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Winberg M, Hälleberg Nyman M, Fjordkvist E, Eldh AC, Joelsson-Alm E. Adherence to evidence-based guidelines for prevention of urinary retention in hip surgery patients: a multicentre observational study. Int J Qual Health Care 2024; 36:mzae045. [PMID: 38804913 PMCID: PMC11155696 DOI: 10.1093/intqhc/mzae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/01/2024] [Accepted: 05/27/2024] [Indexed: 05/29/2024] Open
Abstract
Urinary retention is a healthcare complication putting patients at risk of unnecessary suffering and harm. Orthopaedic patients are known to face an increased such risk, calling for evidence-based preoperative assessment and corresponding measures to prevent bladder problems. The aim of this study was to evaluate healthcare professionals' adherence to risk assessment guidelines for urinary retention in hip surgery patients. This was an observational study from January 2021 to April 2021 with a descriptive and comparative design, triangulating three data sources: (I) Medical records for 1382 hip surgery patients across 17 hospitals in Sweden were reviewed for preoperative risk assessments for urinary retention and voiding-related variables at discharge; (II) The patients completed a survey regarding postoperative lower urinary tract symptoms, and; (III) data were extracted from a national quality registry regarding type of surgery, preoperative physical status, and perioperative urinary complications. Group differences were analysed with Chi-square/Fisher's exact test, t-test, Wilcoxon rank-sum test, or Mann-Whitney U-test. Logistic regression was used to analyse variables associated with completed risk assessments for urinary retention. Of all study participants, 23.4% (n = 323) had a preoperative documented risk assessment of urinary retention. Whether a risk assessment was performed was significantly associated with acute surgery [odds ratio (OR) 3.56, 95% confidence interval (CI) 2.48-5.12] and undergoing surgery at an academic hospital (OR 4.59, 95% CI 2.68-7.85). Acute patients were more often affected by urinary retention and had bladder issues and/or an indwelling catheter at discharge. More than every tenth patient (11. 9%, n = 53) completing the survey experienced intensified bladder problems after their hip surgery. The study shows a lack of adherence to risk assessment for urinary retention according to evidence-based guidelines, which negatively affects quality of care and patient safety.
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Affiliation(s)
- Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 83, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro SE-701 82, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro SE-701 82, Sweden
- Faculty of Medicine and Health, University Health Care Research Center, Örebro SE-702 82, Sweden
| | - Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro SE-701 82, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro SE-701 82, Sweden
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping SE-581 83, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm SE-118 83, Sweden
- Department of Anaesthesia and Intensive Care, Södersjukhuset, Stockholm SE-118 83, Sweden
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Arroyo-Huidobro M, de la Fuente JL, Pagespetit MR, Perez OM, Morera JR, López AMA, Casanova DA, Garcia-Lerma E, Pérez-López C, Rodríguez-Molinero A. Incidence of urinary incontinence after hip fracture surgery and associated risk factors: a prospective study. BMC Geriatr 2024; 24:3. [PMID: 38166670 PMCID: PMC10763427 DOI: 10.1186/s12877-023-04597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The contribution of the postoperative process to developing or worsening urinary incontinence (UI) after hip fracture surgery (HFS) remains unclear. We aimed to evaluate UI incidence and worsening among older patients undergoing HFS, and explore associated risk factors. METHODS This prospective cohort study included patients ≥ 75 years admitted between October 2019 and October 2021 to the Traumatology Service of three hospitals in the Consorci Sanitari de Alt-Penedès i Garraf (Barcelona, Spain) with hip fracture requiring surgical treatment. UI was assessed using the first two questions of the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) at baseline and at days 30 (± 3 days) and 90 (± 3 days) after HFS. Surgery-related data and post-surgical complications were recorded. RESULTS A total of 248 patients with a mean (SD) age of 85.8 (6.78) years were included; 77.8% were female and 154 (62.1%) had UI at baseline. After HFS, 3.24% experienced urinary tract infections (UTIs), 3.64%, acute urinary retention (AUR), 8.57%, constipation, and 53.9%, prolonged catheterization (> 24 h). Fifty-eight patients without baseline UI developed UI at 30 days, resulting in a UI incidence of 61.7% (95% CI 51.1-71.54) between days 0 and 30. Of the 248 patients, 146 (59.1%) experienced worsening of UI. AUR and UTIs were identified as risk factors for UI development and worsening after HFS, respectively. CONCLUSION The incidence of UI in older patients after HFS is significant. Patient management protocols should consider AUR and UTIs to reduce or eliminate the incidence of UI in older patients undergoing HFS.
