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Barriers and enablers to providing evidence-based in-hospital urinary continence care: A cross-sectional survey informed by the Theoretical Domains Framework
Abstract: Aims: To identify the barriers and enablers perceived by hospital-based clinicians to providing evidence-based continence care to inpatients.; Design: This was a cross-sectional study of inpatient clinicians using a questionnaire.; Methods: Acute care and rehabilitation clinicians from 15 wards that admit patients after stroke at 12 hospitals (NSW = 11, Queensland =1, metropolitan = 4, regional = 8) were invited to complete an online questionnaire. The 58 questions (answered on a 5-point Likert scale) were aligned to 13 of the 14 domains of the Theoretical Domains Framework. Results were dichotomized into 'strongly agree/agree' and 'unsure/disagree/strongly disagree' and proportions were calculated. Data collection occurred between January 2019 and March 2019. Results: The questionnaire was completed by 291 participants with 88% being nurses. Barriers were found in nine domains including knowledge; skills; memory attention and decision making; emotion; environmental context and resources; behavioural regulation; social professional role; intensions, social influences; and beliefs about capabilities. Enablers were found in seven domains including goals; social influences; knowledge; skills; social, professional role and identity; reinforcement and beliefs about consequences.; Conclusion: This multi-site, multi-professional study that included predominantly nurses highlights the barriers and enablers to inpatient continence care. Future implementation studies in inpatient continence management should address these identified barriers and enablers to improve effectiveness of implementation of evidence-based care. Implications for the Profession: This study highlights that although there are many barriers to ward nurses providing evidence-based continence care, there are also several enablers. Both should be addressed to improve practice.; Reporting Method: We adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Supplementary File 1).; Relevance to Clinical Practice: Establishing barriers to practice gives a broader understanding of why practice does not occur and establishes areas where researchers and clinicians need to address in order to change behaviour.
Source: Boyle, K. Journal of Clinical Nursing, Aug 2023; 32(15-16): 5103-5112
Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes
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.
Source: Campbell, J. Age and Ageing, Sep 2023; 52(9): 1-8
Reusable and Disposable Incontinence Underpads: Environmental Footprints as a Route for Decision Making to Decarbonize Health Care
Abstract: Background: Objectives of quality principles in the clinical setting present nursing with opportunities for quality patient care but at lower environmental footprint. This affects patients, hospital personnel, and community because choices reduce climate change and thus support an innovative nursing role. Purpose: This article aims to support nursing knowledge to include environment in decisions regarding patient care and reusable versus disposable incontinence underpads (IUPs). Methods: A life cycle analysis was conducted, including soiling, reusable cycles before removal, supply chains, laundry use, and end-of-life environmental impact. Results: The selection of reusable IUPs versus disposables reduced total natural resource energy consumption by 71%, greenhouse gas emissions by 61%, blue water consumption by 57%, and solid waste by 97%. Conclusions: The nursing community can use this information in its health care organizations regarding IUP to advocate for decisions to select reusable IUPs that benefit our environment (air, water, and land).
Source: Griffing, E. Journal of Nursing Care Quality, Jul-Sep 2023; 38(3): 278-285
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Ultrasound-Assisted Continence Care Support in an Inpatient Care Setting: Protocol for a Pilot Implementation Study
Abstract: BACKGROUND: This nonrandomized exploratory intervention and feasibility study examines how digital assistive technology (DAT), comprising a DFree ultrasound sensor, affects nursing care for continence support and evaluates nurses' willingness to incorporate DAT into the planning and practical implementation of care processes. OBJECTIVE: The relief provided by DFree in the clinical care setting and the extent to which it supports nursing care for activities of daily living pertaining to "micturition" is unclear. DAT DFree is expected to reduce nurses' workload in clinical continence-care settings and was designed as a human-technology interaction that ensures a high level of usability for the subjects (i.e., the nurses) and increases user acceptance by at least one level (e.g., from average to slightly above average) during the study. METHODS: Approximately 45 nurses from neurology, neurosurgery, and geriatric medicine clinics and polyclinics at the University Medicine Halle will be included in the 90-day (3-month) intervention on-site in the respective wards. After the wards are equipped with digital technologies, the participating nurses will be trained to use DFree and will be able to select DFree as a possible patient-care resource if the anamnesis includes bladder dysfunction among only patients who are willing to participate. The willingness of nurse participants to use DFree in planning their care process will be assessed using the Technology Usage Inventory at 3 measurement points. The primary target values include the results of the multidimensional Technology Usage Inventory assessment that will be processed using descriptive statistics. Ten participating nurses will be invited to conduct extensive guided interviews that are intended to provide information about the device's usefulness and feasibility in the specific field of continence care and possible improvements. RESULTS: It is expected that the intention to use will be confirmed by nurses, and the number of nursing problems, such as bladder dysfunction-induced bedwetting, will be reduced with a high rating of DAT usability. CONCLUSIONS: First, this study aims to produce multilevel innovative impacts, including practical, scientific, and societal effects. The results will provide practical solutions for workload reduction in the field of nursing support for continence care, where digital assistive technologies are becoming increasingly important. The DFree ultrasonic sensor is a new technical tool for the treatment of bladder dysfunction. Generating feedback to improve technical applications can increase the user-friendliness and usefulness of the device. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00031483; https://drks.de/search/en/trial/DRKS00031483. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47025.
