The Bathing Of Older Adults with Dementia

Availability of family care resources, bathing assistance and toileting assistance among older adults with functional limitations: an evidence-based study from China

BACKGROUND

An aging population has contributed to an increasing prevalence of functional limitations among older adults. Family support plays a crucial role in toileting and bathing assistance. Yet, the relationship between availability of family care resources and such actual assistance remains insufficiently explored. Our study aims to describe availability of family care resources and identify the association between availability of family care resources and toileting assistance or bathing assistance.

METHODS

This study employed a cross-sectional analysis of data from the 2018 National Survey of the China Health and Retirement Longitudinal Study (CHARLS). The availability of family care resources was assessed using measurements of spouse availability, adult child availability, and living arrangement. Bathing assistance and toileting assistance were measured based on self-reported receipt of such assistance. Descriptive statistics were used to depict the overall and subgroup situation of availability of family care resources. Multivariable logistic models were employed to investigate the relationship between availability of family care resources and the receipt of toileting assistance or bathing assistance.

RESULTS

Among the sample of older adults with functional limitations, 69% had a spouse, 63% had at least one adult child, and 80% resided with family members. Among those with bathing disability, 13% reported lacking bathing assistance, and among those with toileting disability, 54% reported lacking toileting assistance. Participants with 1-2 adult children had lower odds of receiving toileting assistance (OR: 0.28, 95% CI: 0.09, 0.91, p= 0.034) compared to those with three or more adult children. Spouse availability and living arrangement did not exhibit statistically significant associations with toileting assistance. Participants without a spouse had lower odds of receiving bathing assistance (OR: 0.27, 95% CI: 0.09-0.78, p= 0.016) in comparison to those with a spouse; however, adult child availability and living arrangement did not display statistically significant associations with bathing assistance.

CONCLUSION

The present findings suggest a gap in family commitment when it comes to assisting older adults with functional limitations in bathing/toileting. To address this, policymakers are encouraged to prioritize the implementation of proactive mechanisms for identifying family caregivers, alongside incentives to enhance their engagement in practical caregiving activities. Furthermore, it is crucial to emphasize the prioritization of affordable and easily accessible formal toileting/bathing assistance options for older adults who lack sufficient family care resources.

Comfort during the bed bath-A randomised crossover trial on the effect of washing without water versus water and soap in nursing students

AIMS AND OBJECTIVES

To compare the washing without water method with the water and soap method regarding comfort perceptions of the bed bath.

BACKGROUND

Bathing affects nurses' and care recipients' comfort. Bedridden care recipients can be bathed in bed with water and soap or with washing without water products. Little is known about the differences between these two bed bath methods regarding comfort perceptions among care recipients and nurses.

DESIGN

Crossover randomised laboratory-controlled trial, conducted from March 2018-November 2019, according to the CONSORT guidelines.

METHODS

Nursing students were randomly allocated roles as a patient (who received both types of bed baths) or a nurse (who provided both types of bed baths). Also, the order in which the bed baths were received/provided was randomised. A total of 97 students were included in the analysis. Student patients filled out the Patient Evaluation of Emotional Comfort Experienced (PEECE) scale to measure emotional comfort and a single-item question on physical comfort after each bed bath. Student nurses filled out the Physical Demands scale after each bed bath to measure their physical comfort perceptions.

RESULTS

No differences were found between the two bed bathing methods regarding student patients' emotional or physical comfort levels. Among student nurses, the washing without water method was less physically demanding than the water and soap method.

CONCLUSIONS

Taking into account time-efficiency and physical comfort for nurses, washing without water seems to be a valuable alternative to water and soap from a care recipient comfort perspective, which should be assessed in a clinical setting in future research.

RELEVANCE TO CLINICAL PRACTICE

The washing without water method is less physically demanding for nurses and takes less time. It does not have a detrimental effect on care recipients' emotional and physical comfort. The trial is registered at www.trialregister.nl (ID = NL6787).

