title: Assisting cognitively impaired nursing home residents with bathing: effects of two bathing interventions on caregiving.
abstract: OBJECTIVE
  When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing, nursing home caregivers are in a unique position to improve residents' experience. This report addresses whether certified nursing assistants (CNAs) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors (gentleness and verbal support) and experienced greater preparedness (confidence and ease) and less distress (hassles) when assisting residents with bathing.
  
  
  METHODS
  We used a crossover design and randomized 15 nursing homes into two treatment groups and a control group of 5 facilities each. In one treatment group, CNAs received person-centered training, first with showering for 6 weeks (Time 1) and then with the towel bath for 6 weeks (Time 2). We reversed the treatment order in the other treatment group. Control group CNAs used usual showering procedures without person-centered training. We collected observational and self-report data at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes. We analyzed data from 37 CNAs assisting 69 residents by using 3x2 repeated measures analyses of variance to compare the three groups on change from baseline.
  
  
  RESULTS
  Compared with the control group, treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease.
  
  
  CONCLUSIONS
  A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents.
authors.affiliation: School of Nursing, Oregon Health & Science University, Portland, OR 97239, and Department of Psychology, John Umstead Hospital, Butner, NC, USA. hoefferb@earthlink.net
authors.forename: Beverly
authors.initials: B
authors.lastname: Hoeffer
authors.forename: Karen Amann
authors.initials: KA
authors.lastname: Talerico
authors.forename: Joyce
authors.initials: J
authors.lastname: Rasin
authors.forename: C Madeline
authors.initials: CM
authors.lastname: Mitchell
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stewart
authors.forename: Darlene
authors.initials: D
authors.lastname: McKenzie
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Barrick
authors.forename: Joanne
authors.initials: J
authors.lastname: Rader
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000374:Aggression / Q000523:psychology*; D001494:Baths / Q000379:methods* / Q000451:nursing; D001512:Bedding and Linens; D018592:Cross-Over Studies; D003704:Dementia / Q000451:nursing / Q000523:psychology*; D005260:Female; D005851:Geriatric Nursing; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D009735:Nursing Homes; D018802:Patient-Centered Care / Q000379:methods*; D011595:Psychomotor Agitation / Q000517:prevention & control* / Q000523:psychology; D014481:United States