Q
How have you been challenging your preconceptions ?
A Using the specific example of pain relief , for a long time I have assumed – likely due to institutional preconceptions – that there was scientific evidence to support my clinical reasoning . There is not .
Although I now appreciate that this impacts on my scientific clinical reasoning , my experiences of using bathing to resolve general aches and pains justifies my use of experiential clinical reasoning .
There was , however , some evidence to support balneotherapy and spa treatment for the treatment of pain . This in itself forces me to reflect on whether as an evidence based profession an ‘ it just does ’ argument is enough to justify recommendations ? One of my biggest reflections focused not on who we recommend bathing for medically , but who we have dismissed as appropriate to bathe based on their diagnosis .
Q
Can you give us an example ?
A Take someone with a diagnosis of epilepsy for example . In my experience , we are much more likely to recommend showering for someone with seizure activity because of the increased risk of fluctuating consciousness and therefore accidental drowning .
The barrier to bathing for someone with epilepsy has arisen from the complexities of the guidance around removing a person from a bath when they are having a seizure , or supporting their airways to remain clear of the water .
However , in reflecting on this I used the Person Environment Ooccupation model ( Law et al 1996 ) to determine the interaction between the three components , and therefore the potential approach to resolve or reduce the risk .
It became clear that as the marketplace has changed , so has my ability to alter the environment in new ways .
For example , I can now use a platform bath to remove the water from the person , rather than the person from the water . This significantly alters the risk assessment .
Although supervision may remain a requirement , there is no reason why , alongside a robust risk assessment , this could not be facilitated .
The same reflection stands for faecal incontinence , where the soiled water can be removed , the hi / lo feature used to adjust the bath height to suit the carer , and a shower hose used to maintain hygiene .
This applies to a number of other medical conditions or circumstances where the balance of risk may have previously tipped in favour of nonbathing alternatives .
Q
How are you applying your own values with your clients ?
A The most straightforward piece of self-reflection was to ask myself : Why do I bathe ? As a father of four boys , my bathing experiences as an adult
February 2022 OTnews 51