How staff at the North Bay Regional Health Centre took the stress out of bathing for patients living with dementia.

By Lindsay Smylie Smith

For many of us, taking a bath is a relaxing experience. Some people use it as an opportunity to unwind at the end of a long day, and parents are often encouraged to bathe children to help them relax before bedtime. For patients living with dementia, the experience can often be the opposite—frightening and stressful for the patient, their families and the staff caring for them.

“When you are living with dementia, you are trying to make sense of the world around you,” explains Debbie Hewitt Colborne, RN and Coordinator of Seniors’ Services at the North Bay Regional Health Centre. “This can be more difficult when you need assistance with personal care—it’s an intimate experience and can be very stressful for our patients.”

Knowing that personal care could cause some of the most intense responsive behaviours from patients, staff from the B1 Dementia Transition Unit came up with a plan. “We recognized an opportunity to make bathing a less stressful experience with some changes to our tub room,” Hewitt Colborne explains.

Before the upgrade, the tub room likely wouldn’t have been appealing for anyone to bathe there, let alone a patient who may be feeling vulnerable and unsure of their surroundings. Visually, the room was an institutional looking drab colour and looked very busy and messy—clothing was stacked in the corner, supplies out in the open and pieces of equipment being stored in there.

The team, comprised of nursing, clerical and housekeeping staff, set to work to make the tub room a more calming environment. First the room was painted blue—a shade specifically chosen for its well documented calming properties. Artwork was hung on the wall that could be seen from the bathtub, in an effort to create a more home-like environment. Finally new cupboards were installed with doors that could be closed to store supplies out of sight, and arrangements were made to remove most of the excess clutter and unnecessary items that had found a temporary home in the room.

The biggest change, however, was the installation of a blanket/towel warmer.  “This addition was key for the experience of the patient living with dementia,” Hewitt Colborne says.

Katherine Gagnon, RN and Team Lead on B1, has seen first-hand the positive effect these changes have had on patient experience. Gagnon remembers one patient in particular had historically found the bathing experience very stressful—which sometimes resulted in both verbal and physical responsive behaviours.

First staff brought him to the tub room and prepared him for the bath by getting him undressed. “As soon as we did,” she remembers, “we put a warm towel on him right away. Immediately you could feel him relax.”

They continued that way during the entire bath—any area of the patient that was exposed was covered with a warm towel, and they were able to provide his bath without the stress that the patient previously experienced.

Making the tub room more home-like is part of a larger goal to make the environment on B1 more dementia friendly—and to better provide what is known as ‘person and family centered care’. Person and family centered care is the idea that health care should be tailored to a patient’s individual needs and goals, together with the involvement of the patient and their families.

Hewitt Colborne explains sometimes even if staff have received all the right training and are eager to put these elements into practice, sometimes the environment they are working with can be limiting.

“We know that environment is only one piece of the care we provide in a healthcare setting,” she says. “Bathing in the tub room before the renovations is an example of where the institutional setting limited our staff’s ability to provide the person-centered care they had been trained on,” she says. “Staff are already equipped with the knowledge and understanding of our philosophy of care, but this change enabled them to practice in a way that exercised these principles.”

In this instance, the addition of the towel warmer helped make the experience of bathing more personalized, and helped keep the focus on the patient’s comfort rather than just about the task of bathing. Another example is once the room was cleared of the excess clutter, the CD player was more accessible allowing staff to play music to enhance the relaxation for patients during their care.

The change to a more home like environment has also had a positive effect on the staff working on the unit. The warmer environment is more welcoming, and the transformation instills a sense of pride as staff can see first-hand the effects this change has had on their patients and families.

Lindsay Smylie Smith is a Communications Specialist at North Bay Regional Health Centre.