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.

The Bathing Of Older Adults with Dementia

Older adults who need assistance with bathing often find the activity to be both physically and emotionally demanding, as do their caregivers. Research has identified several contributing factors, including pain; fatigue and weakness; confusion; anxiety resulting from being naked in front of strangers, being afraid of falling, and being in a noisy or unfamiliar place; and discomfort from cold or drafty bathing areas or harsh water sprays. The authors of this article make the case for the elimination of forced bathing. Research supports this change in philosophy and practice, whereby bathing is not a task to be performed but rather a human interaction. Inexpensive, practical, and evidence-based alternatives are discussed.

Effect of Person-Centered Showering and the Towel Bath on Bathing-Associated Aggression, Agitation, and Discomfort in Nursing Home Residents with Dementia: A Randomized, Controlled Trial

OBJECTIVES

To evaluate the efficacy of two nonpharmacological techniques in reducing agitation, aggression, and discomfort in nursing home residents with dementia. The techniques evaluated were person-centered showering and the towel bath (a person-centered, in-bed bag-bath with no-rinse soap).

DESIGN

A randomized, controlled trial, with a usual-care control group and two experimental groups, with crossover.

SETTING

Nine skilled nursing facilities in Oregon and six in North Carolina.

PARTICIPANTS

Seventy-three residents with agitation during bathing (69 completed the trial) and 37 nursing assistants who bathed them.

MEASUREMENTS

Agitation and aggression were measured using the Care Recipient Behavior Assessment; discomfort was measured using a modification of the Discomfort Scale for Dementia of the Alzheimer Type. Raters who were blinded to subject status coded both from videotaped baths. Secondary measures of effect included bath duration, bath completeness, skin condition, and skin microbial flora.

RESULTS

All measures of agitation and aggression declined significantly in both treatment groups but not in the control group, with aggressive incidents declining 53% in the person-centered shower group (P<.001) and 60% in the towel-bath group (P<.001). Discomfort scores also declined significantly in both intervention groups (P<.001) but not in the control group. The two interventions did not differ in agitation/aggression reduction, but discomfort was less with the towel bath (P=.003). Average bath duration increased significantly (by a mean of 3.3 minutes) with person-centered showering but not with the towel bath. Neither intervention resulted in fewer body parts being bathed; both improved skin condition; and neither increased colonization with potentially pathogenic bacteria, corynebacteria, or Candida albicans.

CONCLUSION

Person-centered showering and the towel bath constitute safe, effective methods of reducing agitation, aggression, and discomfort during bathing of persons with dementia.

Bathing persons with dementia

In the care of persons with Alzheimer's disease and related disorders, bathing frequently poses a formidable challenge for caregivers. This article reports the results of a consensus conference on techniques to reduce disruptive behaviors during bathing, and to make the process less stressful for persons with dementia.

Problematic Wandering Behavior in the Cognitively Impaired Elderly: A Single-Subject Case Study

Three psychosocial factors that may influence wandering behavior have been previously identified: lifelong patterns of coping with stress, previous work roles, and a need to search for persons or places associated with security. Strategies for managing wandering behavior include environmental modifications, planned activities, physical exercise, and attention to psychosocial history. However, limited attention has been given to testing psychosocial approaches that could be used by nursing home staff when interacting with residents who wander. The findings of this study suggest that providing sufficient staff time for interacting with residents, programs that address residents' needs for activity and rest, and appropriate environmental modifications should occur in conjunction with the decreased use of antipsychotic medications and physical restraints.

Geropsychiatric Nursing: ESSENTIAL Curriculum Content

1. An incremental model should be used to determine what geropsychiatric content belongs at each level of educational programs in nursing. 2. Identifying teaching methods that will enable students to learn knowledge retrieval, management, and use skills--as well as to develop critical thinking and ethical decision making abilities--will become more important than identifying essential content. 3. With the increased emphasis on cost-effective primary care and autonomous role functioning within interdisciplinary teams, we must move toward an advanced practice role that combines attributes of the clinical specialist and nurse practitioner.

Predictors of life outlook of older single women

The purpose of this study was to examine whether personal and social factors differentiate between widowed, divorced or separated, and never married older women, and predict the life outlook of older single women. A secondary analysis of data from a subsample of the older single women (n = 816) in the 1975 National Survey of the Aged was undertaken. Significant differences between groups were found: never married women were better educated, healthier, less lonely, and had a more positive life outlook than widows. The model predicted 29% of the variance in life outlook. Health and loneliness had the strongest effects on life outlook when predictors were compared.

Children's acquisition of sex-role behavior in lesbian-mother families

Children's play and activity interests as indices of sex-role behavior were compared for a sample of lesbian and heterosexual single mothers and their children. More striking than any differences were the similarities between the two groups of children on acquisition of sex-role behavior and between the two groups of mothers on encouragement of sex-role behavior.