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Affiliation(s)
- Marta Arroyo-Huidobro
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain.
- Geriatrics Unit, Department of Internal Medicina, Hospital Clinic de Barcelona, C. de Villarroel, 170, Barcelona, 08036, Spain.
| | - Josefa López de la Fuente
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Mar Riera Pagespetit
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Oscar Macho Perez
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Jaume Roig Morera
- Geriatrics Area, Hospital Vilafranca, Consorci Santiari Alt'Pènedes i Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - Anna Maria Abelleira López
- Geriatrics Area, Hospital Vilafranca, Consorci Santiari Alt'Pènedes i Garraf, Vilafranca del Penedès, Barcelona, Spain
| | - David Aivar Casanova
- Hospital Residencia Sant Camil, Consorci Santiari Alt'Pènedes i Garraf, Sant Pere de Ribes, Barcelona, Spain
| | - Esther Garcia-Lerma
- Biostatistics Unit, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospital de Llobregat, Barcelona, Spain
| | - Carlos Pérez-López
- Area de Recerca, Consorci Sanitari Alt'Pènedes I Garraf, Villafranca del Penedès, Barcelona, Spain
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Campbell J, Hubbard R, Ostaszkiewicz J, Green T, Coyer F, Mudge A. Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes. Age Ageing 2023; 52:afad181. [PMID: 37738169 PMCID: PMC10516354 DOI: 10.1093/ageing/afad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Incontinence is common in hospitalised older adults but few studies report new incidence during or following hospitalisation. OBJECTIVE To describe prevalence and incidence of incontinence in older inpatients and associations with clinical outcomes. DESIGN Secondary analysis of prospectively collected data from consecutive consenting inpatients age 65 years and older on medical and surgical wards in four Australian public hospitals. METHODS Participants self-reported urinary and faecal incontinence 2 weeks prior to admission, at hospital discharge and 30 days after discharge as part of comprehensive assessment by a trained research assistant. Outcomes were length of stay, facility discharge, 30-day readmission and 6-month mortality. RESULTS Analysis included 970 participants (mean age 76.7 years, 48.9% female). Urinary and/or faecal incontinence was self-reported in 310/970 (32.0%, [95% confidence interval (CI) 29.0-35.0]) participants 2 weeks before admission, 201/834 (24.1% [95% CI 21.2-27.2]) at discharge and 193/776 (24.9% [95% CI 21.9-28.1]) 30 days after discharge. Continence patterns were dynamic within the peri-hospital period. Of participants without pre-hospital incontinence, 74/567 (13.1% [95% CI 10.4-16.1) reported incontinence at discharge and 85/537 (15.8% [95% CI 12.8-19.2]) reported incontinence at 30 days follow-up. Median hospital stay was longer in participants with pre-hospital incontinence (7 vs. 6 days, P = 0.02) even in adjusted analyses and pre-hospital incontinence was significantly associated with mortality in unadjusted but not adjusted analyses. CONCLUSION Pre-hospital, hospital-acquired and new post-hospital incontinence are common in older inpatients. Better understanding of incontinence patterns may help target interventions to reduce this complication.
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Affiliation(s)
- Jill Campbell
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
- Geriatric Medicine Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Joan Ostaszkiewicz
- Aged Care Division, National Ageing Research Institute, Melbourne, Australia
- Health and Innovation Transformation Centre, Federation University, Ballarat, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Theresa Green
- School of Nursing, Midwifery & Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona Coyer
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Australia
- Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Alison Mudge
- Internal Medicine and Aged Care Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Greater Brisbane Clinical School, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Winberg M, Hälleberg Nyman M, Fjordkvist E, Joelsson-Alm E, Eldh AC. Patients' experiences of urinary retention and bladder care - A qualitative study in orthopaedic care. Int J Orthop Trauma Nurs 2023; 50:101034. [PMID: 37437464 DOI: 10.1016/j.ijotn.2023.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/25/2023] [Accepted: 06/07/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Urinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines prescribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients' experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation. PURPOSE The aim was to describe patients' experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery. METHOD This was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden. RESULTS The patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients' experiences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self-management strategies and further care. CONCLUSIONS Patients' perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.