Bathing and toileting difficulties of older adults in rural China: the role of environment

BACKGROUND

For older adults, difficulties in bathing and toileting are often the most prevalent in the index of Activities of daily living (ADL). This study aims to examine how environmental factors are associated with difficulty of bathing and toileting among older adults in rural China.

METHOD

The data are from the 2014 Thousand-Village Survey (TVS), a national survey of Chinese rural residents of old age. The sample consists of 10,689 subjects, 55 years or older, from 536 villages across all provinces of China. Logistic regressions were applied to examine how difficulty of bathing and toileting was related to environmental factors such as geographic location, neighbourhood amenity, and related facilities of bathing and toileting.

RESULTS

Older adults living in the Southern regions of China had lesser difficulty in bathing and toileting than those living in Northern China, controlling for other confounders. Better neighbourhood conditions also reduced the likelihood of having such disabilities. Persons who bathed indoors without showering facilities, in public facilities, and outdoors were significantly more likely to have bathing disability than those who showered indoors with facility. Rural older adults who used pedestal pans and indoor buckets for toileting were more likely to have toileting disability than those who used indoor squatting facilities.

CONCLUSION

Environmental barriers were associated with functional disability among older adults in rural China, but the disabled individuals may change their environments to adapt to their functional capabilities. Our findings suggest that it is imperative to promote the use of showering facilities and pedestal pans for toileting in rural China.

Stress in the Volunteer Caregiver: Human-Centric Technology Can Support Both Caregivers and People with Dementia

Background and Objectives: Currently, one in eight people over the age of 65 have dementia, and approximately 75% of caregiving is provided by volunteer family members with little or no training. This study aimed to quantify points of stress for home-based caregivers with the aim of reducing stress for them while concurrently supporting quality of life for the people with dementia whom they cared for. The overreaching purpose was to increase our knowledge of the caregiver stress burden and explore potential technologies and behaviors to ease it. Materials and Methods: We interviewed home-based and professional caregivers regarding causes of emotional and physical stress and methods they used to alleviate it. Results: This study found that: (1) dementia symptoms created a burden of stress for home-based caregivers primarily in the areas of medication management, memory loss, hygiene care and disruptive behaviors; (2) home-based caregivers identified "finding available resources" as the most important source of stress relief; (3) a minority of home-based caregivers possessed a resource network and knew how to find resources but all professional caregivers were able to find resources and support; (4) home-based caregivers combated dementia symptoms with positive distractions and human touch with little use of technology, since it was mostly unknown; and 5) facility-based caregivers were knowledgeable and readily used dementia-based technology. Conclusion: Since professional caregivers have access to technological resources that our home-based caregivers lack, one might logically conclude that we should transfer technology used by professionals to those with dementia. However, great caution needs to be in place before we take that step. Successful technology should address the human experience as home-based caregivers try to use new technologies. Human-centric technology addresses the needs of both people with dementia and the home-based caregiver.

Finding the fundamental needs behind resistance to care: Using the Fundamentals of Care Practice Process

A person living with Alzheimer's disease (PA) can experience difficulty during bodily care and therefore may show resistance to care behaviours (RTCBs). Nurses must take a clinical approach to planning care that meets the person's needs. Therefore, it is necessary to identify training strategies for bedside nurses and nursing students.

AIMS AND OBJECTIVES

To describe and discuss how the FOC practice process (FOC-PP) can help nurses understand PAs who show RTCBs during bodily care.

BACKGROUND

Resistance to care behaviour phenomenon and the importance of bodily care as fundamental care are described. The FOC-PP enables nurses to apply the FOC framework in their practice.

DESIGN

This discursive paper is based on the literature of the FOC framework and PP.

METHOD

A clinical scenario that develops through the five stages of the FOC-PP.

RESULTS

The scenario centres on Mrs. Emily Morgan, 81, who lives in a nursing home and is not receiving the bodily care that she needs. Camille, a nursing student, and her supervisor Florence collaborate with Mrs. Morgan's family to improve the quality of her care. Three particular aspects of nursing practice based on the FOC-PP are described: the critical thinking process, relational process and pedagogical process.