Source: Hofstetter, S. J MIR Research Protocols, Jul 2023; 12; e47025
Incontinence-Associated Dermatitis: Prevalence in Intensive Care Units and Knowledge, Attitudes, and Practices of Nurses
Abstract: Background: Incontinence-associated dermatitis (IAD) is a major concern among hospitals, especially in intensive care units (ICUs). Purpose: To describe ICU nurses' knowledge, attitudes, and practices of IAD and to examine the relationships with IAD prevalence in the ICU setting. Methods: A descriptive correlational design was used including the Knowledge, Attitudes and Practices of Incontinence-Associated Dermatitis Questionnaire and 1-month IAD prevalence data. Results: The prevalence of IAD in ICUs was 6.89%. A positive correlation was found between IAD prevalence and nurses' IAD knowledge and attitudes. Nurses working in the ICU for more than 7 years, caring for patients at high risk for or having IAD, and thinking IAD-related nursing practices were sufficient had significantly higher IAD knowledge, attitudes, and practices. Conclusions: Findings indicate that ICU nurses learned about IAD through clinical experience and have inadequate training on IAD. A standardized evidence-based care protocol for IAD should be developed.
Source: Kaçmaz, H. Journal of Nursing Care Quality, March 2023; 38(4): 354-360
Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site, Co-Created Implementation Study
Abstract: Many adult inpatients experience urinary continence issues; however, we lack evidence on effective interventions for inpatient continence care. We conducted a before and after implementation study. We implemented our guideline-based intervention using strategies targeting identified barriers and evaluated the impact on urinary continence care provided by inpatient clinicians. Fifteen wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) at 12 hospitals (metropolitan = 4, regional = 8) participated. We screened 2298 consecutive adult medical records for evidence of urinary continence symptoms over three 3-month periods: before implementation (T(0): n = 849), after the 6-month implementation period (T(1): n = 740), and after a 6-month maintenance period (T(2): n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T(0), and 11/15 wards contributed at T(1) and T(2) (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T(0): n = 283, T(1): n = 241, T(2): n = 256) receiving recommended care were: assessment T(0) = 38%, T(1) = 63%, T(2) = 68%; diagnosis T(0) = 30%, T(1) = 70%, T(2) = 71%; management plan T(0) = 7%, T(1) = 24%, T(2) = 24%. Overall, there were 4-fold increased odds for receiving assessments and management plans and 6-fold greater odds for diagnosis. These improvements were sustained at T(2). This intervention has improved inpatient continence care.
Source: Marsden, D. Healthcare (Basel), Apr 2023; 11(9): 1241
Addressing Gender-Related Inequality in Continence Care
Abstract: Urinary incontinence is a common condition that affects both men and women, and with profoundly negative effects. Prevalence figures do show that it is more common in younger women than men, but as people age the difference decreases, with research identifying that one-in-three older men have continence issues. However, even with this increase, there is little direct best practice guidance on addressing male urinary incontinence compared to that for women. Professionals seem to be unaware that men have known existing barriers to accessing health care and this would be especially true for incontinence care. There seems to be a lack of education in identifying and assessing symptoms, and little thought to appropriate management if required. This can also be true of manufacturers that provide continence management equipment. This article will look at some of these themes and highlight the gender gaps and give guidance on how professionals may address these.
Source: McLaughlin, L. British Journal of Nursing, Jan 2023; 32(Sup 1): 1-16
Technological Solutions for Urinary Continence Care Delivery for Older Adults: A Scoping Review
Incontinence during and following hospitalisation: a prospective study of prevalence, incidence and association with clinical outcomes
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.
Source: Campbell, J. Age and Ageing, Sep 2023; 52(9): 1-8
Reusable and Disposable Incontinence Underpads: Environmental Footprints as a Route for Decision Making to Decarbonize Health Care
Abstract: Background: Objectives of quality principles in the clinical setting present nursing with opportunities for quality patient care but at lower environmental footprint. This affects patients, hospital personnel, and community because choices reduce climate change and thus support an innovative nursing role. Purpose: This article aims to support nursing knowledge to include environment in decisions regarding patient care and reusable versus disposable incontinence underpads (IUPs). Methods: A life cycle analysis was conducted, including soiling, reusable cycles before removal, supply chains, laundry use, and end-of-life environmental impact. Results: The selection of reusable IUPs versus disposables reduced total natural resource energy consumption by 71%, greenhouse gas emissions by 61%, blue water consumption by 57%, and solid waste by 97%. Conclusions: The nursing community can use this information in its health care organizations regarding IUP to advocate for decisions to select reusable IUPs that benefit our environment (air, water, and land).
Source: Griffing, E. Journal of Nursing Care Quality, Jul-Sep 2023; 38(3): 278-285
Contact the library for a copy of this article
Ultrasound-Assisted Continence Care Support in an Inpatient Care Setting: Protocol for a Pilot Implementation Study
Abstract: BACKGROUND: This nonrandomized exploratory intervention and feasibility study examines how digital assistive technology (DAT), comprising a DFree ultrasound sensor, affects nursing care for continence support and evaluates nurses' willingness to incorporate DAT into the planning and practical implementation of care processes. OBJECTIVE: The relief provided by DFree in the clinical care setting and the extent to which it supports nursing care for activities of daily living pertaining to "micturition" is unclear. DAT DFree is expected to reduce nurses' workload in clinical continence-care settings and was designed as a human-technology interaction that ensures a high level of usability for the subjects (i.e., the nurses) and increases user acceptance by at least one level (e.g., from average to slightly above average) during the study. METHODS: Approximately 45 nurses from neurology, neurosurgery, and geriatric medicine clinics and polyclinics at the University Medicine Halle will be included in the 90-day (3-month) intervention on-site in the respective wards. After the wards are equipped with digital technologies, the participating nurses will be trained to use DFree and will be able to select DFree as a possible patient-care resource if the anamnesis includes bladder dysfunction among only patients who are willing to participate. The willingness of nurse participants to use DFree in planning their care process will be assessed using the Technology Usage Inventory at 3 measurement points. The primary target values include the results of the multidimensional Technology Usage Inventory assessment that will be processed using descriptive statistics. Ten participating nurses will be invited to conduct extensive guided interviews that are intended to provide information about the device's usefulness and feasibility in the specific field of continence care and possible improvements. RESULTS: It is expected that the intention to use will be confirmed by nurses, and the number of nursing problems, such as bladder dysfunction-induced bedwetting, will be reduced with a high rating of DAT usability. CONCLUSIONS: First, this study aims to produce multilevel innovative impacts, including practical, scientific, and societal effects. The results will provide practical solutions for workload reduction in the field of nursing support for continence care, where digital assistive technologies are becoming increasingly important. The DFree ultrasonic sensor is a new technical tool for the treatment of bladder dysfunction. Generating feedback to improve technical applications can increase the user-friendliness and usefulness of the device. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00031483; https://drks.de/search/en/trial/DRKS00031483. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/47025.