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Affiliation(s)
- Madeleine Winberg
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden.
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82, Örebro, Sweden; Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Erika Fjordkvist
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82, Örebro, Sweden; Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83, Stockholm, Sweden.
| | - Ann Catrine Eldh
- Faculty of Medicine and Health Sciences, Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden.
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Hunter KF, Dahlke SA. Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons. Int J Older People Nurs 2023; 18:e12538. [PMID: 37013362 DOI: 10.1111/opn.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations. OBJECTIVES To examine nursing practice with older people through the lens of unconscious bias. METHODS In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care. RESULTS Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow. CONCLUSIONS Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice. IMPLICATIONS FOR PRACTICE Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person-centered care in unit practices.
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Affiliation(s)
- Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Ann Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Rosendal KA, Lehn S, Overgaard D. Body care of older people in different institutionalized settings: A systematic mapping review of international nursing research from a Scandinavian perspective. Nurs Inq 2023; 30:e12503. [PMID: 35666581 PMCID: PMC10078501 DOI: 10.1111/nin.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
Body care is considered a key aspect of nursing and imperative for the health, wellbeing, and dignity of older people. In Scandinavian countries, body care as a professional practice has undergone considerable changes, bringing new understandings, values, and dilemmas into nursing. A systematic mapping review was conducted with the aims of identifying and mapping international nursing research on body care of older people in different institutionalized settings in the healthcare system and to critically discuss the dominant assumptions within the research by adapting a problematization approach. Most identified papers reported on empirical research with a biomedical approach focusing on outcome and effectiveness. Conceptual papers, papers with a focus on the perspectives of the older people, or contextual and material aspects were lacking. The research field is dominated by four dominant assumptions: Body care as an evidence-based practice, body care as a relational ethical practice, the body as a body-object and a body-subject, the objects in the body care practices as nonrelational materialities. Given the complexities of professional body care practices, there is a need for other research designs and theoretical perspectives within nursing that expand our understanding of body care taking into consideration the multiple social and material realities.
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Affiliation(s)
- Kirstine A Rosendal
- Department of People and Technology, Research Centre in Health Promotion, University of Roskilde, Roskilde, Denmark
| | - Sine Lehn
- Department of People and Technology, Research Centre in Health Promotion, University of Roskilde, Roskilde, Denmark
| | - Dorthe Overgaard
- Department of Nursing and Nutrition, Faculty of Health, University College Copenhagen, Copenhagen N, Denmark
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Eldh AC, Hälleberg-Nyman M, Joelsson-Alm E, Wallin L. Facilitating facilitators to facilitate-Some general comments on a strategy for knowledge implementation in health services. FRONTIERS IN HEALTH SERVICES 2023; 3:1112936. [PMID: 37138952 PMCID: PMC10149731 DOI: 10.3389/frhs.2023.1112936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/23/2023] [Indexed: 05/05/2023]
Abstract
Numerous endeavours to ensure that day-to-day healthcare is both evidence-based and person-centred have generated extensive, although partial, comprehension of what guarantees quality improvement. To address quality issues, researchers and clinicians have developed several strategies as well as implementation theories, models, and frameworks. However, more progress is needed regarding how to facilitate guideline and policy implementation that guarantees effective changes take place in a timely and safe manner. This paper considers experiences of engaging and supporting local facilitators in knowledge implementation. Drawing on several interventions, considering both training and support, this general commentary discusses whom to engage and the length, content, quantity, and type of support along with expected outcomes of facilitators' activities. In addition, this paper suggests that patient facilitators could help produce evidence-based and person-centred care. We conclude that research about the roles and functions of facilitators needs to include more structured follow-ups and also improvement projects. This can increase the speed of learning with respect to what works, for whom, in what context, why (or why not), and with what outcomes when it comes to facilitator support and tasks.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Correspondence: Ann Catrine Eldh
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
