Incontinence: prevalence, management, staff knowledge and professional practice environment in rehabilitation units

Nurse and Health Care Aide Knowledge of Urinary Continence Promotion and Management In Hospitalized Older People

PURPOSE

The aims of this study were to determine if there was a change in medical unit nursing staffs' knowledge about lower urinary tract symptoms following an education presentation and whether the education session met their learning needs.

DESIGN

Single-group, before-after study.

SUBJECTS AND SETTING

The study sample comprised 21 licensed nurses and 16 health care aides from 3 medical units in a tertiary care hospital in western Canada.

METHODS

Participants completed pre- and post-true/false questionnaires developed for the project to assess lower urinary tract symptom knowledge, and a questionnaire to determine whether the education session met staff learning needs.

RESULTS

Knowledge was moderate on the pretest in both groups, with licensed nurses showing a significant improvement after the education intervention. Health care aides did not have a significant change in knowledge; they persisted in their belief that incontinence is a normal change of aging.

CONCLUSIONS

Health care aides need targeted education and enhanced care processes to shift their knowledge and thinking about continence.

Older Persons and Nursing Staff's Perspectives on Continence Care in Rehabilitation: A Qualitative Study

PURPOSE

The aim of the study was to understand continence care in geriatric rehabilitation from the perspectives of older persons and nursing staff.

DESIGN

This is a qualitative descriptive study.

METHODS

Ten patients and 10 nursing staff participated in semistructured interviews. Observations of care were recorded in field notes. Content analysis was used to develop themes of patient and nursing staff perspectives.

FINDINGS

Three themes were developed: Perceptions of Assessment, Continence Management, and Rehab: The Repair Shop. Patients had limited insight into continence assessment and management by nursing staff. For older persons, incontinence was embarrassing and created dependence; independence in toileting meant gaining control. Staff viewed continence as an important part of rehabilitation nursing but focused on containment and regular toileting, with patients seeing absorbent pads as commonly suggested.

CONCLUSIONS

Continence care approaches that engage older persons during rehabilitation are needed.

CLINICAL RELEVANCE

Restoration of continence through patient-centered care is core to older person rehabilitation.

Registered nurse's experiences of continence care for older people: A qualitative descriptive study

AIM

This study aimed to illuminate nurses' experience of continence care for older people receiving home care, either in their own home or in an assisted living facility.

BACKGROUND

Registered Nurses (RNs) have a major role to play in identifying and establishing appropriate actions regarding continence care for older people. However, the crucial nursing care pathway for continence care is commonly described as poor.

METHODS

Interviews were conducted with 11 RNs providing home care, and the transcribed texts were analysed using inductive content analysis.

RESULT

The impressions of RNs were categorised according to four themes: perceptions of continence care, an open approach to continence care, the need for personalised aid fittings and the importance of teamwork in continence care. Key findings were the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care; substantiation that evidence-based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care; and the need for nurses to support the right of older persons to receive an assessment of their continence problems, deemed to be the minimum standard of quality care.

CONCLUSION

The provision of continence care that is based on key nursing standards, such as evidence-based and person-centred care, as well as individualised continence care that is based on evidenced-based guidelines, would ensure an improvement in the continence care that is presently on offer to older people.

IMPLICATIONS FOR PRACTICE

Nurses need to embrace leadership at the point of care and to be more visible with the provision of direct care in order to improve continence care for older people receiving home care.

Post-Cerebrovascular Accident Unpredictable Incontinence: A Qualitative Analysis of an Interdisciplinary Rehabilitation Team's Perspective

PURPOSE

This study investigates experiences of the interdisciplinary rehabilitation team in the treatment of patients with urinary incontinence after stroke.

DESIGN

A qualitative approach was chosen. Ten members of an interdisciplinary treatment team were interviewed in a neurological inpatient rehabilitation setting.

METHODS

Data were obtained via focus groups with nurses, physicians, physiotherapists, and occupational therapists in a rehabilitation clinic. The analysis followed the principles of qualitative content analysis.

FINDINGS

According to the interdisciplinary treatment team, professionals and patients prioritize incontinence treatment differently. Challenges surrounding collaboration, communication, structural conditions, and the perception of intervention success were identified as barriers to promoting continence.

CONCLUSION

To overcome this discrepancy in treatment priority, awareness of poststroke urinary incontinence must be improved.

CLINICAL RELEVANCE

A key component is communication about urinary incontinence with patients and among team members.

"Will I come home incontinent?" A retrospective file review: Incidence of development of incontinence and correlation with length of stay in acute settings for people with dementia or cognitive impairment aged 65 years and over

AIM

The aim of the retrospective file review is to obtain incidence of the development of incontinence at time of discharge from an acute/sub-acute care setting for patients who were aged 65 years and over, diagnosed with dementia or cognitive impairment, ambulant and continent pre-admission. Along with, identifying correlation between length of stay and development of incontinence. The data were obtained to measure a need for recommendations related to continence promotion in hospitals. It is hypothesised that the sample group are at risk of developing incontinence throughout their stay.

METHOD

Files for the sample group who were admitted to a regional Victorian hospital acute/sub-acute care over a two-year period were reviewed. A total of 182 files were reviewed, of which 100 files met the inclusion criteria.

RESULTS

The study revealed a significant relationship between admission and the development of incontinence for the sample group (p = .007). At time of discharge from the hospital, 36% suffered urinary incontinence. Of the 36%, 2% also developed new faecal incontinence at time of discharge. A further 21% of patients also experienced an episode of urinary incontinence throughout their stay, but were continent at discharge. An independent-sample t-test was conducted to compare mean length of stay between the group that remained continent (M = 15.88, SD = 13.028) and the group that developed incontinence (M = 24.33, SD = 19.497); t(98) = 2.586, p = .011 (two-tailed).

CONCLUSION

Statistically significant results confirm the hypothesis' that the; sample group are at significant risk of developing incontinence throughout a hospital admission, and increased length of stay increases the likelihood of developing a form of incontinence.

[Nurses' interventions in the management of urinary incontinence in the elderly: an integrative review]

The objective of this study was to verify the strategies that nurses use to manage urinary incontinence (UI) in the elderly. An integrative literature review was performed on the following databases: WEB OF SCIENCE, MEDLINE, SCOPUS and CINAHL, in the period from 2006 to 2010. A total of 186 articles were located, and after excluding duplicates and performing a careful reading of the full articles, the sample was comprised of seven articles. Most studies utilize an overall approach to urinary incontinence, without characterizing the type or the subjects' claims. Only one study addressed the management of urinary incontinence in the elderly with dementia; another specified the type (hyperactive bladder). Therefore, there is a need for further clinical nursing studies regarding the management of urinary incontinence, aiming to provide scientific evidence to support this practice.