“Heartbreaking, Hardest Part of the Job”: A Qualitative Descriptive Study of Acute Care Nurses’ Work with Patients with Dementia Who Self-Neglect Their Hygiene
Abstract
1. Introduction
2. Materials and Methods
2.1. Research Questions
2.2. Study Design
2.3. Participant Selection and Interviews
2.4. Ethics
2.5. Data Analysis
3. Results
3.1. Theme One: Non-Preferred Approaches to Care
3.2. Theme Two: Preferred Approaches to Care
3.3. Theme Three: Barriers to Actualizing Preferred Approaches
3.4. Theme Four: Responding to Continued Resistance to Care
3.5. Theme Five: Justified Use of Force
3.6. Theme Six: Minimizing the Harm
4. Discussion
Recommendations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Professional designation | |
Licensed/registered practical nurse | 5 |
Registered nurse | 13 |
Years of nursing experience | |
>10 | 5 |
<10 | 13 |
Gender | |
Man | 2 |
Woman | 16 |
Race | |
Latina/o/x | 1 |
Black | 1 |
White | 16 |
Employment status | |
Full-time | 14 |
Part-time | 3 |
Retired | 1 |
Area of specialization | |
Medical/surgical nursing | 9 |
Intensive care | 2 |
Emergency medicine | 4 |
Neurology | 2 |
Geographic distribution | |
Urban | 13 |
Rural | 5 |
Participant (n = 18) | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Critique. | Angela | Nancy | Anna | Astrid | Joy | Sophie | Nicole | Alexa | Margaret | Ella | Bethany | Shaina | Evangeline | Beatrice | Nancy | Donald | Jesus | Stella | Total (n/%) |
Failing to assess cognition and the root causes of behaviors | X | X | X | X | X | X | X | X | X | X | X | X | 12 (66.7%) | ||||||
Doing the care in the evening | X | X | X | X | X | X | X | X | X | X | X | 11 (61.1%) | |||||||
Ineffective communication with patient during care | X | X | X | X | X | X | 6 (33.3%) | ||||||||||||
Failing to ask about home routines | X | X | X | X | X | 5 (27.8%) | |||||||||||||
Taking the patient into an enclosed room | X | X | X | X | X | 5 (27.8%) | |||||||||||||
Failing to recognize or consider the signs of past trauma/abuse | X | X | X | X | X | 5 (27.8%) | |||||||||||||
Moving too quickly | X | X | X | 3 (16.7%) | |||||||||||||||
Failing to recognize the urgency of the patient’s need for care | X | X | X | 3 (16.7%) | |||||||||||||||
Trying to do all care at once | X | X | 2 (11.1%) | ||||||||||||||||
Failing to ask permission to unbutton his pants | X | X | 2 (11.1%) | ||||||||||||||||
Labeling the patient as aggressive | X | X | 2 (11.1%) | ||||||||||||||||
Having too many people in the room during care | X | X | 2 (11.1%) | ||||||||||||||||
Missing the patient’s non-verbal cues | X | X | 2 (11.1%) | ||||||||||||||||
Considering chemical restraints too quickly | X | X | 2 (11.1%) | ||||||||||||||||
Not following or forming a care plan | X | X | 2 (11.1%) | ||||||||||||||||
Not considering chemical restraints earlier | X | 1 (5.6%) | |||||||||||||||||
Reapproaching too many times | X | 1 (5.6%) | |||||||||||||||||
Not reapproaching enough | X | 1 (5.6%) |
Participant N = 18 | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Approach | Angela | Nicole | Astrid | Alexa | Margaret | Anna | Joy | Sophie | Ella | Bethany | Nancy | Stella | Jesus | Shaina | Donald | Karen | Beatrice | Evangeline | Total (n/%) |
PRN medication or scheduling care for after medications take effect | X | X | X | X | X | X | X | X | X | X | X | 11 (61.1%) | |||||||
Wait until patient is comfortable with staff | X | X | X | X | X | X | X | X | X | X | X | 10 (55.6%) | |||||||
Ask for help (different gender) | X | X | X | X | X | X | X | X | X | 9 (50%) | |||||||||
Ask for help (colleague with better rapport) | X | X | X | X | X | X | X | X | 8 (44.4%) | ||||||||||
Ask for help (family) | X | X | X | X | X | X | X | X | 8 (44.4%) | ||||||||||