Source: Hofstetter, S. J MIR Research Protocols, Jul 2023; 12; e47025
Incontinence-Associated Dermatitis: Prevalence in Intensive Care Units and Knowledge, Attitudes, and Practices of Nurses
Abstract: Background: Incontinence-associated dermatitis (IAD) is a major concern among hospitals, especially in intensive care units (ICUs). Purpose: To describe ICU nurses' knowledge, attitudes, and practices of IAD and to examine the relationships with IAD prevalence in the ICU setting. Methods: A descriptive correlational design was used including the Knowledge, Attitudes and Practices of Incontinence-Associated Dermatitis Questionnaire and 1-month IAD prevalence data. Results: The prevalence of IAD in ICUs was 6.89%. A positive correlation was found between IAD prevalence and nurses' IAD knowledge and attitudes. Nurses working in the ICU for more than 7 years, caring for patients at high risk for or having IAD, and thinking IAD-related nursing practices were sufficient had significantly higher IAD knowledge, attitudes, and practices. Conclusions: Findings indicate that ICU nurses learned about IAD through clinical experience and have inadequate training on IAD. A standardized evidence-based care protocol for IAD should be developed.
Source: Kaçmaz, H. Journal of Nursing Care Quality, March 2023; 38(4): 354-360
Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site, Co-Created Implementation Study
Abstract: Many adult inpatients experience urinary continence issues; however, we lack evidence on effective interventions for inpatient continence care. We conducted a before and after implementation study. We implemented our guideline-based intervention using strategies targeting identified barriers and evaluated the impact on urinary continence care provided by inpatient clinicians. Fifteen wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) at 12 hospitals (metropolitan = 4, regional = 8) participated. We screened 2298 consecutive adult medical records for evidence of urinary continence symptoms over three 3-month periods: before implementation (T(0): n = 849), after the 6-month implementation period (T(1): n = 740), and after a 6-month maintenance period (T(2): n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T(0), and 11/15 wards contributed at T(1) and T(2) (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T(0): n = 283, T(1): n = 241, T(2): n = 256) receiving recommended care were: assessment T(0) = 38%, T(1) = 63%, T(2) = 68%; diagnosis T(0) = 30%, T(1) = 70%, T(2) = 71%; management plan T(0) = 7%, T(1) = 24%, T(2) = 24%. Overall, there were 4-fold increased odds for receiving assessments and management plans and 6-fold greater odds for diagnosis. These improvements were sustained at T(2). This intervention has improved inpatient continence care.
Source: Marsden, D. Healthcare (Basel), Apr 2023; 11(9): 1241
Addressing Gender-Related Inequality in Continence Care
Abstract: Urinary incontinence is a common condition that affects both men and women, and with profoundly negative effects. Prevalence figures do show that it is more common in younger women than men, but as people age the difference decreases, with research identifying that one-in-three older men have continence issues. However, even with this increase, there is little direct best practice guidance on addressing male urinary incontinence compared to that for women. Professionals seem to be unaware that men have known existing barriers to accessing health care and this would be especially true for incontinence care. There seems to be a lack of education in identifying and assessing symptoms, and little thought to appropriate management if required. This can also be true of manufacturers that provide continence management equipment. This article will look at some of these themes and highlight the gender gaps and give guidance on how professionals may address these.
Source: McLaughlin, L. British Journal of Nursing, Jan 2023; 32(Sup 1): 1-16
Technological Solutions for Urinary Continence Care Delivery for Older Adults: A Scoping Review
Abstract: PURPOSE: The aim of this scoping review was to examine available evidence regarding use of technology-based continence care delivery for older adults and to identify gaps in knowledge. METHODS: Scoping review. SEARCH STRATEGY: With the help of a medical librarian, CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, Web of Science, and websites were searched. Search terms included technology, sensors, older adults, urinary incontinence, continence care, nursing homes, long-term care, and continence management. All literature elements except for opinion pieces and case reports written in English within the last 15 years were included. Articles not written in the English language were excluded; our search indicated that less than 6% of returned elements were written in other languages. FINDINGS: After duplications were removed, 2146 potential sources were identified. After exclusions, 19 results were included in the review. Review findings suggest positive effects of technology-based continence care on older adults and those involved in their care such as enhanced delivery of a successful toileting program. Information on potential harms, from either the perspective of care provider or recipient, is limited. It is important that needs of older adults and collaborative efforts are considered in the implementation of technology-based continence care. A paucity of guidelines on the use and adoption of technology-based continence care was found; additional research into uptake and sustainability is needed. CLINICAL IMPLICATIONS: Technological solutions, such as sensors, need to be accurate in the measurement of urine saturation levels and timely in notifying caregivers for effective delivery of continence care. Adverse consequences of incontinence, such as incontinence-associated dermatitis or urinary tract infection, may potentially be reduced or avoided with technology-based continence care delivery.
Source: Omotunde, M. Journal of Wound, Ostomy, and Continence Nursing, 2023; 50(3): 227-234
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Improving knowledge of continence care to prevent skin damage associated with incontinence
Source: Omotunde, M. Journal of Wound, Ostomy, and Continence Nursing, 2023; 50(3): 227-234
Contact the library for a copy of this article
Improving knowledge of continence care to prevent skin damage associated with incontinence
Abstract: Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.
