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Lindsay C, Wolfe L, Ductan C, LeBlanc K. The Influence of Absorbent Products on Skin Integrity: A Scoping Review. J Wound Ostomy Continence Nurs 2023; 50:151-160. [PMID: 36867039 DOI: 10.1097/won.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE Absorbent products are commonly used to absorb urine and fecal matter and to mitigate potential skin complications such as incontinence-associated dermatitis (IAD). Evidence concerning the effect these products have on skin integrity is limited. This scoping review aimed to explore the evidence/literature on the effect of absorbent containment products on skin integrity. METHOD A scoping literature review. SEARCH STRATEGY The electronic databases CINAHL, Embase, MEDLINE, and Scopus were searched for published articles between 2014 and 2019. Inclusion criteria were studies that focused on urinary and/or fecal incontinence, use of incontinent absorbent containment products, impact on skin integrity, and published in English. The search identified a total of 441 articles that were identified for the title and abstract review. FINDINGS Twelve studies met inclusion criteria and were included in the review. Variability in the study designs did not allow firm conclusions regarding which absorbent products contributed to or prevented IAD. Specifically, we found variations in assessment of IAD, study settings, and types of products used. IMPLICATIONS There is insufficient evidence to support the effectiveness of one product category over another for maintaining skin integrity in persons with urinary or fecal incontinence. This paucity of evidence illustrates the need for standardized terminology, a widely used instrument for assessment of IAD, and identification of a standard absorbent product. Additional research using both in vitro and in vivo models, along with real-world clinical studies, is needed to enhance current knowledge and evidence of the impact of absorbent products on skin integrity.
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Affiliation(s)
- Carly Lindsay
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Lauren Wolfe
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Charline Ductan
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
| | - Kimberly LeBlanc
- Carly Lindsay, RN, BNSc, MClSc-WH, NSWOC, WOCC(C), Kingston Health Sciences Centre, Kingston General Hospital, Kingston, Ontario, Canada
- Lauren Wolfe, RN, BSN, MClSc-WH, NSWOC, CWOCN, Vancouver Coastal Health, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Charline Ductan, RN, BScN, MClSc-WH, CGN(C), Sunnybrook St. Michael's Hospital - Unity Health, Toronto, Ontario, Canada
- Kimberly LeBlanc, PhD, RN, NSWOC, WOCC (C), FCAN, Academic Chair, Wound, Ostomy and Continence Institute; Association of Nurses Specialized in Wound, Ostomy and Continence Canada; Advanced Practice Nurse, KDS Professional Consulting; Adjunct Professor, Faculty of Health Sciences, Western University; Affiliate Faculty, Ingram School of Nursing; Faculty of Medicine, McGill University, Orléans, Ontario, Canada and Honorary Senior Lecturer, School of Medicine, Cardiff University, Wales, United Kingdom
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Hoedl M, Bauer S, Eglseer D, Everink I, Gordon AL, Lohrmann C, Saka B, Schols JMGA, Osmancevic S. Urinary incontinence prevalence and management in nursing homes in Austria, the Netherlands, Turkey and the United Kingdom: A multi-site, cross-sectional study. Arch Gerontol Geriatr 2022; 103:104779. [PMID: 35853273 DOI: 10.1016/j.archger.2022.104779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of this study is to describe and compare the prevalence rates of urinary incontinence as well as the management of urinary incontinence in the nursing home setting in Austria, the Netherlands, Turkey and the UK. METHODS This study is a secondary analysis of the 2017 and 2018 data from a multi-site, cross-sectional study which is performed annually in the nursing home setting in Austria, the Netherlands, Turkey and the UK. RESULTS A total of 23,334 nursing home residents was included in this study, most of whom were female. The urinary incontinence prevalence rates ranged from 13.8% in Turkey to 35.1% in Austria. In all countries, the most frequently used intervention for urinary incontinence management was the use of absorbent products and/or catheters (ranging from 81% in Turkey to 94.5% in Austria). The countries differed with regard to the methods used to assess the type of urinary incontinence, scheduled individual bathroom visits and medication evaluation. In the UK (77.1%), scheduled individual bathroom visits were a more frequent measure than in Austria (51.3%), the Netherlands (24.4%) and Turkey (10.2%). CONCLUSION The most frequently used nursing intervention in all countries was the use of absorbent products and/or catheters. Future studies on the over- or misuse of these products are warranted. In order to avoid the over- or misuse of these products in the nursing home setting, the use of the evidence- and consensus-based algorithm provided by the Wound, Ostomy and Continence Nurses Society™ is recommended.