Describe procedure and/or risks to declining care | X | X | X | X | X | X | X | X | 8 (44.4%) | ||||||||||
Non-aggressive touch | X | X | X | X | X | X | X | 7 (38.9%) | |||||||||||
Bring a support person to help you | X | X | X | X | X | X | 6 (33.3%) | ||||||||||||
Giving options (location/mode of bathing) | X | X | X | X | X | 5 (27.8%) | |||||||||||||
Set up the tools and let patient wash themselves | X | X | X | X | X | 5 (27.8%) | |||||||||||||
Attend to setting events (e.g., hunger) | X | X | X | X | X | 5 (27.8%) | |||||||||||||
Ask for help (finding “the one” staff who can connect with the patient) | X | X | X | X | 4 (22.2%) | ||||||||||||||
Divide the bath up into parts | X | X | X | X | 4 (22.2%) | ||||||||||||||
Distraction/rewards | X | X | X | 3 (16.7%) | |||||||||||||||
Ask for help (doctor) | X | X | X | 3 (16.7%) | |||||||||||||||
Interdisciplinary collaboration | X | X | 2 (11.1%) | ||||||||||||||||
Being ready when patient enters bathroom on their own | X | 1 (5.6%) | |||||||||||||||||
“Bathing Without a Battle” approaches | X | 1 (5.6%) | |||||||||||||||||
Do care in the bed | X | 1 (5.6%) | |||||||||||||||||
Describe your position as senior staff | X | 1 (5.6%) |
Participants (n = 13) | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Risks | Angela | Nicole | Astrid | Alexa | Margaret | Anna | Sophie | Ella | Bethany | Stella | Jesus | Donald | Evangeline | Total (n=/%) |
Skin breakdown | X | X | X | X | X | X | X | X | X | X | X | X | X | 13 (100%) |
Infection | X | X | X | X | X | X | X | X | X | X | 10 (76.9%) | |||
Impacting the patient’s health (general) | X | X | X | X | X | 5 (38.5%) | ||||||||
Sepsis | X | X | X | 3 (23.1%) | ||||||||||
Social impacts | X | X | X | 3 (23.1%) | ||||||||||
Prolonged hospital stay | X | X | 2 (15.4%) | |||||||||||
Death | X | X | 2 (15.4%) | |||||||||||
Mood | X | X | 2 (15.4%) | |||||||||||
Prolonging treatment | X | 1 (7.7%) |
Participants (n = 8) | |||||||||
---|---|---|---|---|---|---|---|---|---|
Rationale | Angela | Nicole | Astrid | Alexa | Margaret | Sophie | Ella | Jesus | Total (n=/%) |
To get it over with | X | X | X | X | X | 5 (62.5%) | |||
Tasks on acute care floors must be done quickly | X | X | X | 3 (37.5%) | |||||
Less traumatizing for the patient | X | X | X | 3 (37.5%) | |||||
Less traumatizing to the staff | X | 1 (12.5%) | |||||||
To reassure the patient | X | 1 (12.5%) | |||||||
To be efficient | X | 1 (12.5%) | |||||||
Unsure | X | 1 (12.5%) |
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Morris, P.; McCloskey, R.; Durkee-Lloyd, J.; O’Regan, K. “Heartbreaking, Hardest Part of the Job”: A Qualitative Descriptive Study of Acute Care Nurses’ Work with Patients with Dementia Who Self-Neglect Their Hygiene. Healthcare 2025, 13, 1562. https://doi.org/10.3390/healthcare13131562
Morris P, McCloskey R, Durkee-Lloyd J, O’Regan K. “Heartbreaking, Hardest Part of the Job”: A Qualitative Descriptive Study of Acute Care Nurses’ Work with Patients with Dementia Who Self-Neglect Their Hygiene. Healthcare. 2025; 13(13):1562. https://doi.org/10.3390/healthcare13131562
Chicago/Turabian StyleMorris, Patricia, Rose McCloskey, Janet Durkee-Lloyd, and Karla O’Regan. 2025. "“Heartbreaking, Hardest Part of the Job”: A Qualitative Descriptive Study of Acute Care Nurses’ Work with Patients with Dementia Who Self-Neglect Their Hygiene" Healthcare 13, no. 13: 1562. https://doi.org/10.3390/healthcare13131562
APA StyleMorris, P., McCloskey, R., Durkee-Lloyd, J., & O’Regan, K. (2025). “Heartbreaking, Hardest Part of the Job”: A Qualitative Descriptive Study of Acute Care Nurses’ Work with Patients with Dementia Who Self-Neglect Their Hygiene. Healthcare, 13(13), 1562. https://doi.org/10.3390/healthcare13131562