Notes from “Bathing Without a Battle”
Based on the research and training programme developed by the University of North Carolina at Chapel Hill.
Caregivers in nursing facilities rate assisting persons with dementia during bathing or showering one of the hardest, if not the hardest, caregiving task that they perform.
Miller, 1997; Namazi & Johnson, 1996
Why Bathing Becomes a Battle
The Sensory Environment
Bathing typically happens in a room that provides a visual, auditory, olfactory, thermal, and textural context. The spatial qualities of that room can either cause problems, support independence, or help caregivers provide assistance. For someone with dementia, an unfamiliar or overstimulating bathroom can trigger fear and resistance before the water even runs.
The Caregiver Relationship
An important insight from the research was that the relationship between the caregiver and care recipient was essential. Nursing assistants who were able to shift from a task-focused to a person-focused approach were far more successful in trying new approaches.
Another insight was that nursing assistants valued the support they experienced from a consultant for trying new ideas. Having someone validate and guide their efforts made a measurable difference.
The Power of the In-Bed Bath
Another important discovery was the in-bed bath. In this approach, the person is fully covered with a towel moistened with no-rinse soap and washed and massaged through the towel. This method often proved comforting and soothing for individuals who found even a person-directed shower or tub bath distressing.
It was also effective in reducing aggressive behaviours and distress. Nursing assistants who participated found bathing persons with dementia to be a more positive experience as a result.
Communication: The Difference Between Cooperation and Conflict
Engaged communication included: conversation with the person about general topics, attention to the person’s need for comfort and personal preferences during bathing, reassuring and explaining what would happen next, comforting phrases, diversion requests for the person’s participation, and humour and compliments.
Non-engaged communication included: talking to another caregiver rather than the person, firm directives and coaxing, degrading comments and jokes at the person’s expense, and saying nothing when the person indicated a desire for communication or showed anxiety.
💡 Key takeaway: A person-directed approach — paced to meet the needs of the person being bathed — rather than a task-oriented approach that is often rushed to meet the needs of the caregiver, is key to preventing the battle.
When Policies Create Problems
Some facilities allow only one towel and one washcloth per bath. This makes it difficult to keep the person covered and warm.
Other facilities require showers and do not allow bed baths at all. In home settings, there may be rigid beliefs about how to help someone stay clean, or beliefs about when baths can and cannot be done.
⚠️ Warning: Rigid policies and beliefs about bathing can set the stage for a battle before the caregiver even enters the room.
Perhaps ideas about past and present bath practices will help transform bathing into pleasurable and comforting spa-like rituals for elders — rather than into a cleansing task that just needs to get done.
Bathing Without a Battle: Resources
- Bathing Without a Battle — the book on Amazon.co.uk
- Bathing Without a Battle — training programme at UNC Chapel Hill