Honor lived experience and strengthen trust with Black patients and communities.

SAMANTHA GRANT*, a 56-year-old Black woman, is admitted to the hospital for emergency open-heart surgery after a severe cardiac event. She has meticulously groomed, natural, coiled hair. At home, Ms. Grant uses products suited for Black hair textures.

During her 2-week hospitalization, Ms. Grant is unable to maintain her usual haircare routine due to physical limitations and a lack of appropriate products provided by the hospital. She’s offered only generic shampoos and conditioners not formulated for her hair type. She feels ashamed about her unkempt hair during visits with friends and family, as well as during transport to various areas in the hospital for tests. Without proper moisturization and detangling products, Ms. Grant’s hair becomes matted and brittle.

After discharge, Ms. Grant attempts to restore her hair’s health but finds it impossible due to severe tangling and breakage, resulting in hair loss that forces the decision for a drastic cut. This experience leaves Ms. Grant feeling emotionally distressed and grappling with low self-esteem, adding to the already significant stress of her surgery and recovery.

Ms. Grant’s case illustrates a gap in culturally sensitive nursing care and the need for nurses to know how to properly care for Black hair (ethnic hair found among people of African heritage). Pusey-Reid and colleagues identified curricular gaps in inclusivity in nursing educational material. In addition, Friedman and Sison reported on the frequent neglect of hair care for Black patients in healthcare settings due to a lack of appropriate products.

Tackling a problem

At our college of nursing, students in a newly formed Black Nursing Student Union developed an initiative to address the gap in Black hair care education. As the faculty advisor and workshop developer, Angela Allen, a Black woman with lived experience, worked alongside student leaders to design and deliver this programming. Allen teaches the workshops with members of the Black Nursing Student Union, ensuring that the education is grounded in both clinical knowledge and lived experience.

We identified persistent knowledge deficits and biases among healthcare professionals, which can negatively affect patients’ dignity, trust, and health outcomes. We offer workshops to healthcare professional students enrolled at the university and to professionals practicing at the associated medical center. The popular workshops, designed to support men and women of color, include background information on the importance of Black hairstyles and their historical meaning, the physical characteristics of Black hair, and instructions for caring for Black hair, including necessary tools and products.

Historical meaning

Byrd and colleagues discuss how long before enslavement, Black hair held profound cultural, social, and spiritual meaning across African civilizations. Archaeological evidence dating back to approximately 3500 BCE depicts intricate braided styles, demonstrating that braiding traditions extended back thousands of years. Hairstyles weren’t merely esthetic; they served as cultural identifiers, communicating tribe, lineage, age, marital status, wealth, social rank, and spiritual beliefs. Hair functioned as a sacred and expressive form of identity, artistry, and connection to heritage.

During enslavement, hair also became a tool of resistance and survival. According to Quampah and colleagues, enslaved people used cornrows as a means of communication, including as escape maps. To ensure survival after achieving freedom, some people transported rice seeds braided into their hair. These practices illustrate that Black hairstyles carried layered meanings—cultural, practical, and political.

Today, cornrows and other protective styles continue to evolve in pattern, size, and artistic expression, reflecting both historical continuity and contemporary creativity. (See CROWN Act.)

Physical characteristics of Black hair. Culturally relevant nursing care requires an understanding of the physiological characteristics of Black hair, generally described as curly or coiled with a thick, coarse texture. Protective styles, including braids, help prevent damage to the hair while allowing it to grow.

Westgate and colleagues describe how genetics and biological factors related to hair follicles influence hair type. For example, the curly nature of Black hair prevents moisture from traveling easily down the hair shaft, resulting in increased dryness and fragility. As a result, hair health requires regular hydration and maintenance.

Geisler and colleagues note that various chemicals and hair styling practices may place Black women and men at greater risk for certain conditions and diseases. For example, perming or relaxing hair requires the application of chemicals from the hair roots to the ends. Some of these chemicals may damage the scalp and the hair shaft. Hot metal combs used in a technique to straighten hair also can damage the hair and scalp. Heating the comb requires placing it on an open stove fire or plugging it into a wall outlet. This practice comes with safety concerns, such as burning the scalp, which can cause blisters and sores. If not treated properly, infections can occur.

Contact dermatitis and allergic reactions resulting from chronic exposure to dyes, fragrances, and some chemical treatments may cause significant hair and scalp damage. Also, traction alopecia, caused by pulling hair tighter from the root, remains prevalent among Black individuals and is associated with certain hairstyling practices, such as braids and twists. Other common conditions include folliculitis (inflammation or infection of hair follicles) presenting as papules or pustules, and tinea capitis (fungal infection of the scalp), with symptoms such as scaling, broken hair, or patchy hair loss. Nurses can ask patients about their preferences and concerns before providing care, remain alert to these conditions, and collaborate with the medical team to determine how best to recognize and care for conditions of the scalp.

In addition, some nurses may find it challenging to complete a thorough scalp exam with individuals who wear weaves and wigs. Made from either human or synthetic hair, weaves and wigs are sewn or glued (using weave or wig adhesive) to natural hair. They’re not easily removed, making it difficult to obtain a good view of the scalp and complete a thorough assessment. The scalp can become dry and itchy under the weave and wigs, and some individuals use long, sharp objects, such as pens, pencils, or knitting needles to scratch the scalp, which can cause excoriation. (See Scalp assessment.)

