A multidisciplinary approach to improving urinary continence

Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context

RATIONALE, AIMS, AND OBJECTIVES

The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery.

METHODS

A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

RESULTS

Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

CONCLUSION

To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.

Promoting male urinary continence

Urinary incontinence is a common problem among men of all ages, and can have a major impact on quality of life. Although incontinence rates in men could be as high as 24%, there is far less published information about male than female continence problems. Nurses have an important role to play in promoting continence by working with patients to identify appropriate incontinence management options. Incontinence can often be treated by non-invasive or minimally invasive means. Incontinence management should be considered before containment. However, nurses do need knowledge about management options to be able to support and advise patients. This article discusses a range of non-invasive and minimally invasive incontinence options. Although catheterisation should not be the first choice for most patients, it is discussed as it may be the most suitable option for some, particularly men with neurogenic bladders.