Inability to independently complete cleansing activities

Difficulty accessing bathroom

Difficulty accessing water

Difficulty drying body

Difficulty gathering bathing supplies

Difficulty regulating bath water

Difficulty washing body

Anxiety

Cognitive dysfunction

Decreased motivation

Environmental constraints

Impaired Physical Mobility

Neurobehavioral manifestations

Pain

Weakness

Older adults

Impaired ability to perceive body part

Impaired ability to perceive spatial relationships

Musculoskeletal diseases

Neuromuscular diseases

AUTHOR'S NOTE

Refer to Self-Care Deficit Syndrome.

Level 1 Basic Focused Assessments

All Use the Following Scale to Rate the Individual's Ability to Perform. Add the Number to the Individual's Nursing Diagnosis such as Bathing Self-Care Deficit (3)

0 = Is completely independent

1 = Requires use of assistive device

2 = Needs minimal help

3 = Needs assistance and/or some supervision

4 = Needs total supervision

5 = Needs total assistance or unable to assist

R:This coding allows for establishing a baseline from which to evaluate progress.

Observe strength, flexibility, endurance, coordination, and/or balance. Ask the individual what self-care activities are most important to them to improve.

R:Determining the individual's goals as a starting point helps the provider establish credibility and lays the foundation for a trusting relationship built on a strong sense of collaboration. This is a dramatic shift from traditional models of care that employ a hierarchical, paternalistic approach toward providing advice and presuming adherence (Pignataro, 2018).

The individual will perform bathing activities at expected optimal level or report satisfaction with accomplishments despite limitations, as evidenced by the following indicators:

• Relates a feeling of comfort and satisfaction with body cleanliness.
• Demonstrates the ability to use adaptive devices.
• Describes causative factors of the bathing deficit.

Level 1 Fundamental Focused Interventions (all settings)

Assess Causative Factors

Refer to Related Factors.

Engage in Motivational Interviewing Interactions (Pignataro, 2018)

Techniques used in MI often are represented by the acronym OARS:

O: Ask open-ended questions. > What activity do you want to improve your ability to do?

A: Use affirmations, or positive statements, that demonstrate an authentic interest in the patient's own perspectives. > I am pleased that you are very interested in improving your ….

R: Reflective listening reinforces this interest and offers opportunities to clarify information or make inferences that invite the individual to continue to share his or her thoughts and opinions.

What can increase your ability to (identify self-care activity, such as using the toilet)?

S: The provider can pause the conversation to summarize information, pulling together pieces of the dialogue in a way that inspires action. > So you are interested in (summarize the activities that the individual has expressed interest in improving).

R:MI is an evidence-based, patient-centered form of communication that has been used effectively to encourage a broad range of healthy behaviors, such as vaccinations, preventive screenings, exercise, weight management, and tobacco cessation (Pignataro, 2018). MI can foster initiation, rapport, create transformative dialogues, enhance adherence, and inspire successful lifestyle changes (Ibid).

Provide Opportunities to Relearn or Adapt to Activity

General Nursing Interventions for Inability to Bathe

• Bathing time and routine should be consistent to encourage optimal independence.
• Encourage the individual to wear prescribed corrective lenses or hearing aid.
• Keep the bathroom temperature warm; ascertain the individual's preferred water temperature.
• Provide for privacy during bathing routine.
• Elicit his or her usual bathing routine.
• Keep the environment simple and uncluttered.
• Observe skin condition during bathing.
• Provide all bathing equipment within easy reach.
• Provide for safety in the bathroom (nonslip mats, grab bars).
• When the individual is physically able, encourage the use of either a tub or shower stall, depending on which he or she uses at home. (The individual should practice in the hospital in preparation for going home.)
• Provide for adaptive equipment as needed:
  • Chair or stool in bathtub or shower
  • Long-handled sponge to reach back or lower extremities
  • Grab bars on bathroom walls where needed to assist in mobility
  • Bath board for transferring to tub chair or stool
  • Safety treads or nonskid mat on floor of bathroom, tub, and shower
  • Washing mitts with pocket for soap
  • Adapted toothbrushes
  • Shaver holders
  • Handheld shower spray
• Provide for relief of pain that may affect the ability to bathe self.

R:Offering choices and including the individual in planning care reduces feelings of powerlessness; promotes feelings of freedom, control, and self-worth; and increases the individual's willingness to comply with therapeutic regimens. Assistive devices can improve self-care abilities.

Specific Bathing Interventions for People with Visual Deficits

• Place bathing equipment in a location most suitable to the individual.
• Avoid placing bathing equipment to the blind side if the individual has a field cut and is not visually accommodated to surroundings.
• Keep the call bell within reach if the individual is to bathe alone.
• Give the individuals with visual impairment the same degree of privacy and dignity as any other individual.
• Announce yourself before entering or leaving the bathing area.
• Observe the individual's ability to perform mouth care, hair combing, and shaving.

R:Inability to perform self-care produces feelings of dependency and poor self-concept. With increased ability for self-care, self-esteem increases.

Specific Bathing Interventions for People with Cognitive Deficits

• Determine the best method to bathe the individual (e.g., towel bath, shower, tub bath).
• Provide a consistent time for bathing as part of a structured program to help decrease confusion.
• Keep instructions simple and avoid distractions; orient the individual to the purpose of bathing equipment and put toothpaste on the toothbrush.
• Preserve dignity.
• Provide verbal warning prior to doing anything (e.g., touching, spraying with water).
• Apply firm pressure to the skin when bathing; it is less likely to be misinterpreted than a gentle touch.
• Use a warm shower or bath to help a confused or agitated individual to relax.

R:Aggression may be precipitated by baths or showers. Soap and towels in a warm environment have been found to reduce aggression.

Initiate Health Teaching and Referrals, as Indicated

• Teach the use of adaptive devices.
• Ascertain bathing facilities at home and assist in determining if there is any need for adaptations; refer to occupational therapy or social services for help in obtaining needed home equipment.
• Teach the individual to use the tub or shower stall, depending on what is used at home.

R:Cleanliness is important for comfort, positive self-esteem, and social interactions. Inability to care for oneself produces feelings of dependency and poor self-concept. With increased ability for self-care, self-esteem increases.