Bathing: Turning Refusal into Appreciation
By Pamela D Wilson CSA, CG, MS, BS/BA
How many of you experience refusals by family members or residents who simply refuse to bathe? The excuses are common: “I’m not dirty, I don’t need a bath, I bathed yesterday (when they haven’t bathes in a month), and I don’t work anymore so I don’t sweat and don’t need to bathe.”
How many of you when attempting to bathe a loved one or resident experience yelling, hitting, kicking, pinching or even biting? Does your loved one become agitated upon hearing the word shower or bath? How many of you now dread the experience of bathing as much as the person you are attempting to bathe?
Research by Gozalo (2014) confirms that bathing is an important but often difficult task.
Bathing is the personal care task most commonly associated with such behavior, with 20 to 40% of persons with dementia manifesting aggressive or agitated behaviors such as hitting, kicking and screaming while bathing. Moreover many remain upset for hours after the bath.
What solutions exist? What if you were able to reduce behaviors by at least 50% by attempting to use a different bathing technique? What if you were able to reduce bathing time? What if a previous traumatic bathing experience could be transformed into a pleasant bathing experience? Are you interested in learning techniques to make this happen?
Over a decade ago, research completed at the University of North Carolina at Chapel Hill resulted in a program called “Bathing Without a Battle”. The program was developed to help professional caregivers and home caregivers learn techniques that result in a more positive bathing experience.
An important technique pre-bath or shower is changing the approach to the activity. This means refraining from using the words bath or shower but instead using the term wash-up or something similar. Maintaining dignity and comfort is also important. Some individuals will be more willing to participate if they are kept warm by being covered with a blanket, sheet or towel. Verbal distractions are also important during the task of bathing. Singing or talking about family, hobbies or activities will distract so that the task of bathing may be completed more easily.
Other techniques include different types of bathing experiences and the use of no rinse soap, for example, Septa Soft manufactured by Calgon-Vestal. The website Bathing without a Battle shares information about various bathing techniques that include: towel bath, recliner bath, toilet or commode bath, singing bath, 7-day bath, under the clothes bath and a shared shower
Does this work? Yes. Research by Gozalo (2014) conducted with residents at six nursing homes in the state of New York proves positive results.
Along with differences in the bathing processes, significant reductions were found in aggressive, agitated, verbal and physical behaviors including decreased use of anti-psychotic medications after staff were trained how to administer person centered care with residents diagnosed with dementia.
The most important aspect to support success is incorporating these techniques into standard operating procedures for care community staff. This requires the support of community leadership in supporting ongoing training for all staff. The benefit to staff is increased confidence in working with individuals who refuse to bathe, including decreased fear of being injured. The benefit to residents is improved hygiene and personal well-being, including a decrease in urinary tract infections resulting from poor hygiene.
Can family members and home caregivers use these techniques? Yes
The techniques identified through the Bathing Without a Battle program will make bathing less stressful and more positive. Additionally these techniques may be translated and used to make other daily interactions with those diagnosed with dementia or Alzheimer’s easier and less stressful.
1 Gozalo, P., Shivaani, P., Qato, D., Sloane, P., Mor, V. (2014) Effect of the bathing without a battle training intervention on bathing-associated physical and verbal outcomes in nursing home residents with dementia: A randomized crossover diffusion study. JAGS 62: 797-804, 014 doi: 10:1111/jgs.12777.
2 Bathing Without a Battle. http://www.bathingwithoutabattle/unc.edu
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