- Department of Orthopaedics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Lars Wallin
- Department of Health and Welfare, Dalarna University, Falun, Sweden
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Northcott A, Boddington P, Featherstone K. Pad cultures: An ethnography of continence care and its consequences for people living with dementia during a hospital admission. DEMENTIA 2022; 21:2191-2209. [PMID: 35861583 PMCID: PMC9483683 DOI: 10.1177/14713012221116490] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is little research examining how continence care is organised and delivered to people living with dementia across an acute hospital admission, despite the prevalence of this patient population and their vulnerability within these settings. OBJECTIVE To explore how continence care is delivered to people living with dementia during an acute hospital admission. DESIGN Ethnographic. SETTING(S) Acute medical units and wards within three hospitals across England and Wales. PARTICIPANTS People living with dementia and ward staff (registered nurses and care assistants) on participating wards. METHODS Ethnographic fieldwork collected over a period of 12 months (180 days of non-participant observation) focussing on the organisation and delivery of continence care to people living with dementia. Observations were supported with in situ ethnographic interviews (n = 562) with patients, visitors and staff within the six observed wards. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory. RESULTS The findings comprised of five overall themes: (1) visibility of continence; (2) rationales of continence care; (3) containment and contagion; (4) consequences of continence care and (5) supporting continence. CONCLUSIONS We introduce the term 'pad cultures' to refer to the established routine use of continence pads in the care of a wider group of people living with dementia (regardless of continence status and independence), with the rationale to provide safeguards, ensure containment and prevent 'accidents' or incontinent episodes. There was an expectation within acute wards that people living with dementia not only wear continence pads but that they also use them.
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Affiliation(s)
- Andy Northcott
- Geller Institute of Ageing and Memory, University of West London, Ealing, London, UK
| | - Paula Boddington
- Geller Institute of Ageing and Memory, University of West London, Ealing, London, UK
| | - Katie Featherstone
- Geller Institute of Ageing and Memory, University of West London, Ealing, London, UK
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Prevalence and Risk Factors of Urinary Incontinence Among Elderly Adults in Rural China: A Cross-Sectional Survey. J Wound Ostomy Continence Nurs 2022; 49:78-86. [PMID: 35040817 DOI: 10.1097/won.0000000000000829] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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 explore the prevalence of urinary incontinence (UI) and several subtypes: (stress, urge, and mixed UI) and the influence of multiple factors on the likelihood of UI. DESIGN Epidemiological study based on cross-sectional data collection. SUBJECTS AND SETTING The sample comprised 1279 inhabitants 65 years and older residing in 10 villages randomly selected from the Shanxi province, located in North China. METHODS The presence and types of UI were assessed using the International Consultation of Incontinence Questionnaire-Short Form. Sociodemographic parameters were also recorded, along with data on lifestyle, bowel function, and medical conditions. The Activity of Daily Living Scale and Mini-Mental State Examination instruments were used to evaluate physical and cognitive functions, respectively. A multivariate logistic regression model with the backward method was employed to identify factors associated with UI. RESULTS The prevalence of any UI among the rural Chinese elderly 65 years and older was 46.8%, with a female predominance (56.3% in females vs 35.0% in males). The most common incontinence subtype in women was mixed UI (n = 170, 24.0%), followed by stress UI (n = 131, 18.5%) and urge UI (n = 97, 13.7%). The most prevalent form of UI in males was urge UI (n = 190, 33.2%), followed by stress UI (n = 5, 0.9%) and mixed UI (n = 5, 0.9%). Less than one quarter of respondents (17%, n = 102) of participants with UI had consulted a doctor. Multivariate analysis found that poorer physical function, poor quality of sleep, and fecal incontinence were common factors associated with UI in both women and men. In women, higher body mass index and constipation were also independent correlates, as were poor vision and heart disease in men. Poorer physical function was associated with all UI subtypes. For female stress UI, poorer cognitive status, tea drinking, and hypertension also emerged as independent risk factors. Heart disease was an independent risk factor in both female and male urge UI; as was consumption of a non-plant-based diet for female mixed and urge UI; nonfarmer and traumatic brain injury for female urge UI; and poor vision and fecal incontinence in male urge UI. CONCLUSIONS Chinese rural citizens showed a high UI prevalence, but only a small proportion had consulted a health care provider. Physical function decline was the most important contributor to UI among participants. Individualized intervention programs targeting modifiable risk factors among high-risk populations should be developed.
