forcing baths on dementia patients?

[PDXnursing]

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...

[rebelgirl#1]

Yikes.

I gave baths for a long time in the late 70's and early 80's to people who did not want baths. Most of time there is a way to talk them into baths, bird bath, shower. Something but not throwing water on them. I would be gunning to get you if I got that kind of bath.

[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.

[JDZ344]

If my patients refuse a bath, I try to convince them to at least let me help them wash their hands and face. Then, later, if they are incontient, I will wash the rest of the body whilst they are in the bed. Or I will just go away and try again later. Sometimes running a bath and then saying to them "Hey Mary, the bath is all run, shall I help you take your clothes off and get in?" in enough.

That poor man There are ways to make it less stressful for him. Unfortunatly, they are not the 'fast' ways, so people may not use them.

[Sally Lou]

Wow.

Um, ok.

When we did clinicials one of the cna's did something similar to this to a patient in front of the student to prove the point that you have to respect the persons rights. The student knew it was wrong and the cna saw the look on her face, she admitted that she only did it for the reason above. Too many people think being a CNA is an easy job and they want to weed out those people.

[PDXnursing]

Thanks, I'm glad to be hearing your responses. The whole experience was very uncomfortable for me and made me feel upset-imagine how he felt! I think I'm going to speak to the LPN, I don't think that all of the caregivers have had the proper training. I don't want to overstep my bounds, but it seems that someone should suggest some no-rinse soap or something to use other than the shower stall. On my second day I had to show my trainer how to make an occupied bed! Then I heard another one say "well, there's not a whole lot you can do about bed sores." Or maybe there is just a huge difference between ALF standards and SNF (where I did my clinicals).

[ctmed]

Generally, In psych the patient can not refuse a bath. That said.. there is a certain way to talk to them. If the patient still does not want to, go inform a nurse and ALWAYS get help. Another voice or approach can make this job slightly easier and protects you if the patient gets violent.

[puravidaLV]

This is an old topic but someone reads this and thinks on a psych unit you can force a patient to take a shower you need to look at not only operating procedures, legal status of patient (hold or voluntary), have a PHYSICIANS ORDER because otherwise you just might have assaulted the pt.