Investigating Shower and Bathing Options in Health Care

Investigating Shower and Bathing
Options in Health Care
Shay Wiggs, P.T.
Regional Director of Therapy Services,
LTC Support Services
Wayne Stone, Safe Resident Handling and Equipment
Coordinator, LTC Support Services
Illinois Health Care Association September 13, 2016
Objectives
The participant will:
• Understand challenges associated with showering
and bathing
• Have an improved awareness of individual
functional ability needs in relation to hygiene
care
• Individual assessment requirements
• Become familiar with the variety of showering
and bathing equipment available
Challenges
•
•
•
•
Environmental
Individual
Equipment
Cost
Introduction
• Purpose of bathing
– Fundamental purpose of bathing is to maintain
health and physical well being of the body
– Physiologically, bathing allows cleansing of the
skin and removal of accumulated foreign matter.
– Bathing displaces dead skin, prevents irritations
and rashes that would otherwise transform into
infections, and washes away waste materials that
can interfere with the normal functioning of the
skin.
Additional Benefits
• Stimulates circulation
• Promotes a feeling of self worth by improving
a patients appearance
• Fosters relaxation and can be a benefit with
sleep disorders
• Can aid in combatting depression.
Types of Baths
• Depending on the patients physical abilities,
health problems, and degree of hygiene
needed, you can choose from a variety of
bathing techniques.
– Complete Bed Bath
– Partial Bed Bath
– Therapeutic Bath
– Shower Bath
– Tub Bath
Statistics
• According to the CDC every year about
235,000 people over the age of 15 visit
emergency departments because of injuries
suffered in the bathroom and 14% are
hospitalized
• More than a third of the injuries happen while
bathing or showering
• Injuries increase with age, peaking after 85
Statistics
• These results suggest that bathrooms tend to
be most hazardous for persons in the oldest
age groups.
• Bathroom injury rate for women is 72% higher
than for men.
– Possible contributing factors can be differences in
physical activity, lower-body strength, bone mass
or even more willingness to seek treatment
What can I say?
Types of Injuries
• Falls were the most common primary cause of
injury resulting in:
– Contusions or Abrasions
– Strain or sprain
– Fracture
– Laceration
– Internal Injury
– Concussion
Why Do Individuals Have Difficulty
with Bathing or Showering?
• Individual Challenges
– Fear of Falling
– Poor balance & trunk control
– Poor upper and lower body strength
• Inability to lift legs over bath
• Unable to pull / push with upper extremities
– Loss of ROM of extremities / contractures
– Person is unable to stand or partially weight bear
– Reduced cognitive ability
Why Do Individuals Have Difficulty
with Bathing or Showering?
• Individual Physical Characteristics
– Tall
– Short
– Bariatric
– Body Shapes (Pear, Apple, Hour glass)
• How does this impact the capabilities of the facilities
equipment?
Individual Assessment
• Functional Status
• Cognitive Status
• Behavior Triggers
– Allow evaluation time to observe the patient with the
caregiver in the actual bath/shower environment.
This is the only way that the trigger and other
problems can be identified
– This is a “push in” approach in which the therapist is
teaming with the caregiver and the patient in the
normal day-to-day environment. This helps to
develop an accurate problems list.
Individual Assessment
• Common Difficult Behaviors
– Physical resistance including hitting, pushing,
kicking, and biting
– Verbal agitation such as “leave me alone,” crying
out, yelling, or cursing
– Withdrawal and fear in which the person may
shake, cry, or hold themselves tightly and rock
– Refusal
Individual Assessment
• Role of the Therapist is to help team discover:
– Unmanaged pain
– Temperature management
– Feeling frightened, vulnerable, and exposed
– Feeling embarrassed
– Feeling a loss of control
– Not understanding what is happening,
misperceptions, and poor communication
– A primary goal is to maintain dignity
Individual Assessment
• Plan to reduce triggers
– Involve all needed disciplines (PT, OT, ST) to
intervene as the triggers and problems are vast
and spread across the expertise of all disciplines
Individual Assessment
• Strategies to reduce the frequency and severity of
behaviors
– Reduce pain by:
• Change PRN pain meds to routine
• Make sure the person’s body is positioned comfortably
• Provide a gentle touch
– Keep the person warm by:
• Keep the person’s body covered as much and often as
possible with towels
• Maintain a comfortable temperature of both room and
water
• If transporting to a central bath area, make sure the person
is fully clothed or wearing a robe
Individual Assessment
– Reduce fear by:
• Caregivers should build a relationship with the patient and
changes in caregivers should be minimal
• Avoid spraying on the person’s face; the water spray can be
painful or frightening for some people
• Change the bathing/shower environment to look and feel
homelike and inviting
• Communicate what’s about to happen during each step of
the activity
• Make the bath/shower fun or relaxing by setting the tone
through music, lighting, etc.
