Bathing resistant residents

October 2008 Vol. 6, No. 10
Bathing resistant residents
As a CNA, personal care, such as assisting with
bathing, is part of your daily assignments. However,
Program Prep
Program time
Approximately 45 minutes
you will often run into a resident who resists bathing.
This CNA Training Advisor will teach you how to
Learning objectives
handle resistant residents who do not want to bathe.
Participants in this activity will learn how to do the following:
It will walk you through steps of what to do to handle a
➤ Discover what might make a resistant resident ready to bathe
➤ Learn the three essential rules to personal care
situation involving a resistant resident.
This lesson will also cover the three essential rules
for personal care and grooming. You’ll also learn
➤ Identify the benefits to bathing
➤ Find out how to bathe bed-bound residents
the benefits of bathing, which will help you explain
Preparation
to a hesitant resident why they need to bathe on a
➤ Review the material on pp. 2–4
regular basis.
➤ Duplicate the CNA Professor insert for participants
Remember, resident safety can be compromised
during bathing, as things tend to get slippery.
It is important for CNAs to learn how to perform a
proper bathing procedure, even for bed-bound residents. At the end of the lesson, CNAs will be given a
checklist (see p. 4) that describes a step-by-step process
➤ Gather equipment for participants (e.g., an attendance sheet, pencils, etc.)
Method
1. Place a copy of CNA Professor and a pencil at each participant’s seat
2. Conduct the questionnaire as a pretest or, if participants’
reading skills are limited, as an oral posttest
for bathing a resident.
Have a good day of training, and stay tuned for next
month’s CNA Training Advisor on supervising the
3. Present the program material
4. Review the questionnaire
5. Discuss the answers
wanderer.
About your CNA training advisor
Judith Ryan, RN, BSN, is the senior advisor for CNA Training
Advisor. She is the director of staff development at Abbott House,
a 55-bed nursing home in Lynn, MA. Ryan has been a nurse for F-Tag 373: Feeding Assistance:
A Video Training Guide
Under F-tag #373, nursing homes must en-
20 years. As part of her job, she is responsible for conducting in-
sure that feeding assistants are properly trained and
services on a wide range of topics for CNAs.
work within the limits of their roles—or they may
face CMS survey citations. F-Tag 373: Feeding Assistance: A Video Training Guide, uses familiar nursing
Questionnaire answer key
home scenarios to outline CMS’ requirements under F-tag #373 for feeding assistants.
1. b
3. a
5. a
7. b
9. c
2. d
4. b
6. d
8. a
10. b
For more information or to order, call 800/650-6787 or visit
www.hcmarketplace.com.
CNA Training Advisor Page October 2008
Bathing resistant residents
Some residents are resistant to bathing. Never force a resident to
bathe. Instead, report the resistance to your supervisor. Often, a simple
change in staff members, bathing time, or day will make the resident
Bathing assistance
When assisting a resident with a tub bath or shower, be aware of
slippery floors, overly hot water, drafts, and/or dizziness. A common
more agreeable and cooperative. It is important to respect any prefer-
procedure to follow would be to:
ences a resident has.
1. Assemble soap, washcloth, towel, and gloves. Clean the floor of the
Personal care is just that—personal—and we are all self-conscious
about our bodies. Before we begin to discuss the individual procedures
of personal care, imagine that you are unable to take care of yourself
shower if the resident is taking a shower.
2. Place a rubber mat on the tub or shower floor. Put a bath mat in
front of the tub or shower.
and must have someone else help you with your personal cleanliness
3. Temper the tub or shower water to a comfortable 105ºF–110ºF.
and grooming, which involves exposure of and assistance with your
4. Assist the resident in removing his or her clothing and help him or
body’s private areas.
her carefully enter the tub or shower.
5. Let the resident wash as much as possible, and then wash any areas
What do you think is a resident’s greatest need in this
the resident cannot reach.
6. Assist the resident out of the tub or shower, pat him or her dry,
situation?
➤
and dress the resident. Do not rub his or her skin, as it might cause
Discuss.
irritation.
7. Clean the tub or shower.
What is most important to the resident when someone else
There are additional forms of bathing that are often useful for residents. You can assist a resident with a soak, in which a body part is
provides his or her personal care?
➤
placed in 105ºF–110ºF water for a short period of time. Then there is a
Discuss.
sitz, in which the perineal area (i.e., private parts) is soaked.
A partial bath involves bathing only certain parts of the body. Resi-
CNAs must respect the rights and privacy of a resident at all times but
dents might need you to assist only with parts they can’t reach, such
must know how to help the resident maintain his or her comfort, cleanli-
as the back, or they might prefer to wash certain areas only on some
ness, and safety. No matter which aspect of personal care and grooming
days to prevent the dry skin that is caused by daily all-over bathing.
you perform, always keep three essential rules in mind:
The term “partial bath” often refers to washing only the face, armpits,
1. Respect the privacy, dignity, and choices of the resident
perineum, hands, and feet.
