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Vaittinen T, Koljonen K, Tella S, Asikainen E, Laatikainen K. Holistically sustainable continence care: A working definition, the case of single-used absorbent hygiene products (AHPs) and the need for ecosystems thinking. Proc Inst Mech Eng H 2024; 238:667-681. [PMID: 37655850 PMCID: PMC11318206 DOI: 10.1177/09544119231188860] [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: 02/13/2023] [Accepted: 06/19/2023] [Indexed: 09/02/2023]
Abstract
Incontinence is a common health issue that affects hundreds of millions of people across the world. The solution is often to manage the condition with different kinds of single-use continence technologies, such as incontinence pads and other absorbent hygiene products (AHPs). Throughout their life cycle, these fossil-based products form a remarkable yet inadequately addressed ecological burden in society, contributing to global warming and other environmental degradation. The products are a necessity for their users' wellbeing. When looking for sustainability transitions in this field, focus on individual consumer-choice is thus inadequate - and unfair to the users. The industry is already seeking to decrease its carbon footprint. Yet, to tackle the environmental impact of single-use continence products, also societies and health systems at large must start taking continence seriously. Arguing that continence-aware societies are more sustainable societies, we devise in this article a society-wide working definition for holistically sustainable continence care. Involving dimensions of social, ecological and economic sustainability, the concept draws attention to the wide range of technologies, infrastructures and care practices that emerge around populations' continence needs. Holistically sustainable continence care is thus not only about AHPs. However, in this article, we examine holistically sustainable continence care through the case of AHPs. We review what is known about the environmental impact AHPs, discuss the impact of care practices on aggregate material usage, the future of biobased and degradable incontinence pads, as well as questions of waste management and circular economy. The case of AHPs shows how holistically sustainable continence care is a wider question than technological product development. In the end of the article, we envision an ecosystem where technologies, infrastructures and practices of holistically sustainable continence care can flourish, beyond the focus on singular technologies.
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Affiliation(s)
- Tiina Vaittinen
- Faculty of Management and Business (Politics Unit) and Faculty of Social Sciences (Global Health and Development), Tampere University, Tampere, Finland
| | - Krista Koljonen
- School of Engineering Science, Department of Separation Science, Lappeenranta-Lahti University of Technology LUT, Lappeenranta, Finland
| | - Susanna Tella
- Faculty of Social and Health Care, LAB University of Applied Sciences, Lappeenranta, Finland
| | - Eveliina Asikainen
- Pedagogical Innovations and Culture, Tampere University of Technology, Tampere, Finland
| | - Katri Laatikainen
- School of Engineering Science, Department of Separation Science, Lappeenranta-Lahti University of Technology LUT, Lappeenranta, Finland
- Finnish Defense Research Agency, Lakiala, Finland
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Boddington P, Northcott A, Featherstone K. Personhood as projection: the value of multiple conceptions of personhood for understanding the dehumanisation of people living with dementia. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:93-106. [PMID: 38129583 DOI: 10.1007/s11019-023-10187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 12/23/2023]
Abstract
We examine the concept of personhood in relation to people living with dementia and implications for the humanity of care, drawing on a body of ethnographic work. Much debate has searched for an adequate account of the person for these purposes. Broad contrasts can be made between accounts focusing on cognition and mental faculties, and accounts focusing on embodied and relational aspects of the person. Some have suggested the concept of the person is critical for good care; others suggest the vexed debates mean that the concept should be abandoned. We argue instead that the competing accounts illuminate the very tensions in personhood which are manifest for all of us, but especially for people living with dementia, and argue that our account has explanatory power in shedding light on how precisely dehumanisation and constraints on agency may arise for people living with dementia, and for staff, within an institutional context.
