Effect of the Bathing Without a Battle Training Intervention on Bathing‐Associated Physical and Verbal Outcomes in Nursing Home Residents with Dementia: A Randomized Crossover Diffusion Study

OBJECTIVES: To evaluate the effectiveness of the Bathing Without a Battle intervention in reducing physical and verbal aggressive behaviors for nursing home residents with dementia. DESIGN: A randomized crossover diffusion study, with one group receiving the intervention after one round of baseline observations and a delayed intervention group receiving the intervention after two rounds of baseline observations. SETTING: Six nursing home facilities in the state of New York. PARTICIPANTS: Nursing home residents with dementia (N = 240). INTERVENTION: The Bathing Without a Battle educational program, designed for direct-care staff members responsible for bathing residents diagnosed with dementia and implemented through a train-the-trainer model. MEASUREMENTS: Rates of verbal and physical aggressive and agitated behaviors were measured using the Care Recipient Behavior Assessment; secondary measures of effect included bath duration, bath modality, and antipsychotic medication use. RESULTS: In spite of implementation obstacles (consent delays and change in leadership at one facility), a significant change was observed in how residents were bathed that translated into a significant reduction in the rate of aggressive and agitated behaviors, particularly verbal, during residents' baths. The use of in-bed baths increased 17%, and average bath duration decreased significantly (average 1.5 minutes less) in the postintervention period, particularly for in-bed baths. Verbal behaviors declined 17.8% (P = .008), combined verbal and physical behaviors declined 18.6% (P = .004), and antipsychotic use declined 30% (P = .002) after the intervention. CONCLUSION: The Bathing Without a Battle educational program, delivered through a train-the-trainer format, is an effective means of improving the bathing experience of residents with dementia in nursing homes. This research supports broadly adopting this intervention, especially for nursing homes serving many residents with dementia.