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Kohler M, Ott S, Mullis J, Mayer H, Kesselring J, Saxer S. Promoting urinary continence in people suffering a stroke: Effectiveness of a complex intervention-An intervention study. Nurs Open 2022; 9:1262-1275. [PMID: 35014765 PMCID: PMC8859089 DOI: 10.1002/nop2.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022] Open
Abstract
Aim The study aimed to implement and measure effectiveness of a systematic continence management intervention in people suffering a stroke in undertaking rehabilitation. Design An intervention study was conducted. Methods In the first part of the study, patients were included in the control group and observed. After the training of the nursing staff, participants were assigned to the intervention group. The intervention consisted of screening, assessment, treatment, communication and evaluation. Results Forty‐six patients took part in the study, of which 35 were in the control and 11 in the intervention groups. Within the two groups, significant improvements in outcomes were mostly seen during the study. For the Incontinence Quality of Life Social Embarrassment scale, a significantly higher increase was observed for the intervention group. The improvement between admission and discharge in the intervention group was notably larger for the outcome's incontinence and quality of life.
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Affiliation(s)
- Myrta Kohler
- Rehabilitation Centre Valens, Valens, Switzerland.,Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Stefan Ott
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | | | - Hanna Mayer
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | | | - Susi Saxer
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
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11
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Góes RP, Pedreira LC, Fonseca EDOS, Coifman AHM, Amaral JBD, Souza MLD. Factors inherent to the onset of urinary incontinence in the hospitalized elderly patients analyzed in the light of the Donabedian's triad. Rev Esc Enferm USP 2021; 55:e03773. [PMID: 34346969 DOI: 10.1590/s1980-220x2020004003773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/15/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To apprehend the factors related to the onset and/or worsening of urinary incontinence in the hospitalized elderly patient, considering the Donabedian's triad. METHOD This is a qualitative, descriptive study, conducted with nurses and nursing technicians from a public university hospital. Data were collected using the focus group technique; content analysis was used for treatment and analysis, with subsequent coding of the registration units in the software WebQDA, relating the corpus obtained with the Donabedian's pillars. RESULTS The most reported factors related to the onset and/or worsening of urinary incontinence in hospitalized elderly patients were linked to the pillar structure, with emphasis on the attribute human resources, followed by the attributes material resources and physical structure; the second Donabedian's pillar with the greatest association with the reports was process and, finally, the pillar outcome. CONCLUSION The identification of factors related to the outcome investigated in the hospital environment provided the participants with reflection and awareness about the problem, therefore allowing the proposition of measures and interventions to minimize it and ensure safe and quality care to the hospitalized elderly patient.