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Affiliation(s)
- Paula Boddington
- Geller Institute of Aging and Memory, University of West London, St Mary's Road Ealing, London, SW5 5RF, UK.
| | - Andy Northcott
- Geller Institute of Aging and Memory, University of West London, St Mary's Road Ealing, London, SW5 5RF, UK
| | - Katie Featherstone
- Geller Institute of Aging and Memory, University of West London, St Mary's Road Ealing, London, SW5 5RF, UK
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Aldridge Z, Elsegood L, Murray S, Wileman A. Identifying incontinence and promoting continence in people living with dementia. Nurs Older People 2023:e1451. [PMID: 37990584 DOI: 10.7748/nop.2023.e1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 11/23/2023]
Abstract
Urinary and faecal incontinence are more prevalent among older people but, like dementia, incontinence is not a normal or inevitable part of ageing. The number of people living with dementia who experience continence issues is likely to be underestimated because many people avoid reporting them as a result of embarrassment and stigma, or because they think incontinence is an inevitable symptom of dementia and that nothing can be done about it. Increased awareness and understanding of the relationship between dementia and incontinence is needed so that nurses can persuade people living with dementia and their family carers to discuss continence issues, assess their needs and provide support. There are several practical strategies that can reduce the incidence of incontinence, counter its negative effects and promote continence in people living with dementia.
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Powell D, Fenton N. Using technology to encourage ward-culture change and provide individualised bladder care. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S26-S30. [PMID: 37830854 DOI: 10.12968/bjon.2023.32.18.s26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
When discussing continence care in an acute hospital setting, it can be viewed as a negative subject that is a thinly veiled jab at overstretched nurses. This article takes a fresh and holistic look at continence care, identifying factors that could be causing poor care and how technology could support a change in care. This article includes suggestions on how the data collected could be used to deliver the person-centred care outcomes that may be lacking in some environments, something that one of the authors (DP) has experienced first hand. This article describes the results of a recent trial at Ysbyty Cwm Cynon (Canon Valley Hospital), NHS Wales, which looked at how continence care technology could support positive care outcomes.
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Affiliation(s)
- Darrin Powell
- Clinical Nurse Specialist/Team Leader, Bladder and Bowel Health Service, Cwm Taf Morgannwg University Health Board, Pontypridd
| | - Nicole Fenton
- Healthcare Marketing Manager/Healthcare Writer, Ontex
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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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Dadich A, Rodrigues J, De Bellis A, Hosie A, Symonds T, Prendergas J, Bevan A, Collier A. Patient safety for people experiencing advanced dementia in hospital: A video reflexive ethnography. DEMENTIA 2023:14713012231168958. [PMID: 37032597 DOI: 10.1177/14713012231168958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Patient safety for people experiencing dementia in acute hospitals is a global priority. Despite national strategies as well as safety and quality guidelines, how safety practices are enacted within the complexities of everyday work are poorly understood and articulated. METHODS Using video reflexive ethnography, this 18-month study was conducted within an inpatient geriatric evaluation and management unit for people experiencing dementia and/or delirium in Australia. Patients, family members, and staff members participated by: allowing researchers to document fieldwork notes and video-record their practices and/or accounts thereof; and/or interpreting video-recordings with researchers to co-analyse and make sense of the data. RESULTS Safe care for people experiencing advanced dementia involved: negotiating risk via leadership, teamwork, and transparency; practice-based learning through situated adaptation; managing personhood versus protocols by doing the 'right' thing; joyful and meaningful work; as well as incorporating patient and family voices to do safety together. CONCLUSION Patient safety for people experiencing dementia requires continuous responsiveness and prioritising in the context of multiple risks by a staff collective with a shared purpose. Ongoing research to better understand how the nuances of patient safety unfold in everyday complex clinical realities in diverse contexts and with key stakeholders is required.
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Affiliation(s)
- Ann Dadich
- School of Business, 6489Western Sydney University, Parramatta, NSW, Australia
| | - Jade Rodrigues
- School of Business, 6489Western Sydney University, Parramatta, NSW, Australia
| | - Anita De Bellis
- College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Annmarie Hosie
- School of Nursing and Midwifery, 3431University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Tamsin Symonds
- 6677Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Justin Prendergas
- 6677Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Alan Bevan
- 1066University of Adelaide, Adelaide, SA, Australia
| | - Aileen Collier
- Research Centre for Palliative Care, Death, and Dying (RePadd), 1065Flinders University, Adelaide, SA, Australia
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