NUR 502 Module 7 Final Teaching Project example

Bath Time Without the Battle: A Person-Centered Bathing Training Program for Memory Care Nursing Assistants

[Student Name]

Southern New Hampshire University

NUR 502: Teaching and Learning in Nursing

Module Seven Final Teaching Project

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Bath Time Without the Battle: A Person-Centered Bathing Training Program for Memory Care Nursing Assistants

The Practice Problem

A composite 32-bed memory care unit within a skilled nursing facility logged 41 incidents of resident aggression toward staff over six months. When the nurse educator sorted the reports by time and activity, 23 had occurred during bathing: residents hitting, grabbing or screaming as they were undressed, wheeled to the shower room or sprayed with water. Nursing assistants described bathing as the worst part of the day, two had been injured, and several residents were receiving as-needed antianxiety medication before showers.

Bathing is a predictable trigger for distress in people with dementia. They may not understand why they are being undressed, may feel cold, exposed or frightened by running water, and may experience pain when moved. The aggression in the incident reports is better understood as a resident's attempt to communicate fear or discomfort than as a behavior problem located in the resident. That framing matters for teaching, because it points toward changing how the bath is given rather than managing the resident.

Evidence That Bathing Can Be Changed

Strong evidence supports teaching caregivers a different approach. In a randomized controlled trial in 15 nursing homes, residents with dementia who became agitated during bathing were assigned to usual care or to one of two person-centered methods, a person-centered shower or a towel bath given in bed. Aggressive incidents fell by 53 percent with person-centered showering and 60 percent with the towel bath, discomfort declined with both methods, and neither method reduced how thoroughly residents were cleaned or worsened skin condition (Sloane et al., 2004). A companion analysis of the nursing assistants in the same trial found that those trained in the person-centered approach became gentler, gave more verbal support and found bathing easier than control-group staff (Hoeffer et al., 2006).

These findings show that the problem responds to staff education and that the change benefits both residents and caregivers, which gives the program a clear, evidence-based target.

Learner Needs Assessment

The learners are the unit's 18 nursing assistants across three shifts, most of whom give baths on the day and evening shifts. The educator assessed them in three ways. She observed six baths with residents' and families' consent, noting that assistants rushed, undressed residents fully in their rooms, used handheld sprayers directly on the face and spoke mainly to each other. She reviewed their training records and found that all had completed a state nurse aide program and a one-hour dementia orientation, but none had been taught alternatives to the shower. She then held short interviews during shift overlaps.

The interviews revealed that assistants already cared about residents and wanted fewer fights, but believed the shower schedule could not be changed and that residents had to be fully washed every time. Several said they felt blamed after incidents. Their learning needs therefore span three domains: knowledge of why bathing frightens people with dementia, skill in the person-centered shower and towel bath, and the attitude that they have permission to adapt the bath to the person.

Learning Objectives

At the end of the program, each nursing assistant will be able to: explain three reasons a person with dementia may resist bathing; demonstrate a towel bath on a manikin and then on a resident, keeping the person covered throughout, on two observed occasions; demonstrate person-centered shower techniques, including warming the room, covering the resident and directing water away from the face; describe at least two ways to adapt a bath when a resident shows distress, such as stopping, washing only part of the body or trying later; and state that stopping a distressing bath is an acceptable choice that should be reported, not a failure. The objectives cover cognitive, psychomotor and affective learning and use observable verbs so that each can be checked.

Learning Theory and Methods

The program is built on adult learning principles. Adults are most engaged when teaching speaks to a difficulty they face today, builds on their experience and gives them some control over how they learn (Knowles et al., 2015). Nursing assistants have deep practical experience with residents and a strong, immediate reason to want easier baths. The program therefore begins with their own stories of difficult baths, uses those stories to introduce the idea that behavior communicates need, and moves quickly to hands-on practice.

Methods follow the objectives. Knowledge is taught through short discussion and a brief video of a person-centered bath. Skills are taught through demonstration, practice on a manikin and then coached baths on the unit, because a psychomotor skill used under stress needs rehearsal in the real setting. The attitude objective is addressed through open discussion of the schedule and the fear of blame, with the director of nursing present to confirm that adapting or postponing a bath is supported.

The Teaching Plan

Training is delivered in two 60-minute sessions one week apart, repeated on each shift, followed by coaching on the unit.

Table 1

Person-Centered Bathing Training Plan

Evaluation

Evaluation will address four levels. Reaction will be measured by a brief anonymous survey after each session. Learning will be measured by a knowledge check of five scenario questions and by a skills checklist completed during manikin practice and the first coached bath. Behavior will be measured by observing a sample of baths before training and again at two and six months, using a simple checklist of person-centered actions such as covering the resident and explaining each step. Results will be tracked through monthly counts of bathing-related aggression incidents, staff injuries and as-needed medication given before baths, compared with the six months before the program. Staff will also be asked whether bathing has become easier, since caregiver experience improved in the original trial (Hoeffer et al., 2006).

Sustaining the Change

Training alone rarely changes a unit's routine for long. To keep the new practice in place, the educator will prepare two nursing assistants from different shifts as peer mentors who can coach new staff. Bathing preferences, such as time of day, bath type and what calms the resident, will be added to each resident's care plan and reviewed at care conferences with families. Supplies for towel baths will be stocked on every hall. The unit's bathing schedule will be revised to allow flexibility, and the monthly incident review will include a short discussion of any bath that went badly and what might work next time. New assistants will complete the program during orientation.

Conclusion

Bathing is the most common trigger for aggression on this memory care unit, and randomized evidence shows that person-centered showering and the towel bath reduce aggression and discomfort while making the work easier for nursing assistants. This project applies the full cycle of teaching design, assessing the learners, writing measurable objectives, grounding methods in adult learning theory, delivering practice in the real setting and evaluating results at every level, to give residents a calmer bath and staff a safer shift.

References

Hoeffer, B., Talerico, K. A., Rasin, J., Mitchell, C. M., Stewart, B. J., McKenzie, D., Barrick, A. L., Rader, J., & Sloane, P. D. (2006). Assisting cognitively impaired nursing home residents with bathing: Effects of two bathing interventions on caregiving. The Gerontologist, 46(4), 524-532. https://doi.org/10.1093/geront/46.4.524

Knowles, M. S., Holton, E. F., III, & Swanson, R. A. (2015). The adult learner: The definitive classic in adult education and human resource development (8th ed.). Routledge.

Sloane, P. D., Hoeffer, B., Mitchell, C. M., McKenzie, D. A., Barrick, A. L., Rader, J., Stewart, B. J., Talerico, K. A., Rasin, J. H., Zink, R. C., & Koch, G. G. (2004). Effect of person-centered showering and the towel bath on bathing-associated aggression, agitation, and discomfort in nursing home residents with dementia: A randomized, controlled trial. Journal of the American Geriatrics Society, 52(11), 1795-1804. https://doi.org/10.1111/j.1532-5415.2004.52501.x