title: Completeness of assisted bathing in nursing homes related to dementia and bathing method: results from a secondary analysis of cluster-randomised trial data.
abstract: BACKGROUND
  Bathing assistance is a core element of essential care in nursing homes, yet little is known for quality of assisted bathing or its determinants.
  
  
  OBJECTIVE
  To explore differences in completeness of assisted bathing in relation to bathing method and resident characteristics.
  
  
  METHODS
  Secondary analysis of a cluster randomised trial including 500 nursing home residents designed to compare traditional bathing methods for skin effects and cost-consequences; GlinicalTrials.gov ID [NCT01187732]. Logistic mixed modelling was used to relate resident characteristics and bathing method to bathing completeness.
  
  
  RESULTS
  Bathing completeness was highly variable over wards. Apart from a large effect for ward, logistic mixed modelling indicated bathing was more often complete in case of washing without water (using disposable skin cleaning and caring materials; estimate 2.55, SE 0.17, P < 0.0001) and less often complete in residents with dementia (estimate -0.22, SE 0.08, P = 0.0040).
  
  
  CONCLUSIONS
  Introduction of washing without water is likely to lead to more bathing completeness in nursing homes. However, inequity in care was also identified with a view to highly variable bathing completeness over wards and more incomplete bathing by care staff in residents with dementia.
  
  
  CONCLUSIONS
  Monitoring the performance of assisted bathing in nursing homes is indicated for the identification of undesirable variation in essential care and poorly performing teams. The introduction of washing without water could serve the promotion of bathing completeness in nursing homes overall, but will not solve inequity issues for residents.
authors.affiliation: KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.|Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.|Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
authors.forename: Theo
authors.initials: T
authors.lastname: van Achterberg
authors.affiliation: Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Betsie G I
authors.initials: BG
authors.lastname: van Gaal
authors.affiliation: Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Wytske W
authors.initials: WW
authors.lastname: Geense
authors.affiliation: Department of Public Health and Primary Care Interuniversity, Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium.|University Hasselt, Hasselt, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Verbeke
authors.affiliation: Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Carine
authors.initials: C
authors.lastname: van der Vleuten
authors.affiliation: Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.|Health Sciences, University of Southampton, Southampton, UK.
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
mesh_terms: D000369:Aged, 80 and over; D001494:Baths; D003704:Dementia / Q000451:nursing*; D005260:Female; D006801:Humans; D006920:Hygiene; D008297:Male; D009426:Netherlands; D009735:Nursing Homes; D017592:Skin Care
keywords: aged; baths; nursing; quality improvement; residential facilities