Source: Peart, J. British Journal of Nursing, Aug 2023; 32(15): 708-714
Hospital practitioner views on the benefits of continence education and best ways to provide training
Abstract: Aim: The aim of the study was to explore practitioners' experiences and perspectives on continence training, in order to understand its relevance to practice and how take-up of, and engagement with, such training may be improved.; Design: 27 qualitative interviews were conducted with nursing, medical and allied health practitioners in three hospitals.; Methods: We analysed data thematically, both manually and with the aid of NVivo software. The research adheres to the consolidated criteria for reporting qualitative research checklist.; Results: Practitioners asserted the likely benefits of evidence-based continence training, including more judicious use of products, reduction in associated infection, better patient skin care and more facilitative communication with patients. Practitioners also identified preferred methods of continence training, according to their role and workload. To ensure better take-up of, and engagement with, continence training, it must be authorized as essential and provided in ways that reflect professional preferences and pragmatic resource considerations.
Source: Percival, J. Nursing Open, May 2023; 10(5): 3305-3313
Holistically sustainable continence care: A working definition, the case of single-used absorbent hygiene products (AHPs) and the need for ecosystems thinking
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.
Source: Vaittinen, T. Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, Sept 2023; Online ahead of print
Don't just grab a pad: introducing an effective continence service
Abstract: In 2019, East Suffolk and North Essex NHS Foundation Trust launched a quality improvement project to review how it promoted continence. This led to the introduction of a new continence service with a revised continence assessment, training and education plan, which aims to raise awareness of the importance and impact that good continence care has on patients and their outcomes.
Source: Woollerton, T. Nursing Times, Apr 2023; 119(4): 39-42
Understanding approaches to continence care for people living with dementia in acute hospital settings: an ethnographic study
Abstract: Background: The acute hospital setting has become a key site of care for people living with dementia. People living with dementia are one of the largest populations in our hospitals, with the Department of Health and Social Care recognising that 25–50% of all acute hospital admissions are people who are also living with dementia. However, people living with dementia are a highly vulnerable group in the hospital setting and, following an acute admission, their functional abilities can deteriorate quickly and significantly. Detailed research is required to explore what constitutes ‘good care’.; Objectives: This study’s focus was a common, but poorly understood, aspect of everyday care for people living with dementia during an acute admission, that is continence care. We asked the following questions: what caring practices are observable when interacting with this patient group? How do ward teams respond to and manage continence needs? What informs these approaches? What are staff doing and why? Design: This ethnography was informed by the symbolic interactionist research tradition, focusing on understanding how action and meaning are constructed within a setting. In-depth evidence-based analysis of everyday care enabled us to examine how ward staff responded to the continence care needs of people living with dementia and to follow the consequences of their actions. We carried out a mixed-methods systematic narrative review to refine our approach to fieldwork and analysis.; Setting: This ethnography was carried out for 180 days, across 12 months, in six wards in three hospitals across England and Wales that were purposefully selected to represent a range of hospital types, geographies and socioeconomic catchments.; Participants: In addition to general observations, 108 individuals participated directly in this study, contributing to 562 ethnographic interviews. Ten detailed case studies were also undertaken with people living with dementia. Results: This study identified ‘pad cultures’ as an embedded practice on these acute wards. The routine use of continence pads among people living with dementia (regardless of continence and independence) was widespread. The use of continence pads was viewed as a precautionary strategy, the rationale being to provide safeguards, ensure containment and prevent ‘accidents’ or incontinence episodes, with an expectation that patients living with dementia not only will wear pads, but will use them.; Conclusions: These ‘pad cultures’ enabled the number of unscheduled interruptions to the institutionally mandated timetabled work of these wards to be reduced, but had significant impacts on people living with dementia and, in turn, wider consequences for these individuals and their identities. Ward staff described feeling abandoned with the responsibility of caring for large numbers of people living with dementia, believing that it was impossible to work in other ways to support their patient’s continence.; Limitations: The limitations identified included the potential for the Hawthorne effect to influence data collection.; Future Work: In collaboration with a specialist dementia care and continence teams, the findings are informing the development of education and training at the interactional and organisational level.; Study Registration: This study is registered as PROSPERO CRD42018119495.; Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research ; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.
Source: Featherstone, K. Health and Social Care Delivery Research, Jun 2022; 10(14)
Context for Practice: The Ties That Bind the W, the O, and the C
Abstract: No abstract available
Source: Gray, M. Journal of Wound, Ostomy and Continence Nursing, Sep-Oct 2022; 49(5): 395-399
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Pilot of Patient Engagement in Continence Care on Geriatric Rehabilitation Units
Abstract: Purpose: The aim of this study was to pilot a process of engaging geriatric rehabilitation patients in the assessment and management of their continence concerns.; Design: A descriptive study was conducted.; Methods: The study has four phases: (1) staff education on continence with a pre-post knowledge quiz, (2) design of patient engagement process by a working group, (3) a 6-week pilot of a patient symptom questionnaire and process of engaging patients with audits of disciplinary admission histories and documentation, and (4) patient and staff feedback surveys.; Results: Patients in geriatric rehabilitation identify a range of bladder and bowel symptoms. However, there was little documented evidence from the interprofessional team that corresponded to patients' reported symptoms.; Conclusion: Further research into symptoms bothersome to patients and engagement of both patients and the interprofessional team in addressing these in the rehabilitation setting is needed.; Clinical Relevance to Rehabilitation Nursing: Patients admitted to geriatric rehabilitation have a range of bladder and bowel symptoms which need to be addressed.
