if it is used.
11. Obtain water at about 40.5°C (105°F). Test it with a bath thermometer according to employer policy. Let the client test the water temperature with their hand.

This confirms that the water feels comfortable to the client and helps prevent burns from water that is too hot.

12. Lower the bed rail if it is used.
13. Put on gloves when needed. The bed-shampoo procedure states that gloves are needed when the client has scalp problems.
14. Ask the client to hold a damp face towel or washcloth over the eyes. Keep the nose and mouth uncovered.
15. Wet the hair with the pitcher or nozzle.
16. Apply a small amount of shampoo.
17. Work up a lather ⓘ using both hands. Start at the hairline and move toward the back of the head. If the client leans forward, start at the back and move toward the hairline.
18. Massage the scalp with the pads of your fingertips rather than your fingernails.
19. Rinse the hair.
20. Repeat steps 15 through 18.
21. Rinse the hair completely so no shampoo remains.
22. Apply conditioner, if requested, following the product directions.
23. Squeeze water from the hair.
24. Cover the hair with a bath towel.
25. Dry the client’s face with the towel.
26. Help the client raise their head when appropriate.

Many clients have weakened neck muscles. Supporting the head makes the movement more comfortable and may reduce the risk of neck injury.

27. Rub the hair and scalp with the towel. Use the second towel if the first becomes wet.
28. Comb or brush the hair to remove tangles.
29. Dry and style the hair as quickly as possible.
30. Remove gloves if used and perform proper hand hygiene.

Post-Procedure

31. Make the client safe and comfortable.
32. Place the call bell within reach when this step applies.
33. Follow the care plan for bed-rail use when this step applies.
34. Remove privacy measures.
35. Clean the equipment and return it to the proper place.
36. Discard disposable items.
37. Follow employer policy for dirty linen.
38. Perform proper hand hygiene.

Report and record your actions and observations according to employer policy.

Actions, observations, and basic assessments are reported and recorded for legal reasons and to keep the health care team informed.

The call-bell and bed-rail steps marked in the procedure do not apply in every community setting.

What to Report and Record After Shampooing

Report and record:

• scalp sores
• hair falling out in clumps
• how the client tolerated the procedure
• lice

Common Mix-Ups

Wrong Idea	Better Idea
The worker chooses the client’s hairstyle.	The client should decide how their hair is brushed, combed, and styled.
Any scissors are suitable for hair cutting.	An approved exception requires proper hair shears.
A routine haircut is part of ordinary support-worker hair care.	Routine hair cutting belongs to a professional barber or hairstylist.
All lice infestations have the same location.	Capitis affects the scalp, pubis affects pubic hair, and corporis affects body surfaces.
Hair should be detangled by starting at the scalp.	Start near the ends and gradually work upward.
One shampooing method suits every client.	The method depends on the client’s condition, safety, preferences, and care plan.