Guidance for Bathing Patients with Dementia: Bathing Without a Battle

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For people with the advanced states of Alzheimer's disease and related dementia (ADRD)—many of whom living in nursing homes—being bathed by caregivers who they may not recognize can be upsetting or confusing. People who feel vulnerable or attacked during bathing routines may scream, cry, or lash out at their caregivers. There is evidence that caregivers can alleviate agitation by tailoring bathing techniques to the person's particular needs and attending to their comfort. The "Bathing Without a Battle" CD and video package includes practical bathing methods for humanizing the insensitive bathing experience that institutionalized residents must often endure, along with guidance for developing creative, customized solutions. Nurses, nursing assistants, and administrators can earn continuing education credits by viewing the materials and passing an exam.

The Issue: Alzheimer's disease and related dementia (ADRD) directly affects more than 4 million Americans. For ADRD patients, being bathed by caregivers can be upsetting or confusing. ADRD patients often feel vulnerable or attacked during bathing routines, and may respond by screaming, crying, or lashing out at their caregivers. On the other hand, caregivers—tasked with getting patients clean, often within a certain time frame and following set methods—may feel frustrated or threatened by uncooperative patients. There is evidence that such conflicts can be avoided by employing bathing methods tailored to the particular needs and comfort levels of patients. This has been described as "person-centered" bathing.

Organizations: Cecil G. Sheps Center and Institute of Aging, University of North Carolina at Chapel Hill; Oregon Health and Science University; EO Studios, Inc., Athens, Georgia

Target Populations: Nurses, nursing assistants, administrators, surveyors, ombudspersons, and home caregivers

The Intervention: The "Bathing Without a Battle" CD and video package offers practical approaches that staff can use to individualize and humanize showering, tub-bathing, in-room bathing, and hair washing for patients with ADRD. In addition, it discusses safe bathing equipment, strategies for influencing relevant federal nursing regulations and bathing policies at long-term care facilities, where institutional routines commonly take precedence over resident preferences. The package includes before and after documentary footage of care providers and residents, graphically demonstrating problems encountered in bathing persons with ADRD and the impact of person-centered techniques.

The "Bathing Without a Battle" materials teach caregivers how to design personalized bathing strategies for their patients. Caregivers are encouraged to pinpoint what situations trigger combative resident behavior and to develop creative solutions. For example, if patients seem angry or embarassed about being undressed, it is suggested that caregivers allow them to wear a light gown, even in the shower, and use great care to prevent unnecessary exposure. For some residents, sponge baths or towel baths that take place in their room, or other techniques, such as no-rinse soap, may be as effective as traditional methods and far less upsetting to patients than full-body baths or showers.

The CD includes separate tracks for nurses, nursing assistants, administrators, surveyors, ombudspersons, and home caregivers. It offers three hours of continuing education credit for nurses and two hours of credit for nursing assistants and administrators. The video offers an additional hour of continuing education credit for nursing assistants. Thus far, 18,000 packages have been distributed. With support from The Commonwealth Fund and other foundations, "Bathing Without a Battle" materials were mailed to every U.S. nursing home as well as to state and federal surveyors, Alzheimer's Association chapters, and more than 1,000 home care agencies.

Research: Research has shown that the methods and principles of "Bathing Without a Battle" can help to improve the experience of bathing for people with dementia and their caregivers. "Person-centered" bathing methods were developed as part of clinical trials during the late 1990s, funded by the National Institute on Aging and the National Institute for Nursing Research. In early studies, pre- and post-intervention ratings of more than 500 videotaped baths found a 56 percent reduction in aggressive behavior against caregivers, a 62 percent reduction in care recipient agitation, a 67 percent reduction in care recipient distress, and a 38 percent decrease in the proportion of bath time spent crying or screaming.

A study by Philip Sloane and colleagues published in the November 2004 issue of the Journal of the American Geriatrics Society found that person-centered showering and towel baths were safe, effective methods of reducing agitation, aggression, and discomfort for people with dementia. The trial, which took place in nine nursing facilities in Oregon and six in North Carolina, compared a control group with groups using the person-centered showering technique and the towel bath, an in-bed bath with no-rinse soap. The researchers found that that aggressive incidents declined by 53 percent in the person-centered shower group and 60 percent in the towel group. Discomfort scores were also lower in both intervention groups.

For Further Information: To order the "Bathing Without a Battle" video and CD, visit www.bathingwithoutabattle.unc.edu or contact info@bathingwithoutabattle.unc.edu.

January 2006


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