Source: Hunter, K F. Rehabilitation Nursing, May-Jun 2022; 47(3): 109-118
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Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials
Abstract: OBJECTIVE: The aim of the study was to investigate the effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings. REVIEW METHOD USED: This is a systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Five databases (CINAHL, MEDLINE, Scopus, Web of Science, and Embase) were searched in mid-2019. Searches were updated (in April 2020) to year end 2019. REVIEW METHODS: From an overarching systematic review and meta-analysis examining the effectiveness of pressure injury preventative interventions in adults admitted to acute hospital settings, trials conducted in intensive care were separated for an intensive care-specific synthesis. Two reviewers, with a third as an arbitrator, undertook study selection, data extraction, and risk-of-bias assessment. Included trials were grouped by intervention type for narrative synthesis and for random-effects meta-analysis using intention-to-treat data where appropriate. RESULTS: Overall, 26 trials were included. Ten intervention types were found (support surfaces, prophylactic dressings, positioning, topical preparations, continence management, endotracheal tube securement, heel protection devices, medication, non-invasive ventilation masks, and bundled interventions). All trials, except one, were at high or unclear risk of bias. Four intervention types (endotracheal tube securement, heel protection devices, medication, and non-invasive ventilation masks) comprised single trials. Support surface trials were limited to type (active, reactive, seating, other). Meta-analysis was undertaken for reactive surfaces, but the intervention effect was not significant (risk ratio = 0.24, p = 0.12, I(2) = 51%). Meta-analyses demonstrated the effectiveness of sacral (risk ratio = 0.22, p < 0.001, I(2) = 0%) and heel (risk ratio = 0.31, p = 0.02; I(2) = 0%) prophylactic dressings for pressure injury prevention. CONCLUSIONS: Only prophylactic sacral and heel dressings demonstrated effectiveness in preventing pressure injury in adults admitted to intensive care settings. Further intensive care-specific trials are required across all intervention types. To minimise bias, we recommend that all future trials are conducted and reported as per relevant guidelines and recommendations.
Source: Lovegrove, J. Australian Critical Care, Mar 2022; 35(2): 186-203
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Community nurses' attitudes, knowledge and educational needs in relation to urinary continence, continence assessment and management: A systematic review
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.
Source: McCann, M. Journal of Clinical Nursing, Apr 2022; 31(7-8): 1041-1060
Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model
Abstract: OBJECTIVES: To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. DESIGN: Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care. SETTING AND PARTICIPANTS: Adults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913). METHODS: A multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up. RESULTS: The cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson's disease, Alzheimer's disease and related dementias, and hip fracture. CONCLUSIONS AND IMPLICATIONS: This study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.
Source: Northwood, M. Journal of the American Medical Directors Association, Oct 2022; 23(10): 1683-1690.e2
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Sustainable implementation of person-centred care in residential care facilities: Hindering and supporting factors when improving incontinence care
Abstract: Purpose: The aim of the present study was to focus on the impact of the implementation of a person-centred approach on staff perception of the likelihood of being able to provide person-centred care and strain in the workplace.
Design: The study was a controlled prospective cohort study performed at three residential care facilities in western Sweden involving all nursing staff members active from 2013 through 2015 at baseline and at three follow-ups during and after the implementation period. Two of the residential care facilities were assigned to the intervention group and one was assigned to the control group.
Method: The study was designed to test the sustainability of a person-centred approach based on three aspects: partnership, narrative and documentation. A cross-section of 20 co-workers was purposively sampled from a total of 100 persons working at the two Intervention nursing homes to participate in the intervention group. The process outcome was measured as: perceived ward atmosphere, using the staff version of the validated Person-Centred Climate Questionnaire; person-centred care, measured using the validated Person-centred Care Assessment Tool; and experience of strain in work, using the Strain in Nursing Care Assessment Scale. Descriptive statistics were calculated for all variables using the SPSS Statistics software package.
Findings: The results show that, at the control site, there was lower staff perceptions of the care atmosphere, higher level of strain experienced in their work and a lower likelihood of providing a person-centred care approach, whereas these factors remained rather stable over time at the intervention residential care facilities. Two contrasting results were observed—namely, that the higher the staff's perception of the likelihood of being able to provide individualised care and of a more person-centred ward atmosphere, the higher their stress levels experienced at work. In addition, older ages and long durations of work experience significantly negatively affected the staff's assessment of their ability to create an atmosphere of everydayness and to adopt a person-centred approach in care.
Conclusions: The findings show that sustainability of a person-centred ward atmosphere is possible in the care of older people, despite staffing problems and other organisational challenges, according to the staff's assessment, after implementation of a person-centred programme. The more experienced staff members assessed their likelihood of being able to provide a person-centred care as lower after the implementation phase, indicating that despite the ambition of supporting person-centeredness and quality of care, staffing and management difficulties that are present at the outset of the programme's implementation can later lead to stress and frustration relating to roles and routines.
Source: Alexiou, E. Nursing and Residential Care, Jan 2021; 23(1): 1-14
Development and Implementation of a Simple Wound Care Guideline for Minor Skin Lesions: A Quality Improvement Project
Abstract: PURPOSE: The purpose of this quality improvement project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline ("The Guideline") for patients with minor skin lesions, including candidiasis, skin tears, incontinence-associated dermatitis, and stage 1 and stage 2 pressure injuries that would not require a WOC nurse consultation. PARTICIPANTS AND SETTING: The Guideline was developed for nurses working on inpatient adult acute care units in a large community hospital in southwest Minnesota. APPROACH: The Guideline was validated for its clarity and appropriateness by internal and external hospital-based wound care nurses and implemented through in-person rounding on the nursing units and distribution of badge cards and required completing an online education module. Surveys and wound documentation audits were conducted to measure changes in knowledge and skin care pre- and post-implementation of The Guideline.
