The CROWN Project: Promoting Haircare Equity in Hospitals

By:

Amanda Pitt, MBA, BSN, RN, MEDSURG-BC, NEA-BC
Nursing Operations Specialist and Nurse to Nurse Mentoring Program Administrator
Parkland Health | Parkland Center for Nursing Excellence

Marygrace Hernandez-Leveille, PhD, APRN, ACNP-BC
Nurse Scientist
Parkland Health | Parkland Center for Nursing Excellence

Introduction

Imagine being in the hospital for an extended stay and not having the right products to care for your hair. For many patients with textured hair, this is a reality. The CROWN (Creating a Respectful and Open World for Natural Hair) Project aims to change that by promoting haircare equity in hospitals. This blog explores how an equitable pediatric hair care program can be replicated in an adult safety net hospital, provide insights into managing large-scale nursing projects, and highlight the impact on patients and staff.

The CROWN Project: Background and Vision

Hair plays an important role in identity and self-esteem. Disparities in healthcare for African Americans are well documented and often occur due to social determinants of health. Products in hospitals often contain harsh chemicals that cause breakage in textured hair. Recommendations based on Caucasian norms do not consider the specialized needs of patients with textured hair. The CROWN Project aligns with Parkland’s Strategic Health Equity Initiative to decrease health disparities and was inspired by NewYork-Presbyterian Hospital, where a pediatric patient care director initiated a hair care project for a child victim of abuse and saw an immediate and profound impact on the child’s wellbeing. The CROWN Project aims to replicate this model for adults.

Project Management Insights: The PDSA Model

Managing the CROWN Project involves meticulous planning and execution using the Plan, Do, Study, Act (PDSA) model:

• Plan: Identify the target population (patients with textured hair, length of stay ≥ 5 days), engage stakeholders, and establish a project team. Select community vendors to supply the necessary products (value analysis/contracts).
• Do: Gain leadership buy-in, order pilot products, and conduct a pilot study.
• Study: Analyze pilot data and seek funding.
• Act: Train CROWN Champions, implement the project hospital-wide, and distribute products.

Staff education tools were developed, and project orientation was provided for over 115 champions on 27 units hospital wide. Outcomes were obtained through evaluations. The CROWN project was awarded a $100,000 grant for its innovation.

Impact on Patients and Nursing Staff

The CROWN project involved nurse training and creating a toolkit to support replication in other hospitals. It has significantly improved the hospital experience for patients with textured hair and provided nurses with training to offer better care.

Problem Statement

Patients with textured hair face challenges and complications such as tangling, matting, scalp irritations, and hair loss during hospitalization, highlighting the need for a dedicated hair care program.

Goals and Objectives

The Parkland CROWN Project aims to provide hair care products and in-hospital care for patients with textured hair hospitalized for more than five days, starting with a pilot to refine the program for wider implementation.

Conclusion

The CROWN Project is a groundbreaking initiative that addresses a critical gap in patient care. By providing specialized hair care products and training, the project ensures that patients with textured hair receive the care they need during their hospital stay. This holistic approach not only improves patient well-being but also empowers nurses to deliver more inclusive and compassionate patient-centered care. The project will also use textured hair care training for nurses to combat Caucasian bias toward traditional products and recommendations that often cause breakage/hair loss in patients with textured hair (“Hair Care Catered to You” by Sarah Reynolds and Meg Sorg). It provides a holistic approach to patient wellbeing and quality of care, by offering evidence-based specialized hair care products in a predominantly black patient population whose hair care needs during hospitalization have historically been ignored. For more information about Parkland’s toolkit, please email amanda.pitt@phhs.org.

Quotes about the CROWN Project:

“I am so Parkland Proud that we are able to offer this to our patients.” Parkland Nurse

“This is so nice that y’all are offering this. Thank you, thank you! This is awesome.” Elderly female patient

“Oh, snap that’s what’s up, this is cool!” Young male patient

“I appreciate the brush and the bonnet.”  Middle-aged female patient

CROWN Project Reference List

Chelak, K., & Chakole, S. (2023). The role of Social Determinants of Health in Promoting Health Equality: A narrative review. Cureus. https://doi.org/10.7759/cureus.33425

Harris, W., Alleyne, F., Kahsai, M., Hemway, R., Raso, R., Shapiro, A., & Iyasere, J. (2023, May). NewYork-Presbyterian’s Crown Hair Care Program. NEJM Catalyst. https://catalyst.nejm.org/doi/full/10.1056/CAT.23.0031

Joseph-Salisbury, R., & Connelly, L. (2018). “If your hair is relaxed, white people are relaxed. If your hair is nappy, they’re not happy”: Black hair as a site of “postracial” social control in English schools. Social Sciences, 7(219). https://doi.org/10 .3390/socsci7110219

Mbilishaka, A., Ray, M., Hall, J., & Wilson, I. (2020). “No toques mi pelo” (don’t touch my hair): Decoding Afro-Cuban identity politics through hair. African and Black Diaspora: An International

Reynolds, S., & Sorg, M. (2021). Hair Care Catered to You. Purdue Journal of Service-Learning and International Engagement, 8, 86–91. https://doi.org/10.5703/1288284317416
Seldon, T. M., & Berdahl, T. A. (2020). Covid-19 and racial/ethnic disparities in health risk, employment, and household composition. Health Affairs, 39(9), 1624–1632. https://doi.org/10.1377/hlthaff.2020.00897

About the Authors:

Amanda Pitt, MBA, MBA, BSN, MEDSURG-BC,NEA-BC 
Amanda is a nursing leader with 18 years of healthcare experience, who is passionate about nursing excellence, improving patient outcomes, and nurse-to-nurse mentoring. Amanda’s experience includes direct care, clinical education and accreditation, nursing project management, regulatory education, peer review, and professional practice and nursing research development. She has published and presented locally and nationally.

Marygrace Hernandez-Leveille, PhD, APRN, ACNP-BC 
Marygrace is a doctoral-prepared Acute Care Nurse Practitioner and Nurse Scientist with over 30 years of nursing experience who is dedicated and passionate about nursing excellence, patient centered care and mentorship. Dr Leveille has published and presented locally, nationally, and internationally.