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Affiliation(s)
- Manuela Hoedl
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Silvia Bauer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Doris Eglseer
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Irma Everink
- Care and Public Health Research Institute, Department Health Services Research, Maastricht University, Minderbroedersberg 4-6, LK Maastricht 6211, the Netherlands
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Uttoxeter Road, Derby DE22 3DT, UK; East Midlands Academic Health Sciences Network Patient Safety Collaborative, Triumph Road, Nottingham NG7 2TU, UK; NIHR Applied Research Collaboration - East Midlands (ARC-EM), Triumph Road, Nottingham NG7 2TU, UK
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria
| | - Bülent Saka
- Istanbul Faculty of Medicine, Department Internal Medicine, Istanbul University, İstanbul Tıp Fakültesi Çapa - Fatih, LIstanbul, Turkey
| | - Jos M G A Schols
- Care and Public Health Research Institute, Department Health Services Research, Maastricht University, Minderbroedersberg 4-6, LK Maastricht 6211, the Netherlands
| | - Selvedina Osmancevic
- Institute of Nursing Science, Medical University of Graz, Universitätsplatz 4, Graz 8010, Austria.
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Koloms K, Cox J, VanGilder CA, Edsberg LE. Incontinence Management and Pressure Injury Rates in US Acute Care Hospitals: Analysis of Data From the 2018-2019 International Pressure Injury Prevalence™ (IPUP) Survey. J Wound Ostomy Continence Nurs 2022; 49:405-415. [PMID: 36108224 PMCID: PMC9592164 DOI: 10.1097/won.0000000000000905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to identify and describe the prevalence of incontinence (urinary and/or fecal) and incontinence management practices among patients in US adult acute care settings, with and without hospital-acquired pressure injuries (HAPIs), using the data from the 2018/2019 International Pressure Ulcer Prevalence™ (IPUP) survey. DESIGN Observational, cohort study with cross-sectional data collection and retrospective data analysis. SUBJECTS AND SETTING The sample comprised 296,014 patients hospitalized in 1801 acute care facilities in the United States that participated in 2018 and/or 2019 IPUP survey. Of these, 192,852 (65%) patients had information recorded in the survey on incontinence status and were included in the analytical sample. METHODS Data from the 2018/2019 IPUP database were analyzed to evaluate the prevalence of incontinence (urinary [UI], fecal [FI], and dual [DI]), and the use of incontinence and moisture management strategies. Incontinence prevalence was analyzed between 3 groups of patients: (1) those without pressure injuries; (2) patients with stage 1 and 2 HAPIs; and (3) those with severe HAPIs (stage 3, 4, unstageable, deep tissue pressure injury). Analysis of the subgroups within acute care was also undertaken and included medical-surgical, critical care, and step-down units. RESULTS Incontinent patients were older (mean age 69-74 years depending on type of incontinence as compared to 62 years for continent patients) and had lower Braden Scale scores (range, 14.7-16.7, compared to 19.4 for continent patients). Half of the patients were female, 49.6% male, and 0.4% were unknown. Incontinence was identified in 32% of patients. Among patients with incontinence, 33% had UI, 12% had FI, and 55% had DI. Hospital-acquired pressure injuries were present in 27.4% of continent patients and 72.6% of incontinent patients, with DI having the highest rate of HAPIs. Analysis revealed a higher proportion of incontinent patients with unstageable HAPIs than continent patients (14.9% vs 9.6%, P = .00), as well as a higher proportion of incontinent patients with deep tissue HAPIs as compared to continent patients (27.0% vs 22.1%, P = .00). Significantly more incontinent patients regardless of HAPI status were using a bowel or bladder management system (P = .00). CONCLUSION Results of this study support the importance of incontinence as a risk factor in HAPI development. The prevalence of all types of incontinence was 31.7% for the entire sample. Almost three-fourths (72.6%) of patients with HAPI had UF, FI, or DI. A standardized definition of both UI and FI is needed, given that over 70% of all critical care unit patients with a urinary catheter for incontinence management were still classified as urinary incontinent.
