So I just started a job at an assisted living facility on the locked down dementia floor. Last night my trainer showed me how to bathe one of the male residents. It was at bed time (9pm or so) and he insisted that he just wanted to go to bed. The caregiver sat him in the shower chair in the shower stall completely uncovered. He of course began screaming, cursing and swinging. The caregiver used a soapy washcloth to lather up body parts, including his hair. She then used a basin filled with water and kind of flung the water onto him to rinse him without getting hit. The entire time he screamed and cursed, growing more and more agitated. This is how all of the staff showers him. She just laughed and smiled at me.
I'm a new Nursing Assistant so I know that my opinions may be idealistic and there is a "real world" of nursing in which the skill steps learned during the CNA course are just not realistic. I know that you are there to give care to those who can't do it for themselves, even though they may not want us to. It just seems to me that forcing this shower while he was already agitated, leaving him completely naked on a shower chair and flinging buckets of water onto him was not the best approach, nor was it at all dignified. I would think that trying at another time, offering the option of a bed bath, keeping him covered or just trying to wash different body areas throughout your shift would all be better alternatives.
I would love the opinion or advice of those who have worked with the patients with dementia and let me know if I'm totally off base. I'm new so I don't want to challenge the practices that are in place but I question their methods. Also many of the caregivers are not CNAs but have been in the field for years with whatever "training" the AL facility provides...
Last edit by PDXnursing on Sep 6, '10
Sep 6, '10 by CoffeemateCNA
If I saw a CNA doing that, I would fill up the basin and dump it on him/her instead (and probably squirt some soap in their eyes). Is it THAT hard to pick up a shower nozzle and gently rinse someone off??
There is an art to getting residents with dementia to take showers. You have to make it sound like it will be fun and relaxing. You also have to use your acting skills and pretend that you are not in a hurry (when really you are). Sometimes, when they say "no," you can dig a little bit deeper and find the reason why. One of my residents never ever EVER wanted to take showers and everyone always just complied (it was an excuse for them to do less work). I talked with him and got to the root of the problem -- he thought every day was his birthday and that he would miss his birthday party. I told him that it's HIS birthday party, so how could it be a party if HE wasn't there and I assured him the party wouldn't start until he was finished with his shower (and actually that gave him more incentive to shower because he wanted to look nice for his party, not that he even had a party everyday like he thought he did). Never had a problem with his showers again.
I always keep residents covered in the shower. If there are any blankets in the warmer, I will unfold it and put it over the resident at the beginning of the shower and only lift up which parts I need when I need them (and if there are no blankets in the warmer, I just use a regular blanket or a towel). Then at the end I take off the wet (but warm) blanket and put a dry blanket over them while I dry everything off. There is no reason for a resident to be completely exposed during the process.
Last edit by CoffeemateCNA on Sep 6, '10