Prepping for People: Understanding the Management of Black/Natural/Afro-textured Hair in the Peri-operative Space

Introduction: Hair plays a significant role in shaping identities, but the extent to which healthcare workers in the perioperative setting are trained to conduct meaningful conversations and navigate hair care for patients with Black/Natural/Afro-textured Hair (BNAH) remains largely unexplored. This study aims to assess the current state of BNAH management for patients undergoing head and neck surgeries at a large, rural academic medical center.

Methods: From Nov 2024-Jan 2025, an anonymous 25-question survey evaluating current practices, knowledge of, and familiarity with common products and terminology used by patients with BNAH was conducted at Dartmouth Hitchcock Medical Center. It was distributed to perioperative staff and Otolaryngology, Neurosurgery, and Plastic Surgery members. It also evaluated attitudes toward the importance of educating faculty and staff on managing BNAH.

Results: 44 participants completed the one-time survey, with incomplete responses excluded from the analysis. Respondents represented various departments and roles, including 57% clinical nurses, 16% APRN/PAs, 11% attending surgeons, 7% surgical residents, and 9% in ‘other’ positions. No respondents received formal training on the surgical management/prep of BNAH during medical training. While 95% strongly agreed/agreed that “hair is a part of a patient's social, cultural, and personal identity,” 57% did not feel prepared to discuss the management of BNAH with patients. 70% said they “would attend a training session on strategies for approaching BNAH.”

Conclusions: Despite the consensus that hair serves an important role in one’s identity, there is a gap in the ability to manage BNAH perioperatively. There is an opportunity in medical training to provide structured education/resources around BNAH which could create a more equitable and inclusive environment for patients and empower healthcare providers to better support diverse surgical patients, regardless of hair texture. This study plans to expand throughout the Dartmouth Health System to broaden its reach, support further conclusions, and inform future training initiatives.