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Affiliation(s)
- Kimberly Koloms
- Correspondence: Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, IL 60015 ()
| | - Jill Cox
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Catherine A. VanGilder
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
| | - Laura E. Edsberg
- Kimberly Koloms, MS, Hillrom Inc, now a Baxter company, Deerfield, Illinois
- Jill Cox PhD, RN, APN-c, CWOCN, FAAN, Clinical Professor, Rutgers University School of Nursing, Newark, New Jersey/WOC Advanced Practice Nurse Englewood Health, Englewood, New Jersey
- Catherine A. VanGilder-Freese, MBA, BS, MT, CCRA, Advanced Clinical Solutions, LLC, Bristol, Tennessee
- Laura E Edsberg, PhD, Professor Natural Sciences, Center for Wound Healing Research, Natural & Health Sciences Research Center, Daemen University, Amherst, New York
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Compression for Lower Extremity Venous Disease and Lymphedema (CLEVDAL): Update of the VLU Algorithm. J Wound Ostomy Continence Nurs 2022; 49:331-346. [PMID: 35809009 DOI: 10.1097/won.0000000000000889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The Wound, Ostomy and Continence Nurses (WOCN) Society charged a task force with updating the venous leg ulcer (VLU) algorithm to include the addition of lymphedema with the new title of "Compression for Lower Extremity Venous Disease and Lymphedema (CLEVDAL)." As part of the process, the task force was charged to develop consensus-based statements to serve as clinical guidance related to CLEVDAL. The 3-member task force assisted by a moderator completed a scoping literature review to identify recommendations supported by research to qualify as evidence-based and to identify areas where guidance is needed to provide CLEVDAL. Based on the findings of the scoping review, the WOCN Society convened a panel of experts to develop consensus statements to direct care for those with lower extremity venous disease and lymphedema. These consensus statements underwent a second round of content validation with a different panel of clinicians with expertise in venous disease and lymphedema management. This article reports on the scoping review and subsequent evidence-based statements, along with the generation and validation of consensus-based statements to assist clinical decision-making in the CLEVDAL algorithm.
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Chen Y, Gao Y, Zhang J, Niu M, Liu X, Zhang Y, Tian J. Quality and clinical applicability of recommendations for incontinence-associated dermatitis: A systematic review of guidelines and consensus statements. J Clin Nurs 2022; 32:2371-2382. [PMID: 35411654 DOI: 10.1111/jocn.16306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/20/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to assess methodological quality of all currently available guidelines and consensus statements for IAD using the Appraisal of Guidelines, Research and Evaluation (AGREE) II and the AGREE Recommendation Excellence (AGREE-REX) instruments. BACKGROUND Globally, incontinence-associated dermatitis (IAD) is a significant health challenge. IAD is a complex healthcare problem that reduces quality of life of patients, increases healthcare costs and prolongs hospital stays. Several guidelines and consensus statements are available for IAD. However, the quality of these guidelines and consensus statements remains unclear. DESIGN A systematic review of guidelines and consensus statements. METHODS Our study was undertaken using PRISMA guidelines. We searched seven electronic databases. Guidelines and consensus statements had to be published in English, Chinese or German languages. Five independent reviewers assessed the methodological quality of guidelines and consensus statements using the AGREE II and AGREE-REX instruments. Mean with standard deviation (SD) and median with interquartile range (IQR) were calculated for descriptive analyses. We generated bubble plots to describe the assessment results of each domain of each guideline and consensus statement. RESULTS We included ten guidelines and consensus statements. The NICE guidelines, obtained the highest scores, fulfilled 86.11%-98.61% of criteria in AGREE II and 76.67%-91.11% for AGREE-REX. In the domains 'Stakeholder Involvement' (4.39 ± 1.64), 'Rigor of Development' (3.38 ± 1.86), 'Applicability' (3.62 ± 1.64), 'Editorial Independence' (3.91 ± 2.56) and 'Values and Preferences' (2.98 ± 1.41), the remaining guidelines and consensus statements showed deficiencies. CONCLUSIONS Altogether, this study demonstrated that the currently available guidelines and consensus statements for IAD have room for methodological improvement. NICE guidelines on faecal incontinence and urinary incontinence have better quality. Remaining guidelines and consensus statements showed substantial methodological weaknesses, especially the domains of 'Stakeholder Involvement', 'Rigor of Development', 'Applicability', 'Editorial independence' and 'Values and Preferences'. This study was registered on INPLASY. (Registration number: INPLASY202190078). RELEVANCE TO CLINICAL PRACTICE The currently available guidelines and consensus statements on IAD have room for methodological improvement.
