By Shericka Bennett
Beyond checking vital signs and medication charts, patient-centred care extends to the more subtle actions nurses take — including reaching for the right hair comb.
After recognizing a gap in hair care practices in intensive care units (ICU), Dannah Shillingford, a registered respiratory therapist at UHN's
Toronto General Hospital, wanted to do more to help change it.
As a Black woman with textured hair, she knew how vulnerable it can feel to have others unfamiliar with your hair type be responsible for your hair care.
"I thought to myself, what if I got sick and nobody did my hair, not because they didn't want to, but because they didn't know how to care for my hair type?" says Shillingford.
For many people, hair carries culture, memory, faith and a sense of self, especially for patients whose illness has already taken so much.
This notion makes hair care crucial in helping patients feel like themselves, while supporting their overall well-being. Yet, a one-size-fits-all approach to haircare in hospitals can overlook different hair types, textures and cultural practices.
"I just want to make it better. I want us to have more knowledge and better products. How do we do that?" says Shillingford.
Shillingford applied for UHN's
Collaborative Academic Practice (CAP) Innovation Fellowship Program to develop hair care resources and provide hands-on training to help nurses care for all hair types.
The CAP Fellowship Program offers health care professionals — who do not already have professional development or research time built into their roles — a unique opportunity to improve patient care by leading a quality improvement project. Over six months, program participants receive paid protected time to gain experience in leadership, change management and quality improvement.
Since 2010, the program has grown to include over 100 alumni who embrace the philosophy that clinicians who provide direct patient care know what needs to be improved and how best to improve it.
Beginning a model for change
The quality improvement project focused on improving staff confidence, knowledge and skill in delivering patient-centred hair care to a diverse patient population.
"Shillingford's project strongly reflects the spirit of the CAP Fellowship Program, as she identified an opportunity to improve culturally sensitive care and utilized her professional knowledge, skills and relationships to formulate a feasible and impactful project," says Dr. Alyssa Indar, Director of Scholarship and Innovation, Collaborative Academic Practice, at UHN.
Often people with curly or textured hair are left with unmet needs because of limited hair care tools and products designed for finer, straight hair.
"We care for a very large demographic of a diverse patient population and our care, including our hair care practices, should reflect that," says Shillingford.
She started her work with a survey that found 45 per cent of ICU staff stated they were slightly to not at all comfortable caring for a hair type other than their own. Only 26 per cent reported feeling very or extremely comfortable.
A patient's personal impact
For patients like Tracey Field, the impact of Shillingford's project was both profound and personal.
Physically unable to do her own hair for weeks while in the ICU, Tracey faced real concerns about hair loss.
"I asked if they care for Black hair because there's a difference," she says.
"Of course, to your loved ones, they're just glad you're alive. But, for me, I felt that I'm not who I want to look like or how I want to feel. I just want to feel human and have my hair washed."
Tracey agreed to participate in one of Shillingford's hair washing demonstrations. She says she was surprised by how Shillingford handled her hair using a bed-side washing bin and familiar products suited to her hair type.
"I remember thinking this is really good. It was just like I was in a salon," says Tracey.
For Tracey, getting a tailored hair wash, protective braids and even a satin bonnet — a protective hair cap used to protect hair from friction and damage while sleeping or during bedrest — changed more than her appearance.
"You need something to lift your spirit. It was a moment of not being an ICU patient or in a hospital. I felt like a regular person," she says.
Building skills, confidence and cultural awareness
Shillingford's project addressed gaps in education. Partnering with Crown N Glory Natural Hair Studio in Toronto, she created a tip sheet and instructional video that details how to cleanse, moisturize, detangle and protect all hair types — including specific techniques for textured hair.
She also hosted drop-in simulation sessions using mannequin heads and hair extensions for nurses to learn the techniques. Cultural and religious aspects of hair styling, including respectful practices for patients who wear hijabs or other head coverings, were also discussed.
A one-time donation from EBIN New York provided her unit with a variety of hair care products.
By the end of her project, over 40 nurses were trained and the results were measurable. The project's post-survey data showed an almost ten per cent increase in staff who stated that they are very comfortable to extremely comfortable caring for a hair type other than their own.
Ripple effect to broader impact
The tangible impact of Shillingford's project has already created a ripple effect across her unit, with hopes to continue driving change across UHN and beyond.
"Shillingford's project has tangibly improved culturally sensitive haircare in her environment. With support from leadership, there are plans to scale up this practice change, and expand the impact of this quality improvement work," says Dr. Indar.
Shillingford has since applied for a
CAP Catalyst Research Grant, which will expand the work completed in her quality improvement project into a two-year research project, supported with formal funding.
"We hope that Shillingford's project inspires other health professionals to enhance our culture of scholarship and innovation at UHN — with the ultimate goal of delivering transformative care," says Dr. Indar.
For Shillingford, her goal is simple: helping patients maintain their dignity.
"We're seeing how inclusive hair care is making a huge difference for patients during their stay," she says. "It's helping us treat our diverse patient population the way that they deserve."