2. Maintain the resident’s safety and comfort
3. Regularly observe the resident’s condition and report problems
What are some important things to observe about a resident’s bathing environment?
Benefits of bathing
➤
There are many benefits associated with bathing.
For example, it:
➤ Provides relaxation and comfort
➤ Removes dead skin cells
Discuss.
Bathing bed-bound residents
For most Americans, daily bathing is considered routine. For the el-
➤ Controls infection by removing microorganisms
derly, daily bathing might be damaging to the skin. However, the face,
➤ Provides muscle and tissue stimulation through gentle rubbing
hands, underarms, and perineal area must be cleansed daily.
➤ Eliminates body odor that develops due to the interaction of harm-
Bed baths are given to residents who cannot get out of bed for tem-
less microorganisms on the skin with odorless secretions of the
porary or permanent reasons. CNAs should wash the resident’s entire
sweat glands
body, one part at a time. The best time for a bath is usually after elimination has occurred, and it can be given along with oral care and a
Bathing also provides an opportunity for the caregiver to inspect the
resident’s skin. Remember to look under the breasts and in the folds of
change of bed linens. Always allow and encourage residents to wash as
much of themselves as possible.
the groin. Early detection and treatment of skin problems can prevent
Remember, especially with bed-bound residents, to always pat the
the resident from developing pressure sores. It also reduces resident
body with a washcloth or towel. Rubbing the resident’s skin might irri-
discomfort, as well as the time and costs involved in treatment.
tate it.
© 2008 HCPro, Inc.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
CNA Training Advisor October 2008
Page Bathing resistant residents
Follow this step-by-step procedure for bathing the bed-bound
8. Apply soap to your washcloth mitt. Wash the face, neck, ears, and
behind the ears, and then rinse and pat dry.
resident:
1. Place the resident in a supine, or lying down, position and cover
9. Place a towel under the resident’s arm that is farthest from you and
him or her with a blanket.
wash the arm, shoulder, and underarm with a soapy mitt. Support
2. Assemble all the equipment you need (e.g., a basin, a washcloth,
soap, gloves, and a towel) and fill the basin with warm water. The
the resident’s elbow as you wash the arm. Rinse and pat dry.
10. Put the basin on the bed and place the resident’s hand in the wa-
water temperature should be 105ºF–110ºF.
ter. Wash the hands and between the fingers with soap and water.
3. Remove the resident’s clothing, keeping him or her covered with
Clean under the fingernails carefully. Dry the hand and cover the
arm with the blanket. Repeat steps 8 and 9 for the arm and hand
the blanket.
4. Put on disposable gloves. Place a towel over the resident’s chest
nearest to you.
11. Pull the blanket back to the waist and cover the resident’s chest
and blanket.
5. Wet the washcloth in the basin and form a mitt with it around
with the towel. Lift the towel to wash the chest with a soapy mitt.
Rinse and pat dry. Wash, rinse, and dry thoroughly under female
your hand.
6. Wipe the resident’s eyes with the washcloth and clean water, using
a different corner of the mitt for each eye so you don’t spread in-
residents’ breasts.
12. Repeat step 10 for the abdomen, keeping the resident covered fection. Wipe each eye gently from the inside corner out.
7. If the resident is alert, ask him or her whether he or she would like
everywhere besides the abdomen.
13. Place a towel under the far leg. Support the leg under the knee
soap on their face. Some will not because soap tends to dry out the
while washing, rinsing, and drying.
14. Wash the foot and between the toes in the basin, dry thoroughly,
faces of elderly residents.
and cover the leg with a blanket. Repeat steps 12 and 13 for the
Save time orienting CNAs
to their new role
near leg and foot.
15. Change the bath water. Turn the resident on his or her side, facing
away from you. Put a towel on the bed beside the resident’s back.
With the CNA Training Solution Video:
Uncover the back and buttocks and wash, rinse, and dry from the
Orientation, trainers save time developing neck to the buttocks.
effective orientation materials, and students
16. Provide perineal care last. n
receive a quality orientation that is vital to
their success. This video is great for an Questions? Comments? Ideas?
instructor-led program, or it can be used Contact Associate Editor Kerry Vegliando
as a self-study lesson for each student.
For more information or to order, call 800/650-6787 or visit
E-mail kvegliando@hcpro.com
www.hcmarketplace.com.
CTA Subscriber Services Coupon
q Start my subscription to CTA immediately.
Options
No. of issues Cost
q Electronic 12 issues
$149
q Print & Electronic 12 issues of each $149
Order online at
www.hcmarketplace.com
Be sure to enter source code
N0001 at checkout!