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Affiliation(s)
- Yamin Chen
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Ya Gao
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.,School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jiaoyan Zhang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Mingming Niu
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Xiaofeng Liu
- Department of Nursing, Jingning People's Hospital, Pingliang, China
| | - Yuqin Zhang
- Department of Dermatology, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
| | - Jinhui Tian
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China.,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China.,School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
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Abstract
The Wound, Ostomy, and Continence Nurses (WOCN) Society identified the need to define and promote peristomal skin health. A task force was appointed to complete a scoping literature review, to develop evidence-based statements to guide peristomal skin health best practices. Based on the findings of the scoping review, the Society convened a panel of experts to develop evidence- and consensus-based statements to guide care in promoting peristomal skin health. These consensus statements also underwent content validation using a different panel of clinicians having expertise in peristomal skin health. This article reports on the scoping review and subsequent 6 evidenced-based statements, along with the generation and validation of 19 consensus-based statements, to assist clinical decision-making related to promoting peristomal skin health in adults.
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Burdens and Educational Needs of Informal Caregivers of Older Adults With Urinary Incontinence: An Internet-Based Study. Rehabil Nurs 2021; 46:172-178. [PMID: 33591086 DOI: 10.1097/rnj.0000000000000317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the burden and educational needs of informal caregivers of care-dependent older adults with urinary incontinence (UI). DESIGN A cross-sectional, descriptive survey of informal caregivers recruited through Google Ads was performed. METHODS An online survey, including the Overactive Bladder-Family Impact Measure, was used to assess five areas of the experience of the informal caregiver that may be affected by caring for a person with UI and their educational needs. FINDINGS Respondents (n = 77) reported a substantial impact of their care recipients' UI on their lives, with concern, travel, and social subscales most affected. However, 42% never sought treatment on behalf of their care recipient. Educational needs included UI treatment strategies and guidance to select appropriate supplies. CONCLUSIONS Caregivers underreported their care recipient's UI and need substantially more support from healthcare providers to manage the condition. CLINICAL RELEVANCE Nurses should assess for UI among care-dependent older adults and, if present, provide information and strategies to lessen the impact on caregiver lives.
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Interventions Post Catheter Removal (iPCaRe) in the Acute Care Setting. J Wound Ostomy Continence Nurs 2020; 47:601-618. [DOI: 10.1097/won.0000000000000704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fader M, Cottenden A, Chatterton C, Engqvist H, Eustice S, Newman DK, Ostaszkiewicz J, Palmer MH, Willson T, Haylen B. An International Continence Society (ICS) report on the terminology for single-use body worn absorbent incontinence products. Neurourol Urodyn 2020; 39:2031-2039. [PMID: 32914896 DOI: 10.1002/nau.24488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
AIMS In 2016, the International Continence Society (ICS) Standardization Steering Committee appointed a working group to address the confusing plethora of synonyms currently used to describe single-use body worn absorbent incontinence products by recommending preferred terminology. METHODS An online questionnaire was posted in 2016/17 inviting input from stakeholders internationally. The data were analyzed and conclusions progressively refined through working group discussions, an open meeting at the 2017 annual ICS conference, and a review of further iterations-including from the parent ICS Standardization Committee-until consensus was reached. Partway in, the International Organization for Standardization started a project with similar scope and the two organizations liaised to harmonize their conclusions while respecting each other's processes. RESULTS A hundred people from 18 countries responded to the questionnaire. About a third (32.2%) of those declaring their nationality were from the UK and a further third (34.5%) from other English-speaking countries. Two-thirds (67.8%) lived in Europe; around a quarter (23%) in North America; and 9.2% in Australasia. Seven main design categories of products were identified and, while clear consensus was readily achieved in naming some of them, others required more work to determine the best term among multiple contenders. CONCLUSIONS The working group concluded that the seven product design categories should be called: (a) pads; (b) unbacked pads; (c) male pads; (d) male pouches; (e) pull-on pads (protective underwear); (f) all-in-ones (wrap-around pads, adult briefs); and (g) belted pads (belted products), in which the bracketed terms are judged acceptable (though not preferred) alternatives.