Source: Bates, A N. Journal of Wound, Ostomy and Continence Nursing, Jul-Aug 2021; 48(4): 285-291
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Understanding Nursing Knowledge of Continence Care and Bladder Scanner Use in Long-Term Care: An Evaluation Study
Abstract: Because urinary continence is an essential indicator for quality of life for older adults in long-term care, it is important to accurately assess and treat those at risk for incontinence. This evaluation study was to increase understanding of the issues related to the implementation of bladder scanners while exploring nursing staff knowledge about continence care of older adults in long-term care settings. Using a mixed-methods design, nursing care staff (RN, LPN, Care Aide) at six long-term care homes completed a bladder care knowledge survey and participated in focus group discussions to explore continence care knowledge and use of bladder scanners to manage continence issues. Twenty-eight nursing care staff participated; findings showed continence care knowledge varied by profession, and the use of portable bladder scanners is affected by knowledge, training, and scopes of practice. Going forward, exploring scopes of practice and education are needed for effective assessment, management, and treatment of continence.
Source: Christianson, T M. Gerontology & Geriatric Medicine, Oct 2021; 7: 1-8
Containment methods for incontinence
Abstract: Read about evidence-based nursing care for urine and stool collection to improve quality of life, promote independence, and reduce complications.
Source: Doty, S K. Nursing made Incredibly Easy!, September/October 2021; 19(5): 30-38
Older Persons and Nursing Staff's Perspectives on Continence Care in Rehabilitation: A Qualitative Study
Abstract: 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 semi structured 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-centred care is core to older person rehabilitation.
Source: Hunter, Kathleen F. Rehabilitation Nursing, Nov-Dec 2021; 46(6): 305-314
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Addressing and acting on individual ideas on continence care
Abstract: Continence care should be individually delivered with dignity, decorum, distinction in all diverse contexts and circumstances. From the dependency of childhood to ultimately the end of life, continence care is essential for all, no matter what the setting is: at home, sheltered structures, community care, residential settings and nursing homes. Person-centred care is central to healthcare policies, procedures to the provision of personalised consultation, developing a collaborative partnership approach to continence assessment, promotion, and management.
Source: Kelly, A. British Journal of Community Nursing, Jan 2021; 26(1): 38-43
'We tend to get pad happy': a qualitative study of health practitioners' perspectives on the quality of continence care for older people in hospital
Abstract: BACKGROUND: Bladder and bowel control difficulties affect 20% and 10% of the UK population, respectively, touch all age groups and are particularly prevalent in the older (65+ years) population. However, the quality of continence care is often poor, compromising patient health and well-being, increasing the risk of infection, and is a predisposing factor to nursing and residential home placement. OBJECTIVE: To identify factors that help or hinder good continence care for patients aged 65 years and over in hospital medical ward settings. Medical care, not surgical, was our exclusive focus. METHODS: We conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software. RESULTS: Interviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training. CONCLUSIONS: Findings help explain the persistence of barriers to providing good quality care for patients aged 65 years and over with incontinence. Resolute continence promotion, in hospitals and throughout the National Health Service, would reduce reliance on products and the accompanying risks of patient dependency and catheter-associated gram-negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.
Source: Percival, J. BMJ Open Quality, Apr 2021; 10(2): e001380
A Qualitative Study on the Experience and Training Needs of ICU Nurses for Incontinence-Associated Dermatitis
Abstract: OBJECTIVE: To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management. METHODS: This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semi structured interviews. The content analysis method was used to analyze, summarize, and refine the interview data. RESULTS: The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD. CONCLUSIONS: The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD.
Source: Zhang, Y. Advances in Skin Wound Care, Oct 2021; 34(10): 532-537
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Registered nurse's experiences of continence care for older people: A qualitative descriptive study
Source: Peart, J. British Journal of Nursing, Aug 2023; 32(15): 708-714
Hospital practitioner views on the benefits of continence education and best ways to provide training
Abstract: Aim: The aim of the study was to explore practitioners' experiences and perspectives on continence training, in order to understand its relevance to practice and how take-up of, and engagement with, such training may be improved.; Design: 27 qualitative interviews were conducted with nursing, medical and allied health practitioners in three hospitals.; Methods: We analysed data thematically, both manually and with the aid of NVivo software. The research adheres to the consolidated criteria for reporting qualitative research checklist.; Results: Practitioners asserted the likely benefits of evidence-based continence training, including more judicious use of products, reduction in associated infection, better patient skin care and more facilitative communication with patients. Practitioners also identified preferred methods of continence training, according to their role and workload. To ensure better take-up of, and engagement with, continence training, it must be authorized as essential and provided in ways that reflect professional preferences and pragmatic resource considerations.
Source: Percival, J. Nursing Open, May 2023; 10(5): 3305-3313
Holistically sustainable continence care: A working definition, the case of single-used absorbent hygiene products (AHPs) and the need for ecosystems thinking
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.
Source: Vaittinen, T. Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, Sept 2023; Online ahead of print
Don't just grab a pad: introducing an effective continence service
Abstract: In 2019, East Suffolk and North Essex NHS Foundation Trust launched a quality improvement project to review how it promoted continence. This led to the introduction of a new continence service with a revised continence assessment, training and education plan, which aims to raise awareness of the importance and impact that good continence care has on patients and their outcomes.