• Caregiver needs to be patient and wait the adequate
amount of time for a patient to process and respond
Individual Assessment
– Reduce Embarrassment by:
• Keep the person’s body covered as much as possible
• Make certain the person feels safe and comfortable
with the caregiver. For example, a caregiver of the
opposite sex may upset a patient
Individual Assessment
– Maintain the patient’s sense of control by:
•
•
•
•
Always ask for permission
Provide choices throughout the experience
Facilitate independence
Honor the person’s preferences for shower or bath,
products, time of day, etc. If the person is unable to
communicate their needs and wants, gather their life
story from their family or significant others.
Individual Assessment
– Reduce the risk for misperceptions and
miscommunication by:
• Communicate what you are there to help the person
with and what’s going to happen throughout each step
of the activity
• For those who are lower functioning consider using
sensory bridging techniques such as providing a
favorite/familiar soap or shampoo to smell before
engaging the patient in the activities. This can help the
person connect to a memory related to the activity and
it can help you facilitate a higher level of understanding
and independence.
Individual Assessment
• Reduce the risk for misperceptions and
miscommunication by:
– Use the proper cueing strategies and
communication techniques to increase
understanding
– Closely observe the patient’s response and adjust
the approach as needed
Individual Assessment
• Promote Function
– A sense of control, accomplishment, and privacy
can all be facilitated by the person doing as much
of the bathing activity for themselves as possible.
The therapist must alter the activity demands,
environment, and care approach to facilitate the
greatest degree of patient participation and
independence.
Next Steps
• How do we take all of the assessment
information we have gathered and apply it to
equipment needs?
• What are basic questions we should ask when
determine equipment that will satisfy
individual bathing needs?
Form, Function, Fit
• The phrase originally comes from the
manufacturing industry
• Meant to describe the identifying characteristics
of a part
• Application can apply to virtually anything
–
–
–
–
Manufacturing
Equipment use
Processes
Etc., etc., etc. . . . . . .
• How can we apply?
Form, Fit, Function
•
Form
–
–
–
–
–
–
•
•
How the item looks ?
What is its shape?
How big is it – size and dimensions?
How heavy is it?
Is there anything that uniquely identifies it?
Example: Shower chair side arm features: padding , wide or narrow, low or high
Fit
– How does the item integrate with the rest of the equipment it is connected to?
– How does it meet the needs of individual(s)?
– How does it “fit” the space it will be used in?
Example: Shower chair side arm – gaps between arm and seat, arm and back
Example: Shower chair – relationship of footprint or size of the chair to bathing area
Function – What does the item do?
– How does it work?
– How easy does it operate?
Example: Shower chair side arm – fixed, adjustability, swing away, removable
Equipment - Categories
• Showering
– Chairs (fixed and adjustable)
– Trolleys / Gurneys (fixed, hydraulic, electric)
• Bathing
– Tubs (Spa) (sit, recumbent, reclining, with and
without reservoirs)
– Trolleys
• Manufacturers continue to work to improve
design and function of bathing products.
Shower Trolleys and Gurneys
• Provide showering and hygiene care for
individuals
– Demanding physical or cognitive conditions
– Wounds
– Burns
– Chemical contamination
Shower Trolleys and Gurneys
Shower Trolleys and Gurneys
Shower Trolleys and Gurneys
Shower Trolleys and Gurneys
Shower Trolleys and Gurneys
Shower Trolleys and Gurneys
Standard Shower/Tub Benches
With Back
Without Back
Multi-Purpose Shower Chair
Basic Shower Chair
Features and Benefits
• Fixed frame PVC construction
• Height clearance for toileting
• Acceptable for general
showering needs
• Easy to clean and disinfect
• Casters can impact
maneuverability over time
• Lower weight capacity
• Low comfort
• Low cost
Shower Chair – Upgrade
Features and Benefits
• Fixed frame lightweight tubular
steel or aluminum frame
• Height clearance for toileting
• Acceptable for general showering
needs
• Fairly easy to clean and disinfect
• Larger casters provide improved
access for thresholds
• Higher capacity
• Improved comfort
• Medium to moderate cost
Improved Access Shower Chair
Shower Chair – Upgrade
Features and Benefits
• Fixed frame PVC construction
• Height clearance for toileting
• Acceptable for general showering
needs
• Fairly easy to clean and disinfect
• Larger casters provide improved
access for thresholds including
stainless steel front casters
• Higher capacity
• Improved comfort
• Medium cost
Improved Access Shower Chair
Individuals Appropriate for the
Standard Shower Chair
• Adequate
– Sitting balance
– Trunk and head control
– ROM of upper and lower extremities
• These individuals typically have ability to
perform stand pivot transfers or limited
ambulation ability
• Transfer device can be used
Shower Chair – Upgrade
Features and Benefits
• Tilt in space tubular steel
construction
• Can provide for nearly flat lateral
transfer
• Acceptable for general and more
difficult showering needs by
reducing sliding issues
• Height clearance for toileting
• More difficult to clean and
disinfect
• Larger casters provide improved
access for maneuverability
• Improved comfort and access
• Moderate cost
Improved Shower Chair
Additional Features
Tilt in Space Feature
Recline Function
Additional Shower Chair Options
Bariatric
Elevating
Additional Shower Chair Options
Reclining
Bariatric
Bariatric Shower Chair Options
Wouldn’t It Be Nice . . . .
Mobile tilt in space or non
tilt with footboard
Stationary tilt in space or
non tilt with footboard
Armrests medium or high
Harness
Seat pads open, closed
Lateral support
Hip guides large,
small
And pan, deflector,
abductor, splash guard,
ankle straps, calf rest etc.
Customizable Shower Chair
Reservoir Side Entry Tub
Side Entry Tub
Benefits
• Quick Fill
• Reduced chill time
• Addresses wide range of
dependency
• Transporter chair
• Spa features
• Built in disinfection system
Reservoir End Entry Design
Recumbent Style Bath
• Requires
transfer
device
• Over the
side entry
and exit
• Can be
prefilled
Side Entry Tub
• No pre-fill
• Increased chill
Factor
• Requires
greater sitting
balance and
trunk control
Side Entry Reclining Tub
• Can pre-fill the foot
well
• The recline feature
assists with seating
and positioning
issues
• Therapeutic and
disinfection features
Side Entry Reclining Tub with Ceiling
Lift Capability
Side Entry Reclining Tub
• Fast fill mixing valve
– Not pre-fill
• One step disinfecting
• Easy resident transfer into
tub
• Reclining feature
TOGETHER WE CAN
References
Tips to Reduce Bathing and Showering Challenges – A Therapist’s Role. CPI by Kim Warchol.
October 2010.
Bathing For Older People With Disabilities. State University of New York at Buffalo by Abir
Mullick.
Occupational Therapist’s Tips For Better Showering & Bathing. 2014 June 16th by Annette
Thompson, OTR/L
Myths and facts about safe patient handling in rehabilitation. Rehabil Nurs. 2008 JanFeb;33(1):10-7.
Using technology to promote safe patient handling and rehabilitation. Rehabil Nurs. 2008 JanFeb;33(1):3-9.
Centers for Disease Control and Prevention: Nonfatal Bathroom Injuries among Persons Aged >
15 Years---United States, 2008