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Affiliation(s)
- Mandy Fader
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Alan Cottenden
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | | | | | - Sharon Eustice
- Bladder & Bowel Specialist Service, Cornwall Partnership NHS Foundation Trust, Bodmin, UK
| | - Diane K Newman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Mary H Palmer
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Bernard Haylen
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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A Laboratory Method for Determining Bacterially Formed Odorants and Reducing Odor in Absorbent Incontinence Products. J Wound Ostomy Continence Nurs 2020; 46:519-523. [PMID: 31651799 DOI: 10.1097/won.0000000000000593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to design a laboratory test method to mimic the formation of bacterially formed odorants during the use of absorbent urinary incontinence products. Three odor inhibitors with different modes of action were tested and evaluated. METHODS Bacterially formed odorants in incontinence products were evaluated by adding a synthetic urine inoculated with a mixture of 4 bacterial strains to product samples cut from the incontinence products. The product samples were incubated in sealed flasks. The odorants that formed in the head space were sampled onto adsorbent tubes and analyzed by gas chromatography. The inhibitory effects of low pH, ethylenediaminetetraacetic acid (EDTA), and activated carbon were then measured. RESULTS This technique enabled production of known odorants 3-methylbutanal, guaiacol, diacetyl, and dimethyl disulfide (DMDS) in concentrations of 50 to 600 ng/L in incontinence products. The method was further evaluated by testing 3 types of odor inhibitors; EDTA significantly reduced formation of all 4 odorants (P < .001). Lowering the pH from 6.0 to 4.9 decreased levels of 3-methylbutanal, DMDS, and guaiacol (P < .001); however, diacetyl levels increased (P < .001). Activated carbon significantly reduced the formation of diacetyl, DMDS, guaiacol, and 3-methylbutanal (P < .001). CONCLUSIONS The technique we developed can be used to evaluate inhibitors with different modes of action to determine odor control in incontinence products. The odorants formed are produced by bacteria and have been identified as key contributors to the odor of used incontinence products. This work can be a step toward establishing a standard in the field of incontinence and odor control; creation of a standard will help the health care sector compare products to be purchased and benefit patients through the development of better products.
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Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers. This article is the second of two that provide an update on urinary incontinence and its management in older adults. It includes an informational tear sheet-Information for Family Caregivers-that contains links to the instructional videos. To use this series, nurses should read the articles first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.
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Abstract
A multidisciplinary international expert panel was convened to provide input for a proposed decision support tool. This tool will assist health care professionals who are not specialized in incontinence care to assess individuals with urinary and/or fecal incontinence and recommend appropriate person-centered management options for the home care and ambulatory community settings. A targeted literature review was complemented by a series of interviews with experts in continence management, followed by a practitioner survey and rounds of expert opinion. A set of factors for assessment were defined, along with questions created to identify and quantify the factors. In addition, a range of lifestyle intervention, toileting and containment strategies were identified that were appropriate for the decision support tool. Future steps required to progress this work to a functioning tool are described.