CONCLUSION

The FOC-PP promotes holistic care centred on the person and his or her needs and encourages the nurse to use his or her skills and knowledge. All these dimensions are fundamental for high-quality nursing care.

RELEVANCE TO CLINICAL PRACTICE

Mrs. Morgan's scenario enables us to perceive that the FOC-PP is very useful for nursing students and bedside nurses. However, given the amount of specific and diverse knowledge required by the FOC-PP, it is necessary to identify avenues for teaching them. Using clinical scenarios could facilitate the integration of the FOC-PP, with taking into account the specific characteristics of individual clients.

Integrating Citizenship, Embodiment, and Relationality: Towards a Reconceptualization of Dance and Dementia in Long-Term Care

Dance, as aesthetic self-expression, is a unique arts-based program that combines the physical benefits of exercise with psychosocial therapeutic benefits. While dance has also been shown to support empowerment, meaningful self-expression, and pleasurable experience, it is rarely adopted to support these aspects of engagement in the context of dementia care. The instrumental reduction of dance to its application as a therapeutic tool can be traced to the contemporary movement towards cognitive science with an emphasis on embodied cognition. This has effectively elided a consideration of how the body itself, separate and apart from cognition, could be a source of intelligibility, inventiveness, and creativity. We argue for the need to broaden the therapeutic model of dance to more fully support embodied and creative self-expression by persons living with dementia. To achieve this, we explore how a relational model of citizenship that recognizes corporeality and relationality as fundamental to human existence brings a new and critical dimension to understanding the importance of dance in the context of dementia. Drawing on this model, we articulate a new kind of ethic characterized by a pre-reflective intercorporeal sensibility that requires the mobilization of public structures and practices to cultivate a relational environment for individuals living with dementia that supports human flourishing.

Rethinking musicality in dementia as embodied and relational

With the biomedicalisation and the pharmaceuticalisation of dementia, music programs, as with other arts- and leisure-based programs, have primarily been implemented as non-pharmacological means to generate social and behavioural changes. We argue that understanding and fully supporting the musicality of persons living with dementia requires engagement with citizenship discourse. Specifically we draw on a model of relational citizenship that recognizes that corporeality is a fundamental source of self-expression, interdependence, and reciprocal engagement. We articulate this argument with reference to the musicality of two residents living with dementia in long-term residential care; one example is drawn from an ethnographic study of selfhood in dementia and the other is from a study of elder-clowning. Relational citizenship brings a new and critical dimension to the discourse on music, ageing, and the body in contemporary society. It further highlights the ethical imperative to fully support musicality through institutional policies, structures and practices.

Effect of facilities management components on the quality of life of Chinese elderly in care and attention homes

Purpose

Quality of life (QoL) for elderly residents of care and attention (C&A) homes has become an important consideration, given the increasingly aging population. Due to the number of hours such residents spend indoors, the quality of the facilities can contribute to their day-to-day QoL. This study aims to investigate the effect of facilities management (FM) on the QoL of Chinese elderly people living in C&A homes.

Design/methodology/approach

A survey of perceived satisfaction with the components of FM and QoL was carried out with a sample of residents. A total of 18 FM components and five QoL domains, including physical health, independence, psychological health, social relationships and living environment, as well as overall QoL, were identified.

Findings

The findings show that physical health is influenced by accessibility, doors and windows and signage; independence can be improved by enhancing accessibility, water supply, lighting and ventilation; accessibility, water supply, distance and doors and windows all predict psychological health; social relationships are improved by lighting and ventilation; distance impacts positively on the living environment; and overall QoL is predicted by lighting, ventilation, accessibility, doors and windows, handrails, recreation and signage.

Originality/value

The study recommends that designers and facilities managers review the micro-climate settings to harness available natural lighting and ventilation, introduce bimetallic strips to the heating systems to maintain a suitable water temperature and install large, easy-to-understand and graphic signage for straightforward wayfinding in C&A homes.