Name
Shipping Total
(CTAE)
N/A
(CTAPE)
$24.00
Sales tax
(see tax information below)*
Grand total
For discount bulk rates, call toll-free at 888/209-6554.
*Tax Information
Your source code: N0001
Please include applicable sales tax. Electronic subscriptions are exempt.
States that tax products and shipping and handling: CA, CO, CT, FL, GA, IL, IN,
KY, LA, MA, MD, ME, MI, MN, MO, NC, NJ, NM, NY, OH, OK, PA, RI, SC, TN, TX,
VA, VT, WA, WI, WV. State that taxes products only: AZ. Please include $27.00
for shipping to AK, HI, or PR.
Title
Organization
Address
City State Phone
Fax
ZIP
E-mail address
(Required for electronic subscriptions)
q Payment enclosed. q Please bill me.
q Please bill my organization using PO #
q Charge my: q AmEx
q MasterCard
q VISA
q Discover
Signature
(Required for authorization)
Card # Expires
(Your credit card bill will reflect a charge to HCPro, the publisher of CTA.)
Mail to: HCPro, P. O. Box 1168, Marblehead, MA 01945 Tel: 800/650-6787 Fax: 800/639-8511 E-mail: customerservice@hcpro.com Web: www.hcmarketplace.com
© 2008 HCPro, Inc.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
CNA Training Advisor Page October 2008
Bathing resistant residents
Bathing assistance checklist
o Check the bathing area for slippery floors or drafts
o Assemble soap, washcloth, towel, and gloves
o If the resident is taking a shower, clean the floor of the shower before the resident gets in
­­­
o Place a rubber mat on the tub or shower floor
o Put a bath mat in front of the tub or shower
o Make sure the water temperature is between 105ºF–110ºF
o Assist the resident in removing his or her clothing
o Help the resident carefully enter the tub or shower
o Let the resident wash as much as possible, and then wash any areas the resident cannot reach
o Assist the resident out of the tub or shower
o Pat the resident dry (do not rub his or her skin, as it might cause irritation)
o Dress the resident
o Clean the tub or shower
Editorial Board
Group Publisher: Emily Sheahan
Executive Editor: Elizabeth Petersen
Associate Editor: Kerry Vegliando
kvegliando@hcpro.com
© 2008 HCPro, Inc.
Judith Ryan, RN, BSN
Director of Staff Development
Abbott House
Lynn, MA
CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online]) is published monthly by HCPro, Inc.,
200 Hoods Lane, Marblehead, MA 01945. Subscription rate: $149/year; back issues are available at $15
each. • CTA, P.O. Box 1168, Marblehead, MA 01945. • Copyright © 2008 HCPro, Inc. All rights reserved.
Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in
any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center
at 978/750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial
comments or questions, call 781/639-1872 or fax 781/639-2982. For renewal or subscription information, call customer service at 800/650-6787, fax 800/639-8511, or e-mail: customerservice@hcpro.com.
• Visit our Web site at www.hcpro.com. • Occasionally, we make our subscriber list available to selected
companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing
department at the address above. • Opinions expressed are not necessarily those of CTA. Mention of
products and serv­ices does not constitute en­dorse­ment. Advice given is general, and readers should consult
professional counsel for specific legal, ethical, or clinical questions.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978/750-8400.
October 2008 Vol. 6, No. 10
Bathing resistant residents
Mark the correct response.
Name:
Date:
1. What should you do if a resident resists bathing?
a. Argue with the resident
6. When assisting with bathing, you should be aware
of ________________.
b. Report the situation to your supervisor
a. slippery floors
c. Force him or her to bathe
b. water temperature
d. All of the above
c. drafts
d. all of the above
2. Something you can do to accommodate a resident
that is resistant to bathing would be to ___________.
a. change the bathing time
7. When bathing a resident, make sure the water temperature is between:
b. choose a new staff member to assist with bathing
a. 100ºF–105ºF
c. change the scheduled day for bathing
b. 105ºF–110ºF
d. all of the above
c. 110ºF–115ºF
d. 115ºF–120ºF
3. It is important to maintain a resident’s privacy when
bathing.
a. True
8. When helping a resident dry off after bathing, you
should pat, not rub, the skin.
a. True
b. False
b. False
4. The only benefit to bathing is that it keeps residents
clean.
9. A bed bath is for residents who _____________.
a. True
a. do not want to get out of bed
b. False
b. don’t want a full bath
c. are not able to get out of bed
5. As a caregiver assisting with bathing procedures, you
should always remember to ________________.
a. inspect the resident’s skin
b. leave the resident to bathe alone
d. all of the above
10. When performing a bed bath, you should complete
perineal care first.
c. rub the resident’s skin
a. True
d. none of the above
b. False
A supplement to CNA Training Advisor