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Getting Ready for Continence Certification. J Wound Ostomy Continence Nurs 2019; 46:550-552. [DOI: 10.1097/won.0000000000000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Commentary: The Evolution of Continence Care Within WOC Nursing. J Wound Ostomy Continence Nurs 2019; 46:226-227. [PMID: 31083066 DOI: 10.1097/won.0000000000000536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Role of the Wound, Ostomy and Continence Nurse in Continence Care: 2018 Update. J Wound Ostomy Continence Nurs 2019; 46:221-225. [PMID: 31083065 DOI: 10.1097/won.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Wound, Ostomy and Continence Nurses Society believes the tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse [CWOCN]) or advanced practice tri-specialty certified nurse (Certified Wound Ostomy Continence Nurse-Advanced Practice [CWOCN-AP]) possesses unique knowledge, expertise for assessment, and first-line management of incontinence as well as for prevention of incontinence. The CWOCN or CWOCN-AP provides care and consultation in the treatment of potential and actual skin complications through absorption, and containment, in persons with urinary, fecal, or dual incontinence. This executive summary describes the role of the CWOCN or CWOCN-AP in the delivery of continence care across care settings. The original statement is available at https://cdn.ymaws.com/www.wocn.org/resource/collection/6D79B935-1AA0-4791-886F-E361D29F152D/Role_of_Continence_Nurse__2018_.pdf.
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Context for Practice. J Wound Ostomy Continence Nurs 2019; 46:87-88. [DOI: 10.1097/won.0000000000000518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Getting Ready for Continence Certification. J Wound Ostomy Continence Nurs 2019; 46:158-160. [DOI: 10.1097/won.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Where Do Women With Urinary Incontinence Find Information About Absorbent Products and How Useful Do They Find It? J Wound Ostomy Continence Nurs 2019; 46:44-50. [DOI: 10.1097/won.0000000000000494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rationale and Design of a Novel Method to Assess the Usability of Body-Worn Absorbent Incontinence Care Products by Caregivers. J Wound Ostomy Continence Nurs 2018; 45:456-464. [PMID: 30188394 PMCID: PMC6226214 DOI: 10.1097/won.0000000000000462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Supplemental Digital Content is Available in the Text. PURPOSE: The purpose of this study was to develop and test a new method to measure the usability of absorbent incontinence care products from the caregivers' perspective and to investigate if the method can be used to differentiate between product types in a product change. DESIGN: Process evaluation and validation study. SUBJECTS AND SETTING: Product developers and end users participated in designing the new method. Thereafter, professional caregivers acted as testers of the new method, ranking usability when performing absorbent product changes on patients in a simulated nursing home care environment, assisted by third-party research institute moderators. METHODS: Design and evaluation of a new method designed to assess the usability of body-worn absorbent incontinence care products for lay caregivers were completed. The evaluation included formative and summative evaluations of effectiveness (product fit), efficiency (time and physical workload), and satisfaction. A person-centered approach aimed at including all subjects and settings to generate a single usability score for decision making and product benchmarking. Experienced caregivers changed 4 types of products: (1) disposable body-worn pads with mesh briefs (2-piece system); (2) disposable all-in-one briefs; (3) disposable, T-shaped, and belted brief; and (4) disposable pull-up pants on simulated patients in standing or lying position. Each product change was performed by 1 unassisted experienced caregiver. The probability of success as a score for each product type was calculated across the 4 metrics and reported with 95% confidence intervals (CIs). Descriptive and inferential statistics were developed assuming a binary statistical model, using the weighted scores from each of the factors. An overall usability score was calculated. RESULTS: The method we developed discriminated between usability of different product types. The overall score for the disposable pull-up product (90%; CI: 83%-97%) was better (P < .05) than for the disposable T-shaped brief (83%; CI: 77%-89%), the disposable brief (53%; CI: 45%-61%), and the disposable body-worn pad with mesh pant (61%; CI: 56%-66%) in standing patients. For lying patients, the overall score for the disposable T-shaped brief product (81%; CI: 73%-89% was better (P < .05) than the disposable brief (65%; CI: 45%-61%) and the disposable body-worn pads with mesh brief (62%; CI: 55%-69%). Reliability was evaluated quantitatively in terms of measurement uncertainties in the results. CONCLUSION: The method we described demonstrated differentiation of usability based on product type indicating concurrent validity. Further testing in diverse real-world care environments is needed to evaluate and confirm the validity and to assess reliability of this method in the research setting.
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