'Speaking about the unspeakable': Clinical psychologists views on the role of the profession regarding 'forced care' of older adults without capacity

'Forced care' describes the provision of personal care to an individual who does not have the capacity to make a decision about that care and resists receiving that care. This study explored the views of clinical psychologists on supporting staff involved with forced care and considered the following question: Do clinical psychologists feel that they have a role in guiding decisions around forced care, and if so, what? Interview data were gathered from five clinical psychologists experienced in the field of Older Adult psychology in the UK. This study concludes that the environment in which psychologists work influences the psychologist's beliefs about whether psychologists should be involved with making recommendations about forced care, and how they should be involved.

Care Perceptions among Residents of LTC Facilities Purporting to Offer Person-Centred Care

Cette étude a exploré d’une manière qualitative comment les résidents des maisons de soins de longue durée (SLD) pensent et s’adaptent aux soins qu’ils reçoivent. Nous avons interrogé et observé un groupe délibérément choisi parmi des personnes âgées dans sept etablissements qui prétendent fournir des soins centrés sur la personne. Les descriptions interprétatives de la part de 43 entrevues personnelles avec 23 participants correspondaient a une réponse à la question: Comment les habitants perçoivent-ils les soins rendus dans les établissements de SLD qui se présentent comme offrant des soins centrés sur la personne? Trois thèmes dominants sont ressortis: (1) l’environnement bienveillant; (2) la préservation de la dignité; et (3) le maintien de l’autonomie personnelle. Les participants étaient sensibles à la charge de travail du personnel infirmier, mais se sentaient éloignés du personnel. Les participants ont donné des exemples de mauvais soins et une manque d’empathie, des indignités humains et des violations de l’autonomie personnelle causées par les politiques institutionnelles qu’ils se sentaient inhibiter leur capacité à recevoir des soins selon leurs propres préférences. En général, ils ont contesté les allégations de soins centrés sur la personne, mais ils s’y sont adaptés pour faire face à un environnement qui menace leur dignité et leur autonomie.

Impact of caregivers' behaviors on resistiveness to care and collaboration in persons with dementia in the context of hygienic care: an interactional perspective

BACKGROUND

The role played by various physical and verbal behaviors of professional caregivers in the onset of resistiveness to care (RTC) and collaborative behaviors of nursing home residents with dementia was assessed in a daily hygienic care routine context.

METHODS

Two hundred and forty hygienic care routines, observed in eight nursing home residents, were analyzed with a video-assisted systematic observation methodology and a sequential statistical analysis strategy.

RESULTS

Caregiver and care recipient behaviors are interdependent in the hygienic care routine context. Physical instrumental behavior, neutral, negative and positive statements, positive and negative instructions, and verbal distraction emitted by caregivers are significantly and moderately associated with the onset of RTC in persons with dementia (PWD), but the strength of relationships observed depends on the care recipient's behavior prior to the caregiver's action. Positive instructions are moderately associated with the onset of collaboration in residents with preserved language abilities. However, for residents with severe language impairment, these same instructions were linked to RTC behaviors.

CONCLUSIONS

Although antecedents to RTC can be identified, the risk that caregiver behaviors trigger resistive responses is higher when care recipients are already exhibiting RTC, and is low when no particular behavior or collaboration is shown. Antecedents to collaboration are also identified and discussed. Although different caregiver behaviors may be more or less likely to elicit resistiveness or collaboration, it is the pre-existing state of the care recipient that will determine its reaction to the caregiver's behavior. Clinical implications emerging from these influential findings are elaborated.

Bathing in residential care: understanding the experiences of residents and their care providers

Purpose

– The purpose of this paper is to understand how changes in an older adult’s physical capacity alter their bathing preferences, how the care environment incorporates residents’ values and beliefs around bathing to fulfil these changing care needs, and how institutional factors, such as staff scheduling and communication processes, influence Resident Care Aides’ (RCAs) bathing practices.