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Affiliation(s)
- Roberta Pereira Góes
- Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brasil
| | - Larissa Chaves Pedreira
- Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brasil
| | | | - Alyne Henri Motta Coifman
- Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brasil
| | - Juliana Bezerra do Amaral
- Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brasil
| | - Monaliza Lemos de Souza
- Universidade Federal da Bahia, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem e Saúde, Salvador, BA, Brasil
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12
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McCann M, Kelly AM, Eustace-Cook J, Howlin C, Daly L. Community nurses' attitudes, knowledge and educational needs in relation to urinary continence, continence assessment and management: A systematic review. J Clin Nurs 2021; 31:1041-1060. [PMID: 34296482 DOI: 10.1111/jocn.15969] [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: 02/12/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify, appraise and summarise the available evidence relating to community nurses' attitudes, knowledge and educational needs in relation to urinary continence. BACKGROUND Community nurses play a pivotal role in identifying and supporting individuals who experience urinary continence issues. Gaps in nurses' continence-related education and knowledge may contribute to sub-optimal assessment and management across the continuum of care. DESIGN A systematic review. METHODS MEDLINE, CINAHL Complete and EMBASE were searched from inception to November 2020; keywords used included community nurses, urinary continence, incontinence, knowledge, attitude and education needs. Given the degree of heterogeneity between included studies, a meta-analysis was not feasible. Included studies were critically evaluated; key study characteristics and findings pertinent to the review purpose were summarised. The review adhered to the PRISMA 2020 checklist. RESULTS Four studies reported in six papers were included. Community nurses lacked knowledge in certain areas of urinary continence and incontinence. Nurses reported they were adequately prepared but without sufficient knowledge to effectively care for those with urinary incontinence. Community nurses' attitudes to urinary incontinence were generally positive, but they demonstrated misconceptions that urinary incontinence was inevitable and less distressing for older people. CONCLUSIONS There is limited research exploring community nurses' knowledge, attitudes and education needs in relation to urinary continence and incontinence care. Community nurses may have knowledge gaps and less favourable attitudes to some aspects of urinary continence care.
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Affiliation(s)
- Margaret McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | | | - Claire Howlin
- Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin, Dublin, Ireland
| | - Louise Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Eldh AC, Joelsson-Alm E, Wretenberg P, Hälleberg-Nyman M. Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION-a study protocol for a randomised trial by a multi-professional facilitator team and their first-line managers' implementation strategy. Implement Sci 2021; 16:65. [PMID: 34174917 PMCID: PMC8233619 DOI: 10.1186/s13012-021-01135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Onset PrevenTIon of urinary retention in Orthopaedic Nursing and rehabilitation, OPTION, project aims to progress knowledge translation vis-à-vis evidence-based bladder monitoring in orthopaedic care, to decrease the risk of urinary retention, and voiding complications. Urinary retention is common whilst in hospital for hip surgery. If not properly identified and managed, there is a high risk of complications, some lifelong and life threatening. Although evidence-based guidelines are available, the implementation is lagging. METHODS Twenty orthopaedic sites are cluster randomised into intervention and control sites, respectively. The intervention sites assemble local facilitator teams among nursing and rehabilitation staff, including first-line managers. The teams receive a 12-month support programme, including face-to-face events and on-demand components to map and bridge barriers to guideline implementation, addressing leadership behaviours and de-implementation of unproductive routines. All sites have access to the guidelines via a public healthcare resource, but the control sites have no implementation support. Baseline data collection includes structured assessments of urinary retention procedures via patient records, comprising incidence and severity of voiding issues and complications, plus interviews with managers and staff, and surveys to all hip surgery patients with interviews across all sites. Further assessments of context include the Alberta Context Tool used with staff, the 4Ps tool for preference-based patient participation used with patients, and data on economic aspects of urinary bladder care. During the implementation intervention, all events are recorded, and the facilitators keep diaries. Post intervention, the equivalent data collections will be repeated twice, and further data will include experiences of the intervention and guideline implementation. Data will be analysed with statistical analyses, including comparisons before and after, and between intervention and control sites. The qualitative data are subjected to content analysis, and mixed methods are applied to inform both clinical outcomes and the process evaluation, corresponding to a hybrid design addressing effectiveness, experiences, and outcomes. DISCUSSION The OPTION trial has a potential to account for barriers and enablers for guideline implementation in the orthopaedic context in general and hip surgery care in particular. Further, it may progress the understanding of implementation leadership by dyads of facilitators and first-line managers. TRIAL REGISTRATION The study was registered as NCT04700969 with the U.S. National Institutes of Health Clinical Trials Registry on 8 January 2021, that is, prior to the baseline data collection.
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Affiliation(s)
- Ann Catrine Eldh
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83, Linköping, Sweden.
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, Uppsala, Sweden.