Source: Woollerton, T. Nursing Times, Apr 2023; 119(4): 39-42
Understanding approaches to continence care for people living with dementia in acute hospital settings: an ethnographic study
Abstract: Background: The acute hospital setting has become a key site of care for people living with dementia. People living with dementia are one of the largest populations in our hospitals, with the Department of Health and Social Care recognising that 25–50% of all acute hospital admissions are people who are also living with dementia. However, people living with dementia are a highly vulnerable group in the hospital setting and, following an acute admission, their functional abilities can deteriorate quickly and significantly. Detailed research is required to explore what constitutes ‘good care’.; Objectives: This study’s focus was a common, but poorly understood, aspect of everyday care for people living with dementia during an acute admission, that is continence care. We asked the following questions: what caring practices are observable when interacting with this patient group? How do ward teams respond to and manage continence needs? What informs these approaches? What are staff doing and why? Design: This ethnography was informed by the symbolic interactionist research tradition, focusing on understanding how action and meaning are constructed within a setting. In-depth evidence-based analysis of everyday care enabled us to examine how ward staff responded to the continence care needs of people living with dementia and to follow the consequences of their actions. We carried out a mixed-methods systematic narrative review to refine our approach to fieldwork and analysis.; Setting: This ethnography was carried out for 180 days, across 12 months, in six wards in three hospitals across England and Wales that were purposefully selected to represent a range of hospital types, geographies and socioeconomic catchments.; Participants: In addition to general observations, 108 individuals participated directly in this study, contributing to 562 ethnographic interviews. Ten detailed case studies were also undertaken with people living with dementia. Results: This study identified ‘pad cultures’ as an embedded practice on these acute wards. The routine use of continence pads among people living with dementia (regardless of continence and independence) was widespread. The use of continence pads was viewed as a precautionary strategy, the rationale being to provide safeguards, ensure containment and prevent ‘accidents’ or incontinence episodes, with an expectation that patients living with dementia not only will wear pads, but will use them.; Conclusions: These ‘pad cultures’ enabled the number of unscheduled interruptions to the institutionally mandated timetabled work of these wards to be reduced, but had significant impacts on people living with dementia and, in turn, wider consequences for these individuals and their identities. Ward staff described feeling abandoned with the responsibility of caring for large numbers of people living with dementia, believing that it was impossible to work in other ways to support their patient’s continence.; Limitations: The limitations identified included the potential for the Hawthorne effect to influence data collection.; Future Work: In collaboration with a specialist dementia care and continence teams, the findings are informing the development of education and training at the interactional and organisational level.; Study Registration: This study is registered as PROSPERO CRD42018119495.; Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research ; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.
Source: Featherstone, K. Health and Social Care Delivery Research, Jun 2022; 10(14)
Context for Practice: The Ties That Bind the W, the O, and the C
Abstract: No abstract available
Source: Gray, M. Journal of Wound, Ostomy and Continence Nursing, Sep-Oct 2022; 49(5): 395-399
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Pilot of Patient Engagement in Continence Care on Geriatric Rehabilitation Units
Abstract: Purpose: The aim of this study was to pilot a process of engaging geriatric rehabilitation patients in the assessment and management of their continence concerns.; Design: A descriptive study was conducted.; Methods: The study has four phases: (1) staff education on continence with a pre-post knowledge quiz, (2) design of patient engagement process by a working group, (3) a 6-week pilot of a patient symptom questionnaire and process of engaging patients with audits of disciplinary admission histories and documentation, and (4) patient and staff feedback surveys.; Results: Patients in geriatric rehabilitation identify a range of bladder and bowel symptoms. However, there was little documented evidence from the interprofessional team that corresponded to patients' reported symptoms.; Conclusion: Further research into symptoms bothersome to patients and engagement of both patients and the interprofessional team in addressing these in the rehabilitation setting is needed.; Clinical Relevance to Rehabilitation Nursing: Patients admitted to geriatric rehabilitation have a range of bladder and bowel symptoms which need to be addressed.
Source: Hunter, K F. Rehabilitation Nursing, May-Jun 2022; 47(3): 109-118
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Effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings: A systematic review and meta-analysis of randomised controlled trials
Abstract: OBJECTIVE: The aim of the study was to investigate the effectiveness of interventions to prevent pressure injury in adults admitted to intensive care settings. REVIEW METHOD USED: This is a systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Five databases (CINAHL, MEDLINE, Scopus, Web of Science, and Embase) were searched in mid-2019. Searches were updated (in April 2020) to year end 2019. REVIEW METHODS: From an overarching systematic review and meta-analysis examining the effectiveness of pressure injury preventative interventions in adults admitted to acute hospital settings, trials conducted in intensive care were separated for an intensive care-specific synthesis. Two reviewers, with a third as an arbitrator, undertook study selection, data extraction, and risk-of-bias assessment. Included trials were grouped by intervention type for narrative synthesis and for random-effects meta-analysis using intention-to-treat data where appropriate. RESULTS: Overall, 26 trials were included. Ten intervention types were found (support surfaces, prophylactic dressings, positioning, topical preparations, continence management, endotracheal tube securement, heel protection devices, medication, non-invasive ventilation masks, and bundled interventions). All trials, except one, were at high or unclear risk of bias. Four intervention types (endotracheal tube securement, heel protection devices, medication, and non-invasive ventilation masks) comprised single trials. Support surface trials were limited to type (active, reactive, seating, other). Meta-analysis was undertaken for reactive surfaces, but the intervention effect was not significant (risk ratio = 0.24, p = 0.12, I(2) = 51%). Meta-analyses demonstrated the effectiveness of sacral (risk ratio = 0.22, p < 0.001, I(2) = 0%) and heel (risk ratio = 0.31, p = 0.02; I(2) = 0%) prophylactic dressings for pressure injury prevention. CONCLUSIONS: Only prophylactic sacral and heel dressings demonstrated effectiveness in preventing pressure injury in adults admitted to intensive care settings. Further intensive care-specific trials are required across all intervention types. To minimise bias, we recommend that all future trials are conducted and reported as per relevant guidelines and recommendations.
Source: Lovegrove, J. Australian Critical Care, Mar 2022; 35(2): 186-203
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Community nurses' attitudes, knowledge and educational needs in relation to urinary continence, continence assessment and management: A systematic review
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.
Source: McCann, M. Journal of Clinical Nursing, Apr 2022; 31(7-8): 1041-1060
Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model
Abstract: OBJECTIVES: To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. DESIGN: Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care. SETTING AND PARTICIPANTS: Adults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913). METHODS: A multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up. RESULTS: The cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson's disease, Alzheimer's disease and related dementias, and hip fracture. CONCLUSIONS AND IMPLICATIONS: This study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.