Design/methodology/approach

– A multiple methods approach involving surveys and interviews with residents and RCAs in a Canadian residential care facility. This paper draws mostly from the semi-structured, qualitative interviews with older adult residents (n=9; Mini Mental Status Exam (MMSE) scores > 15) and RCAs (n=10) on two nursing units offering different bathing options.

Findings

– Decreasing energy levels and physical decline were commonly cited reasons for residents’ changing bathing preferences. Residents were overall very appreciative of the bathing care they received in residential care, and identified the weekly tub bath as an anticipated encounter where they experienced a valued social interaction with their assigned RCA. While identifying bathing as an occasionally stressful aspect of their work, RCAs also described the bathing experience as an intimate bonding activity. The study identified bathing as an important activity in residential care.

Originality/value

– Previous studies have focused on moderate to severely cognitively impaired older adults’ and their demonstration of agitated behaviours during bathing. Most participants in this study had only minor cognitive impairment, as measured by MMSE scores (average score=20.6); therefore, this study provides insight into the experiences and needs of older adults whose perspective is not generally reflected in the literature.

Disaggregating activities of daily living limitations for predicting nursing home admission

OBJECTIVE

To examine whether disaggregated activities of daily living (ADL) limitations better predict the risk of nursing home admission compared to conventionally used ADL disability counts.

DATA SOURCES

We used panel data from the Health and Retirement Study (HRS) for years 1998-2010. The HRS is a nationally representative survey of adults older than 50 years (n = 18,801).

STUDY DESIGN

We fitted Cox regressions in a continuous time survival model with age at first nursing home admission as the outcome. Time-varying ADL disability types were the key explanatory variables.

PRINCIPAL FINDINGS

Of the six ADL limitations, bathing difficulty emerged as the strongest predictor of subsequent nursing home placement across cohorts. Eating and dressing limitations were also influential in driving admissions among more recent cohorts. Using simple ADL counts for analysis yielded similar adjusted R(2) s; however, the amount of explained variance doubled when we allowed the ADL disability measures to time-vary rather than remain static.

CONCLUSIONS

Looking beyond simple ADL counts can provide health professionals insights into which specific disability types trigger long-term nursing home use. Functional disabilities measured closer in time carry more prognostic power than static measures.

A best-evidence review of intervention studies for minimizing resistance-to-care behaviours for older adults with dementia in nursing homes

AIM

To conduct a best-evidence review of non-pharmacological interventions for resistance-to-care behaviours of nursing home residents with dementia in a personal-care context.

BACKGROUND

Resistance to care is a major source of staff burnout in nursing homes and it is also a safety issue for the staff.

DESIGN

Best-evidence review.

DATA SOURCES

We searched for non-pharmacological intervention studies published from 1990-2012, written in English.

REVIEW METHODS

The search identified 19 intervention studies that examined the effects of interventions to reduce the resistance-to-care behaviours of nursing home residents with dementia in a personal-care context. These 19 papers met the quality assessment requirements of the critical appraisal criteria for experimental studies, which were published by the Joanna Briggs Institute.

RESULTS

Only three studies were RCTs and the rest were quasi-experimental. The sample size ranged from 7-127. Nine music interventions, such as pre-recorded music played to a group or playing a resident's preferred music, during his or her personal care, resulted in significant reductions in resistance-to-care behaviours. Resistance-to-care behaviours also were significantly reduced in three of four bathing interventions that focused on person-centred care. In the ability-focused interventions, only two out of five studies reported significant reductions in resistance-to-care behaviours.

CONCLUSION

Non-pharmacological interventions are options to consider to reduce resistance-to-care behaviours in older people with dementia, even though the evidence level is low, given the lack of alternatives. More randomized controlled trials are recommended to confirm the effects of non-pharmacological interventions during personal care.

Translating research into practice in nursing homes: can we close the gap?

PURPOSE

A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model.

DESIGN AND METHODS

The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices.

RESULTS

A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature.

IMPLICATIONS

NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.

Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

BACKGROUND

The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care.

METHODS/DESIGN

The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory--Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly.

