External Applications in Anthroposophic Nursing

Tinkling Wash

Kind of substance

Water

Guiding principle

Tinkling washes are a form of therapeutic washing reduced to the hands, face and feet (usually done only with warm water, without additives). They do not serve to cleanse the body, they enable a process of letting go, re-immersing and once again taking hold of the diseased body in critical situations that occur, and they resemble the Pentagram Rhythmical Einreibung in terms of their effect (see there). Tinkling washes can help if body contact and substance effects seem too oppressive to the patient and a stagnating situation needs to be brought back into flow. They are particularly suitable for patients who are very weakened and severely restricted in self-care.
The tinkling wash takes its name from the splashing sound of the water, which is produced when water is poured over the patient’s hands and feet. The sound of the tinkling water reminds us of “the water of life”, and hopeful images can emerge within, reminiscent of the “eternal stream of life”. The quality of touch and attention in connection with water and warmth is of particular importance in this application.
Partial baths as tinkling washes (hand or foot baths) can be used as a variation, if required, when a further reduction of the application appears sensible.

Indications

  • Fear (Example case 3)
  • Restlessness with dementia, defensive behavior
  • Crisis situations after severe interventions, traumas (Example case 2)
  • Severe exhaustion
  • The dying process (Example case 1)
  • Agitation

Instructions

Materials

  • Washing glove
  • Low basin with warm water
  • 2 terrycloth towels to protect the bed and dry the patient


Instructions
  • Ensure quiet during treatment
  • Position the patient with a semi-erect upper body


At the beginning, the caregiver stands on the right side of the patient and touches the left side of the patient’s face with a warm, wrung out washing glove, remains for a moment and releases again without making a wiping or rubbing movement. The same procedure is applied to the right side of the face. Then both halves of the face are dried with the same quality of touch.
To wash the hands and feet, place the bowl with warm water at hip or calf level on the bed, laying a terrycloth towel underneath in each case. 
Stand next to the bed (facing the patient’s face) and hold the patient’s forearm with your nearest hand so that her fingertips are immersed in water.
With your free hand you let the water flow very slowly and rhythmically with a tinkling sound 3–5 times over her hand. Afterwards, put the squeezed out washing glove into the palm of the patient's hand for a moment. After removing the bowl, place the patient’s hand and forearm on the towel and gently dry them. Then change sides and treat the patient’s left hand in the same way.
For the footbath, stand on one side of the bed next to the patient (looking towards the patient’s feet) and place your nearest hand from outside under the hollow of the patient’s knee and calf and lift the foot into the basin. If the knee cannot be bent, place cushions under the leg so that the foot can be placed over the bowl at the foot end. Then hold the leg with your hand and forearm, and with your other hand scoop water over the foot, as described above. When you are finished, place the foot on the terrycloth towel underneath and gently dry it off.

Evidence
Well-proven in many patients
Dosage
As needed
Onset of effect
Immediate
Length of therapy
As needed
Other recommended therapies
An aurum-lavender heart compress

Case example

Example case 1
A male patient, 56 years old, with advanced bronchial carcinoma, felt that he did not have much time left to live. He usually refused any attention because everything was too much for him. His great weakness and restlessness also did not permit any major nursing care measures associated with effort. He was offered a tinkling wash of his hands and feet, which he accepted. He was able to relax thanks to the wash and said: “That was nice. I feel better.” On the following days he gladly accepted this treatment again.
BW

Example case 2
A general experience with young men suffering from spontaneous pneumothorax shows that they feel inwardly overwhelmed by what is happening to them. They have not practiced self-perception and expressing their needs. Despite pain management, they find themselves in extreme situations and are then paralyzed. Tinkling washes are an astonishing remedy in this situation and are accepted with childlike amazement, with relieving tears or laughter.
UT

Example case 3
A young woman with breast carcinoma, pulmonary metastases and pleural effusion in pleural carcinoma was about to undergo thoracic surgery and was completely tense and blocked by anxiety. A single tinkling wash enabled her to relax, afterwards she was warmed through and inwardly unblocked, so that the tears could flow. The relief already occurred during the hand bath and her body tension was eased. Her arm became heavy and her breathing deepened, her shoulders sank, her chest widened, and her face shone rosy – she smiled.
UT

Author

Red., BW, UT, US

Bibliography

  • Heine R. Variationen zur Ganzkörperwaschung, in:  Anthroposophische Pflegepraxis, Salumed Verlag, Berlin, 2017, p. 313–324
  • Heine R. Die “Klingende Waschung”, in: Dimensionen therapeutischer Prozesse in der Integrativen Medizin. Springer, Wiesbaden, 2016, p. 123–144.
  • Kierey B. Die «Klingende Waschung» in der ambulanten Pflege. Schweizerische Zeitschrift für Ganzheitsmedizin/Swiss Journal of Integrative Medicine 29.2 (2017): 103–104.

Substances