SOMEONE WHO CARES for a patient with dementia may consider bathing to be the most worrisome task he faces. Not only does dementia affect a person's ability to think and function, but it can change her personality, mood, and behavior. These changes make interactions during bathing and other personal care activities potentially difficult, even dangerous. Patients can fall, and they may injure caregivers.
In this article, I'll explain how you can reduce a patient's agitation and discuss alternative bathing tips and techniques that you can use or teach your patient's caregiver to minimize future problems.
Focus on the patient
Alternatives for bathing patients with dementia are the patient-centered bath or shower and the towel bath. (See Soothing with a towel bath.) All are safe, effective ways to reduce agitation and provide a pleasant bathing experience for caregivers and patients.1
The patient-centered bath or shower uses strategies centered on the patient's needs and comfort, not on the task of bathing. Use various techniques to individualize the patient's bathing experience, such as providing choices, distracting her with food as a special treat or playing music, using bathing products suggested by family members, or modifying the type of shower head used to rinse her-a spray that's too strong may make her feel like she's drowning.
Setting the stage
Start by considering the environment from your patient's perspective.2 Someone with dementia has trouble processing information, and overloading her senses may trigger an aggressive outburst. These outbursts may in turn make her more anxious, fueling more aggressive behavior. Simple modifications that reduce tactile, visual, auditory, and olfactory stimuli may improve the bathing experience.
To reduce stimuli, turn down the lights and play soft music to provide a distraction from other noise in your facility. Other suggestions include warming the room before taking the patient into it, speaking calmly to her, and ensuring continuity of care so she can build a relationship with her caregiver.3
Steps to bathing success
Bathing should be a pleasant experience for both of you, not just a task to be performed. Encourage the patient to perform range-of-motion exercises such as washing her face if she's able. As an added benefit, performing a small task like this will make her feel like an active participant in the bathing process. Bathe her at a regular time, preferably when she would have bathed at home, or when it's convenient for her rather than when it's convenient for the facility.
Explain the bathing procedure simply and perform hand hygiene. Respect her dignity by ensuring privacy throughout the process.
When you undress the patient, keep her partially covered for modesty and warmth or even keep a light gown on her. Speak softly and calmly; startling her can cause aggressive behavior. Let her know what you're going to do before you spray her with water or even touch her with a washcloth.
Rub-a-dub-dub with care
When you bathe a patient with dementia, you may inadvertently provoke aggressive behavior by rushing her, speaking in an abrupt tone, or touching her without warning. Try to communicate your actions and intentions at her level of understanding, using a relaxed tone of voice and body language.
Be creative. If your patient can't handle a shower or bath, try bathing one part of her body each day until you've washed her all over. Although her safety is your top priority, take her bathing preferences into consideration as much as you can.
If your bathing seems to cause pain, perform a comprehensive pain assessment and manage her pain appropriately.
Teach your patient's caregiver techniques that he can try at home. For example, recommend that he be flexible about bath times and eliminate any negative actions that can provoke aggressive behaviors. For instance, if talking to her in a loud voice causes her to be aggressive, he'll need to be sure to speak softly.
Implementing patient-centered bathing is one way to maintain high standards of patient care while reducing stress and injuries to staff, patient agitation, and aggressive behaviors. This change in focus should also improve patient satisfaction.
SOOTHING WITH A TOWEL BATH
The towel bath, which focuses on the relationship rather than the task, can significantly reduce the patient's discomfort and aggressive behavior and help foster a therapeutic relationship between caregiver and patient.4 It's especially useful for a patient who's bedridden.
For a towel bath, keep the patient covered and warm throughout the procedure. Cover her with a bath blanket before undressing her. Then, taking care that she's never uncovered, gradually replace the blanket with a large towel that's been soaked with warm water and no-rinse soap. Massage the patient with the wet, soapy bath towel. Then replace the wet towel with the dry one, and dry her with it before dressing her.
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1. Sloane PD, et al. 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. Journal of the American Geriatrics Society. 52(11):1795-1804, November 2004. [Context Link]
2. Rasin J, Barrick AL. Bathing patients with dementia. American Journal of Nursing. 104(3):30-34, March 2004. [Context Link]
3. Somboontanont W, et al. Assaultive behavior in Alzheimer's disease: Identifying immediate antecedents during bathing. Journal of Gerontological Nursing. 30(9):22-29, September 2004. [Context Link]
4. Rader J, et al. The bathing of older adults with dementia. American Journal of Nursing. 106(4):40-48, April 2006. [Context Link]