Bathing People with Dementia: When Education Is Not Enough

Abstract

This qualitative study describes health care assistants' (HCA) perceptions and experiences related to bathing people with dementia in residential care settings. Data were collected from three focus groups with 18 HCA participants from 12 different residential care facilities. HCAs constructed two definitions of a successful bath, which informed their choice of bathing strategies. Three themes emerged from the data analysis in regard to their bathing strategies: I Know You, I Am All Alone, and I Am Not Prepared. These data informed the development of a framework to guide gerontological nurses in creating and supporting the opportunity for successful bathing.

Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis

“…Of the 16 high‐quality studies, study designs were reported as grounded theory (3), ethnography (2), phenomenology (1), soft systems approach (1) and interpretative description (1), or reported as content analysis (3), thematic analysis (2), or framework analysis (1) or did not name the methodological orientation (2). Papers reported qualitative data for observational studies ( n = 12) (Boltz et al, ; Bourret, Bernick, Cott, & Kontos, ; Coyer, O'Sullivan, & Cadman, ; Gaspard & Cox, ; Kitson, et al, 2013b; Kneafsey, Clifford, & Greenfield, ; Lafreniére, Folch, & Bèdard, ; Lomborg et al, ; Sjögren Forss, Nilsson, & Borglin, ; Taylor, Sims, & Haines, , ; Wardh, Hallberg, Berggren, Andersson, & Sorensen, ) and experimental studies ( n = 4) where new practices were introduced (French et al, ; Jensen et al, ; Robison et al, ; Thomas et al, ). Of these, two papers included patient data about a new nursing care method.…”

“…Within the five high‐quality studies about hygiene, findings indicated that nursing behaviours should include explanation of the content and purpose of hygiene care activities and should be tailored where possible to individual patients (Coyer et al, ; Gaspard & Cox, ; Kitson et al, 2013b; Wardh et al, ), such as considering patient wishes to use their own toiletries (Coyer et al, ). Patients recognised the impact of feeling clean on well‐being and integrity but reported the difficult balance between preservation and threats to integrity when receiving body care.…”

“…Strong leaders were able to “counteract established perceptions” (French et al, ) and make judgements on nursing care plan changes that others would follow (Thomas et al, ) and were seen as influencing change by encouraging others and pushing practice forward (Taylor et al, ). People that had influence on nurses were senior nurses, physiotherapists (Kneafsey et al, ; Taylor et al, ), research nurses (French et al, ) and experienced nurse colleagues or peer leaders (Gaspard & Cox, ; Taylor et al, ; Thomas et al, ). We derived four concepts from author themes about nurse leaders ' actions that were associated with nurses consistently performing essential nursing care, these were “generating buy‐in,” “nurse learning and competency,” “defining and enabling nurse roles” and “teamworking.”…”

“…Conversely, nurses reported that good management of existing staff resources with clear role responsibilities was enabling factors for staff to work effectively on agreed care priorities (Boltz et al, ; Bourret et al, ; Coyer et al, ; Robison et al, ; Thomas et al, ). Nurses wanted clarity on what was expected of them, their tasks and required actions, and shared duties (Boltz et al, ; French et al, ; Gaspard & Cox, ; Robison et al, ; Taylor et al, , ; Thomas et al, ; Wardh et al, ). Nurses were able to work effectively when supported by leadership to help organise care activities, and to consider how and when care tasks were to be performed (Bourret et al, ; Coyer et al, ; Kneafsey et al, ; Robison et al, ; Thomas et al, ; Wardh et al, ).…”

“…When empowered, nurses wanted to take responsibility for the details of care delivery (Boltz et al, ; French et al, ; Gaspard & Cox, ; Kneafsey et al, ; Robison et al, ; Taylor et al, ; Thomas et al, ). For example, some nurses were confident in knowing when changes in residents' mobility status had occurred and this confidence extended to them making judgements regarding care plan changes (Taylor et al, ).…”