Nursing care

Proper hair care serves an important role in health and healing within Black culture and communities. As with all aspects of nursing care, knowledge and appropriate application of care help to increase the bond between nurses and patients.

Nursing care for Black hair involves knowledge of hair and scalp assessment, products, and related terminology. Clinical examination should include direct questions about hair styling practices and chemicals used on the hair. Ask patients how frequently they wash their hair, about their routine hairstyling practices, whether they use chemical or heat-based hair treatments and how frequently, and whether they use any sharp objects, such as pens or needles, to scratch the scalp. You can involve the patient in the assessment process by asking them to lift, remove, or move aside any wigs, hair attachments, or weaves so you can perform a thorough assessment. (See Know the terminology.)

Products and tools

Different Black hair types and styles require specific products and tools, yet standard hospital supplies may not adequately address the care needs of patients with Black or textured hair. Typically, hospitals provide baby shampoo, soap, and chemically saturated, waterless disposable shampoo caps that don’t require rinsing. According to Robeznieks, most hospitals lack products suitable for Black or textured hair, which may contribute to tangling and hair damage. Robeznieks recommends sulfate-free shampoos to help prevent dryness, frizz, and increased hair fragility.

Healthcare organizations should consider whether appropriate hair-care products and supplies are available to meet the needs of patients with Black or textured hair. Depending on patient preference and hair type, supplies might include sulfate-free shampoo, moisturizing or detangling products, wide-tooth combs, satin or silk hair coverings, and hair accessories that minimize tension and breakage. Nurses should ask patients about the products and techniques they typically use and, when possible, incorporate those preferences into the plan of care.

Moisturizing products. Black hair responds best to leave-in conditioners because they hydrate, reduce frizz, and prevent breakage. A leave-in conditioner also protects hair from everyday environmental stressors. Butters, creams, custards, edge-control products, gels, and oils protect hair while sealing in moisture and sheen, which ensures a smooth, soft look.

Combs and brushes. Black hair care requires several types of combs and brushes. Combs detangle hair before styling and are used to create straight parts. Detangling is best done when wet and with the application of a detangling product. A rattail comb, which has teeth close together and a long, thin handle, serves as the best detangling tool. Other comb types include wide-tooth, heated, and picks.

Similar to combs, brushes have many uses. They help smooth down the edges of the hair or slick down the hair for a sleek look. Men use wave brushes (the most-used brushes) to form a wave-like pattern in the hair. Other frequently used brushes include bristle, edge, and paddle.

Hair coverings. Protective products are typically worn while sleeping to protect the hair and maintain the hairstyle. Silk or satin products—bonnets, durags, and pillowcases—are the standard. These materials maintain moisture and prevent breakage. Other materials, such as cotton, promote dryness and increase frizziness and breakage.

Wig care. Support patients of all backgrounds who choose to wear their wigs during their hospital stay by safeguarding their comfort and maintaining the wig’s condition. To prevent discomfort or scalp irritation, ensure that the wig is secure but not too tight, especially if the patient is lying down for extended periods. Offer patients satin pillowcases or head coverings to help reduce friction and tangling.

Ask patients if they require education on gentle wig maintenance, such as using a soft wig brush or wide-tooth comb, and advocate for the availability of dry shampoo or wig-friendly cleansers. A patient may require a wig stand for protecting the wig when not in use. By acknowledging the cultural and personal significance of wigs, nurses can help patients feel respected and holistically cared for during their hospital stay.

Nursing implications

Nurses can intentionally seek education on Black hair care through continuing education, workshops, or self-directed learning. In addition, schools of nursing play a critical role in incorporating curricula on the biological and structural differences of hair, including variations in texture, curl pattern, and fragility, as well as evidence-based hair and scalp care options for diverse populations.

Recognizing the susceptibility of Black hair to damage and integrating Black hair care practices into training and workplace policies can help nurses advocate for the provision of appropriate tools and hair care products in healthcare settings.

According to Revan and colleagues, nurses also should consider clinical conditions that increase vulnerability of the hair and scalp. Patients who are immunocompromised, such as those receiving chemotherapeutic agents or living with advanced illness, may experience increased hair shedding, scalp sensitivity, dryness, or infection risk. During these periods, careful scalp assessment becomes even more important. Routinely assess the patient’s scalp for irritation, lesions, flaking, tenderness, or signs of infection, For those with tightly coiled or textured hair, visualization may require that you gently part the hair.

Proactive assessment and early intervention can prevent discomfort, secondary infections, and additional emotional distress during already vulnerable periods of illness.

Valuing and respecting patients

Understanding Black hair care discrimination improves nursing care by exploring biases, stereotypes, and attitudes. Hair care as an aspect of nursing care helps patients maintain their body image, dignity, self-efficacy, and overall sense of well-being. It fosters trust and can support improved health outcomes.

Healthcare organization consideration of cultural and personal identity factors as part of comprehensive patient care is long overdue. Ultimately, nursing care inclusive of racial differences ensures that all patients feel valued, respected, and properly cared for throughout their healthcare journey.

The authors work at Rush University Medical Center in Chicago, Illinois. Angela Allen is an assistant professor and Kathryn Swartwout is associate professor and chairperson.

American Nurse Journal. 2026; 21(10). Doi: 10.51256/ANJ102618

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Key words: Black hair care, hair care, Black hair