DISCUSSION

A novelty of dementia-care mapping is that it offers an integral person-centred approach to dementia care in nursing homes. The major strengths of the study design are the large sample size, the cluster-randomisation, and the one-year follow-up. The generalisability of the implementation strategies may be questionable because the motivation for person-centred care in both the intervention and control nursing homes is above average. The results of this study may be useful in improving the quality of care and are relevant for policymakers.

TRIAL REGISTRATION

The trial is registered in the Netherlands National Trial Register: NTR2314.

Measuring the person-centeredness of caregivers working with nursing home residents with dementia

There is increasing interest in promoting person-centered caregiving within gerontology. However, few observational instruments have been developed to measure person-centered caregiving behaviors. In the present study, two innovative coding instruments-the Person-Centered Behavior Inventory (PCBI) and the Global Behavior Scale (GBS)-were used to test the hypothesis that caregivers' person-centeredness would be negatively correlated with residents' resistiveness to care. The study hypothesis was based on the need-driven dementia-compromised theory of behavior. It was expected that person-centered caregiving would better meet residents' needs and be associated with less resistiveness to care. This hypothesis was tested by coding 70 videotaped interactions between 54 caregivers and 20 residents diagnosed with dementia. Resistiveness to care was measured by behaviorally coding residents' resistive behaviors based on the Resistiveness to Care scale. The study hypothesis was supported when the GBS was used to measure person-centeredness, but not when the PCBI was used. The findings provide preliminary support for the predictive and construct validity of the GBS and the PCBI.

Evaluation of the person-centered care essentials program: importance of trainers in achieving targeted outcomes

A person-centered care (PCC) training program was developed and disseminated to 84 institutes for retired religious persons across the United States. The program was delivered via a train-the-trainer model wherein institute trainers attended a 2-day training conference, then taught the material to direct care workers (DCWs) at their respective sites. Evaluation of the training showed that DCWs' attitudes toward and knowledge of PCC improved after training. The relationship between trainers' perception of the ability of their site to implement PCC training and DCW knowledge improvement varied by training module. Training regarding the physical environment resulted in the smallest gains in DCW knowledge.

Can nurses impact patient outcomes using a patient-centered care model?

OBJECTIVE

The aim of this study was to determine if nurses, using patient-centered care (PCC), affect patient satisfaction, perceptions of nursing care, and quality outcomes.

BACKGROUND

The Institute of Medicine proposed PCC as 1 of 6 national quality aims, whereas the Centers for Medicare and Medicaid Services highlighted integration of PCC as 1 of 12 actions for quality improvement.

METHODS

A total of 116 patients were randomized into an intervention (PCC) or control group. Patients who were to receive PCC were called before admission and cared for by nurses who trained to administer/practice PCC. Control patients received usual care. Both groups completed questionnaires and received postdischarge calls. Length of stay, falls, infections, and adverse events were measured to assess quality of care.

RESULTS

No significant differences were found between groups for length of stay, infection, falls, postoperative complications, quality of care, satisfaction level, or perceptions of nursing care.

CONCLUSIONS

Patient-centered care did not affect patient's level of satisfaction or quality of care. However, findings yielded clinically relevant results regarding patient/staff responses.

Assisting Cognitively Impaired Nursing Home Residents With Bathing: Effects of Two Bathing Interventions on Caregiving

PURPOSE

When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors (gentleness and verbal support) and experienced greater preparedness (confidence and ease) and less distress (hassles) when assisting residents with bathing.

DESIGN AND METHODS

We used a crossover design and randomized 15 nursing homes into two treatment groups and a control group of 5 facilities each. In one treatment group, CNAs received person-centered training, first with showering for 6 weeks (Time 1) and then with the towel bath for 6 weeks (Time 2). We reversed the treatment order in the other treatment group. Control group CNAs used usual showering procedures without person-centered training. We collected observational and self-report data at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes. We analyzed data from 37 CNAs assisting 69 residents by using 3x2 repeated measures analyses of variance to compare the three groups on change from baseline.

RESULTS

Compared with the control group, treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease.

IMPLICATIONS

A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents.