Journal of Gerontological Nursing

DESIGNING THE ENVIRONMENT TO MAKE BATHING PLEASANT IN NURSING HOMES

Karen Kraker, RN, MSN; Cheryl Vajdik, RN, MSN

Abstract

Communal shower /bath facilities and tightly regimented bathing schedules have been significant features of extended nursing care. Recently, clinical professionals concerned with individualizing personal care, as well as advocates for residents, have called for increased attention to individual residents' preferences and expanding options for maintaining cleanliness.

Further encouragement has come from marketing/ administration personnel who seek a competitive advantage by demonstrating to potential residents and their family members that a facility can accommodate personal preferences for bathing/ showering schedules as well as provide greater privacy and convenience in an aesthetically pleasing homelike environment.

In autumn 1994, substantial renovation was completed on the third floor at Warren Barr Pavilion, a 294bed extended care facility owned and operated by the Illinois Masonic Medical Center in Chicago. The project's goal was to de-institutionalize the floor through renovation, re-design and new construction, with the end result of improving the aesthetics and enhancing the independent living capabilities of the floor's residents. Renamed Waterford Place, the suites allow Barr Pavilion to attract residents looking for enhanced personal living options. Careful attention to flooring materials, wall treatments, lighting and furniture has converted the institutional atmosphere into a comfortable and comforting place to live.

The design of the Waterford Place suites received Contemporary Long Term Care magazine's 1995 Order of Excellence award. In informing the firm of O'Donnell, Wicklund, Pigozzi and Peterson, Architects Inc., of the awards, Elise Nakhnikian, editor-in-chief of the magazine said that judges "...were clearly impressed by your entry, calling it a great example of a project-being transformed in a way that meets the lifestyle needs of older people."

Personal bathing was, of course, among the lifestyle needs addressed by the renovation. Waterford Place cares for up to 30 patients in private or semi-private rooms. Each one or two bedroom suite contains a private bathroom with a wheelchairaccessible shower, allowing residents space, privacy and flexibility in their showering and grooming schedules. Residents are encouraged to keep personal grooming items in the bathroom's cabinets, to reinforce the homelike environment.

In planning the private bathrooms, three factors had to be considered: the attractiveness and convenience of the space, the safety of residents and the impact on staffing levels in order to provide individualized bathing schedules.

For aesthetic purposes, the bathrooms were designed to simulate the home environment as much as possible. When standard safety equipment and temperature controls were added, their colors and general design complemented the decor and did not distract from the homelike setting. For example, an attractive cloth curtain covers the plastic shower curtain in each room.

While a regular shower schedule is maintained for all residents, they are also free to request additional showers at their own convenience. As a result, residents report increased satisfaction with both the timing and the convenience of their cleanliness routines. The certified nursing assistants providing the hands-on care report increased patient compliance and less resistance to regularly scheduled showers.

Illinois regulations require one tub per floor in extended care facilities. In Waterford Place, the decision was to comply with a homelike rather than institutional, bath setting. The spacious "Spa" room on the third floor includes a non-institutional Jacuzzi with side door access, dimmer-controlled lighting as well as mirrors and counter space for personal grooming. As with showers, residents may schedule a bath appointment at their convenience. As a result of efforts to make the room as comfortable as possible, residents often choose to use it not for bathing purposes but for relaxation and personal enjoyment, with concomitant cleanliness benefits. Those with some level of dementia or agitation disorders have responded well to the soothing and therapeutic "Spa"…

Communal shower /bath facilities and tightly regimented bathing schedules have been significant features of extended nursing care. Recently, clinical professionals concerned with individualizing personal care, as well as advocates for residents, have called for increased attention to individual residents' preferences and expanding options for maintaining cleanliness.

Further encouragement has come from marketing/ administration personnel who seek a competitive advantage by demonstrating to potential residents and their family members that a facility can accommodate personal preferences for bathing/ showering schedules as well as provide greater privacy and convenience in an aesthetically pleasing homelike environment.

In autumn 1994, substantial renovation was completed on the third floor at Warren Barr Pavilion, a 294bed extended care facility owned and operated by the Illinois Masonic Medical Center in Chicago. The project's goal was to de-institutionalize the floor through renovation, re-design and new construction, with the end result of improving the aesthetics and enhancing the independent living capabilities of the floor's residents. Renamed Waterford Place, the suites allow Barr Pavilion to attract residents looking for enhanced personal living options. Careful attention to flooring materials, wall treatments, lighting and furniture has converted the institutional atmosphere into a comfortable and comforting place to live.

The design of the Waterford Place suites received Contemporary Long Term Care magazine's 1995 Order of Excellence award. In informing the firm of O'Donnell, Wicklund, Pigozzi and Peterson, Architects Inc., of the awards, Elise Nakhnikian, editor-in-chief of the magazine said that judges "...were clearly impressed by your entry, calling it a great example of a project-being transformed in a way that meets the lifestyle needs of older people."

Personal bathing was, of course, among the lifestyle needs addressed by the renovation. Waterford Place cares for up to 30 patients in private or semi-private rooms. Each one or two bedroom suite contains a private bathroom with a wheelchairaccessible shower, allowing residents space, privacy and flexibility in their showering and grooming schedules. Residents are encouraged to keep personal grooming items in the bathroom's cabinets, to reinforce the homelike environment.

In planning the private bathrooms, three factors had to be considered: the attractiveness and convenience of the space, the safety of residents and the impact on staffing levels in order to provide individualized bathing schedules.

For aesthetic purposes, the bathrooms were designed to simulate the home environment as much as possible. When standard safety equipment and temperature controls were added, their colors and general design complemented the decor and did not distract from the homelike setting. For example, an attractive cloth curtain covers the plastic shower curtain in each room.

While a regular shower schedule is maintained for all residents, they are also free to request additional showers at their own convenience. As a result, residents report increased satisfaction with both the timing and the convenience of their cleanliness routines. The certified nursing assistants providing the hands-on care report increased patient compliance and less resistance to regularly scheduled showers.

Illinois regulations require one tub per floor in extended care facilities. In Waterford Place, the decision was to comply with a homelike rather than institutional, bath setting. The spacious "Spa" room on the third floor includes a non-institutional Jacuzzi with side door access, dimmer-controlled lighting as well as mirrors and counter space for personal grooming. As with showers, residents may schedule a bath appointment at their convenience. As a result of efforts to make the room as comfortable as possible, residents often choose to use it not for bathing purposes but for relaxation and personal enjoyment, with concomitant cleanliness benefits. Those with some level of dementia or agitation disorders have responded well to the soothing and therapeutic "Spa" environment.

Many of the residents on this unit have some level of dementia. Miller noted that a comfortable environment, the use of familiar objects and the avoidance of stressful situations eases the stress of bathing the cognitively impaired person (Miller, 1995). This has been the experience noted by the staff at Waterford Place. Residents no longer need to be unclothed where others might see them. All items used by them for their bathing are their own, nothing is shared such as shampoo or shower chairs. Items needed for bathing no longer have to be collected and taken down the hall to the communal shower room.

The initial conclusions that can be drawn from the expansion of bathing options at Waterford Place clearly indicate that providing residents with increased choices and control over their bathing schedule and related activities results in substantially increased satisfaction and compliance with necessary routines. The impetus for renovation of the third floor was driven by market forces in the highly competitive Chicago extended care facility marketplace. What has emerged from the clinical caregiver standpoint, however, is increased opportunities for residents to express lifestyle choices and engage in constructive decision-making.

Rogers found that the feeling of loneliness was diminished by making the environment more homelike and by changing staff/patient interactions to be more personal (Rogers, 1989). The Waterford Place environment allows both criteria to be met. Bathing is not refused by the residents on this unit as is experienced on the other units. The level of satisfaction with their nursing care of the residents on Waterford Place is consistently high. As our population continues to age, institutions will need to change their environments to meet the needs and expectations of the people they serve. The residents of the future will not accept a dormlike environment for their residence. Environments such as Waterford Place will be the standard rather than the exception.

REFERENCES

  • Miller, R. (1995, December). Helping impaired elderly patients get through a bath. RN, 58(12), 65.
  • Rogers, B.L. (1989). Loneliness: Easing the pain of the hospitalized elderly. Journal of Gerontological Nursing, 15(8), 16-21.

10.3928/0098-9134-19970501-11

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