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Södersjukhuset, SE-118 83, Stockholm, Sweden
| | - Per Wretenberg
- Faculty of Health and Medicine, Department of Orthopedics, Örebro University, SE-701 82, Örebro, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, SE-701 82, Örebro, Sweden
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van Vuuren AJ, van Rensburg JA, Jacobs L, Hanekom S. Exploring literature on knowledge, attitudes, beliefs and practices towards urinary incontinence management: a scoping review. Int Urogynecol J 2021; 32:485-499. [PMID: 33404801 DOI: 10.1007/s00192-020-04628-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence affects women of all ages, influencing 8.5% of the world's population in 2018. Effective management of urinary incontinence is influenced by patients help-seeking behaviour and services offered by healthcare professionals within the healthcare system. To facilitate behavioural change, it is important to understand the knowledge(Knowledge: "the comprehension and understanding of acquired facts or information about UI in adults"), attitudes (Attitude: "a predisposed perspective which influences nurses' thoughts, feelings, perceptions and behaviours towards care of adults with UI") and beliefs (Beliefs: "a theoretically conceptualized conviction or expectation regarding UI in general") of healthcare practitioners towards urinary incontinence management. The aim of this review is thus to systematically map the existing literature, reporting on how knowledge, attitude, belief and practices towards urinary incontinence management have been explored. METHODS Six databases were systematically searched. Included studies were published between January 2013 to January 2020 in English, investigating urinary incontinence management in women. RESULTS The search yielded 39 studies, with data emanating from 16 counties. Quantitative, Qualitative and mixed methodologies were used to explore the four concepts of knowledge, attitudes, beliefs and practices. A wide range of healthcare practitioners were questioned and management was explored in five healthcare settings. All factors explored related to the four concepts are reported and factors reaching consensus in included literature were highlighted. CONCLUSION The summarized factors can assist further investigations into the four concepts to change healthcare practitioner's behaviour towards urinary incontinence management.
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Affiliation(s)
| | - J A van Rensburg
- Department of Obstetrics and Gynaecology, Urogynaecology Unit, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Lonese Jacobs
- Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Susan Hanekom
- Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Góes RP, Pedreira LC, Valente CO, Mussi FC, de Souza ML, do Amaral JB. Construction and validation of an instrument for the structural assessment of wards for urinary continence in older adults. Rev Lat Am Enfermagem 2020; 28:e3374. [PMID: 33084776 PMCID: PMC7575244 DOI: 10.1590/1518-8345.3361.3374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to build and validate an instrument for structural assessment of wards for the preservation of urinary continence in hospitalized older adults. METHOD this is a methodological study divided into two stages. The first corresponded to an integrative literature review that guided the construction of the instrument. The second consisted of the content validation stage of the instrument, by means of expert consensus, using the Delphi technique. The selected experts were recognized in the field and authors of the articles included in the integrative review. RESULTS six experts participated in the content validation, which resulted in the "Instrument for Structural Assessment of Wards for the Preservation of Urinary Continence in Older Adults", composed of 27 items, distributed in three dimensions: "physical structure", "human resources", and "material resources". Two Delphi rounds were carried out for validation, resulting in a final version with 83% agreement among the experts. CONCLUSION the instrument reached content validity, requiring application for clinical validation. However, it can be used by researchers and health staff in hospital settings, in order to identify structural weaknesses and guide the priority of interventions for the quality and safety of this care.
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Córcoles-Jiménez MP, Candel-Parra E, Del Egido-Fernández MÁ, Villada-Munera A, Moreno-Moreno M, Piña-Martínez AJ, Jiménez-Sánchez MD, Azor-García RJ. Preventing Functional Urinary Incontinence in Hip-Fractured Older Adults Through Patient Education: A Randomized Controlled Trial. J Appl Gerontol 2020; 40:890-901. [PMID: 32865102 DOI: 10.1177/0733464820952608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate whether an educational intervention would reduce the incidence of functional urinary incontinence (UI) in older adults with a fall-related hip fracture. The project was conducted as a multicenter randomized controlled trial (RCT). A total of 109 patients that had been admitted to six hospitals in Castilla-La Mancha (Spain) for acute treatment of hip fracture, previously continent and without cognitive impairment, were enrolled and randomly assigned to the experimental group (EG) or the control group (CG). Intervention (on EG): urinary habit training (Nursing Interventions Classifications taxonomy) was performed during hospital stay (second to fourth postoperative day), with a telephonic reinforcement 10 days after discharge. The CG received routine care. Primary outcome measure: incidence of UI. Follow-up: telephone assessment 3 and 6 months after discharge (blinded evaluation). The incidence of UI at 6 months was 49% (CG) versus 25.5% (EG) (relative risk = 0.52, 95% confidence interval [0.3, 0.9]; number necessary to treat = 4). The mean of UI episodes was 0.54 (EG) versus 1.8 (CG), p = .007. The educational intervention prevents the development of UI and decreases the number of episodes in case of appearance, in a statistically significant way.
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Affiliation(s)
| | - Eduardo Candel-Parra
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | | | | | - Mónica Moreno-Moreno
- Gerencia de Atención Integrada de Albacete, Hospital General de Albacete, Albacete, Spain
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Reyes BJ, Mendelson DA, Mujahid N, Mears SC, Gleason L, Mangione KK, Nana A, Mijares M, Ouslander JG. Postacute Management of Older Adults Suffering an Osteoporotic Hip Fracture: A Consensus Statement From the International Geriatric Fracture Society. Geriatr Orthop Surg Rehabil 2020; 11:2151459320935100. [PMID: 32728485 PMCID: PMC7366407 DOI: 10.1177/2151459320935100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The majority of patients require postacute care (PAC) after a hip fracture. Despite its importance, there is no established consensus regarding the standards of care provided to hip fracture patients in PAC facilities. METHODOLOGY A writing group was created by professionals from the International Geriatric Fracture Society (IGFS) with representation from other organizations. The focus of the statements included in this article is toward PAC providers located in nursing facilities. Contributions were integrated in a single document that underwent several reviews by each author and then underwent a final review by the lead and senior authors. After this process was completed, the document was appraised by reviewers from IGFS. RESULTS/CONCLUSION A total of 15 statements were crafted. These statements summarize the best available evidence and is intended to help PAC facilities managing older adults with hip fractures more efficiently, aiming toward overall better outcomes in the areas of function, quality of life, and with less complications that could interfere with their optimal recovery.
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Affiliation(s)
- Bernardo J. Reyes
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | | | - Nadia Mujahid
- Warren Alpert School of Brown University, Rhode Island, USA
| | | | - Lauren Gleason
- The University of Chicago Medical and Biological Science, IL,
USA
| | | | - Arvind Nana
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
| | - Maria Mijares
- Charles E Schmidt College of Medicine, Florida Atlantic University,
FL, USA
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Góes RP, Pedreira LC, David RAR, Silva CFT, Torres CAR, Amaral JBD. Hospital care and urinary incontinence in the elderly. Rev Bras Enferm 2019; 72:284-293. [PMID: 31826222 DOI: 10.1590/0034-7167-2018-0273] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/09/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify factors inherent in hospital care that favor urinary incontinence in the elderly. METHOD an integrative review with Scopus, CINAHL and Pubmed searches. Includes original articles, no language restriction, published between 2008 and 2018. Rated level of recommendation and level of evidence were assessed using the Oxford Center for Evidence-Based Medicine classification. Exploited content through thematic analysis in light of the Donabedian model. RESULTS 13 articles constituted the sample. There were factors such as the unjustified and indiscriminate use of devices such as the geriatric diaper; hospital structure adversely affecting the needs of the elderly; and deficit in screening, risk identification and underreporting of the problem favor urinary incontinence in the hospitalized elderly. CONCLUSION modifiable factors related to hospital structures and care processes favor both the onset and worsening of urinary incontinence in the elderly.
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Borglin G, Hew Thach E, Jeppsson M, Sjögren Forss K. Registered nurse's experiences of continence care for older people: A qualitative descriptive study. Int J Older People Nurs 2019; 15:e12275. [PMID: 31577389 DOI: 10.1111/opn.12275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/06/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden.,Department of Nursing Education, Lovisenberg Diaconal University College, Oslo, Norway
| | | | - Maria Jeppsson
- Special Accommodations, Social Services Department, Trelleborg, Sweden
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Vaughan CP, Fitzgerald CM, Markland AD. Management of Urinary Incontinence in Older Adults in Rehabilitation Care Settings. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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