A Fresh Look at Bathing Without a Battle

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Joanne Rader, RN, MN, FAAN
Rader Consulting
Pioneer Network co-founder

Looking for an easily accessible, free way to help staff understand the importance and benefits of person directed care and complying with the new regulations and guidelines? The Bathing Without a Battle training is now available on line, with continuing education credits.

Many of you may be familiar with the training. It was developed using videos and data collected as part of a 1997 research project done in North Carolina and Oregon that explored ways to make bathing a more pleasant experience for both residents and staff who live and work in nursing home and other places where people need assistance with bathing. It provides lots of practical, relevant information about how to easily and safely adapt the bathing process to meet the needs and desires of residents, particularly those with dementia.

The research showed that using these techniques greatly reduced common resistive behaviors such as hitting, biting, yelling related to showering. Those resistive behaviors were reinterpreted as defensive, self-protective behaviors on the part of the person with dementia, who was trying to tell the caregiver, “please find another way to keep me clean as I can’t tolerate the way you are trying to do it.”

In the study, videos were taken before the intervention to personalize the way a resistive person was bathed and after the intervention. The real-life videos ring true for staff who have experienced these difficulties. The profound changes seen in the after videos are convincing evidence of the need for personalizing the way hygiene care is delivered. It is one of the most powerful tools for promoting the need for culture change to direct care staff and administration and is based on solid research.

A word of advice — unless administration is on board with the changes and willing to support personalized bathing with training, changes in documentation, and permitting decisions to be made by caregivers at the bedside, there is no value in sharing it with direct care staff. In fact, as with other culture change initiatives, the situation only seems worse when direct care staff know there is a better way to do the work and are not given the authority or tools to do it.

Training can be accessed through the website http://bathingwithoutabattle.unc.edu. Once registered, users can open modules on practical approaches to showering, tub bathing, in-room bathing, and hair washing; information on innovative bathing equipment and supplies; recommendations for policy change within long-term care organizations; and guidance on regulatory compliance.