Source: Northwood, M. Journal of the American Medical Directors Association, Oct 2022; 23(10): 1683-1690.e2
Contact the library for a copy of this article
Sustainable implementation of person-centred care in residential care facilities: Hindering and supporting factors when improving incontinence care
Abstract: Purpose: The aim of the present study was to focus on the impact of the implementation of a person-centred approach on staff perception of the likelihood of being able to provide person-centred care and strain in the workplace.
Design: The study was a controlled prospective cohort study performed at three residential care facilities in western Sweden involving all nursing staff members active from 2013 through 2015 at baseline and at three follow-ups during and after the implementation period. Two of the residential care facilities were assigned to the intervention group and one was assigned to the control group.
Method: The study was designed to test the sustainability of a person-centred approach based on three aspects: partnership, narrative and documentation. A cross-section of 20 co-workers was purposively sampled from a total of 100 persons working at the two Intervention nursing homes to participate in the intervention group. The process outcome was measured as: perceived ward atmosphere, using the staff version of the validated Person-Centred Climate Questionnaire; person-centred care, measured using the validated Person-centred Care Assessment Tool; and experience of strain in work, using the Strain in Nursing Care Assessment Scale. Descriptive statistics were calculated for all variables using the SPSS Statistics software package.
Findings: The results show that, at the control site, there was lower staff perceptions of the care atmosphere, higher level of strain experienced in their work and a lower likelihood of providing a person-centred care approach, whereas these factors remained rather stable over time at the intervention residential care facilities. Two contrasting results were observed—namely, that the higher the staff's perception of the likelihood of being able to provide individualised care and of a more person-centred ward atmosphere, the higher their stress levels experienced at work. In addition, older ages and long durations of work experience significantly negatively affected the staff's assessment of their ability to create an atmosphere of everydayness and to adopt a person-centred approach in care.
Conclusions: The findings show that sustainability of a person-centred ward atmosphere is possible in the care of older people, despite staffing problems and other organisational challenges, according to the staff's assessment, after implementation of a person-centred programme. The more experienced staff members assessed their likelihood of being able to provide a person-centred care as lower after the implementation phase, indicating that despite the ambition of supporting person-centeredness and quality of care, staffing and management difficulties that are present at the outset of the programme's implementation can later lead to stress and frustration relating to roles and routines.
Source: Alexiou, E. Nursing and Residential Care, Jan 2021; 23(1): 1-14
Development and Implementation of a Simple Wound Care Guideline for Minor Skin Lesions: A Quality Improvement Project
Abstract: PURPOSE: The purpose of this quality improvement project was to use the best available evidence and expert opinion to develop and implement a simple inpatient nursing care guideline ("The Guideline") for patients with minor skin lesions, including candidiasis, skin tears, incontinence-associated dermatitis, and stage 1 and stage 2 pressure injuries that would not require a WOC nurse consultation. PARTICIPANTS AND SETTING: The Guideline was developed for nurses working on inpatient adult acute care units in a large community hospital in southwest Minnesota. APPROACH: The Guideline was validated for its clarity and appropriateness by internal and external hospital-based wound care nurses and implemented through in-person rounding on the nursing units and distribution of badge cards and required completing an online education module. Surveys and wound documentation audits were conducted to measure changes in knowledge and skin care pre- and post-implementation of The Guideline.
Source: Bates, A N. Journal of Wound, Ostomy and Continence Nursing, Jul-Aug 2021; 48(4): 285-291
Contact the library for a copy of this article
Understanding Nursing Knowledge of Continence Care and Bladder Scanner Use in Long-Term Care: An Evaluation Study
Abstract: Because urinary continence is an essential indicator for quality of life for older adults in long-term care, it is important to accurately assess and treat those at risk for incontinence. This evaluation study was to increase understanding of the issues related to the implementation of bladder scanners while exploring nursing staff knowledge about continence care of older adults in long-term care settings. Using a mixed-methods design, nursing care staff (RN, LPN, Care Aide) at six long-term care homes completed a bladder care knowledge survey and participated in focus group discussions to explore continence care knowledge and use of bladder scanners to manage continence issues. Twenty-eight nursing care staff participated; findings showed continence care knowledge varied by profession, and the use of portable bladder scanners is affected by knowledge, training, and scopes of practice. Going forward, exploring scopes of practice and education are needed for effective assessment, management, and treatment of continence.
Source: Christianson, T M. Gerontology & Geriatric Medicine, Oct 2021; 7: 1-8
Containment methods for incontinence
Abstract: Read about evidence-based nursing care for urine and stool collection to improve quality of life, promote independence, and reduce complications.
Source: Doty, S K. Nursing made Incredibly Easy!, September/October 2021; 19(5): 30-38
Older Persons and Nursing Staff's Perspectives on Continence Care in Rehabilitation: A Qualitative Study
Abstract: 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 semi structured 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-centred care is core to older person rehabilitation.
Source: Hunter, Kathleen F. Rehabilitation Nursing, Nov-Dec 2021; 46(6): 305-314
Contact the library for a copy of this article
Addressing and acting on individual ideas on continence care
Abstract: Continence care should be individually delivered with dignity, decorum, distinction in all diverse contexts and circumstances. From the dependency of childhood to ultimately the end of life, continence care is essential for all, no matter what the setting is: at home, sheltered structures, community care, residential settings and nursing homes. Person-centred care is central to healthcare policies, procedures to the provision of personalised consultation, developing a collaborative partnership approach to continence assessment, promotion, and management.
Source: Kelly, A. British Journal of Community Nursing, Jan 2021; 26(1): 38-43
'We tend to get pad happy': a qualitative study of health practitioners' perspectives on the quality of continence care for older people in hospital
Abstract: BACKGROUND: Bladder and bowel control difficulties affect 20% and 10% of the UK population, respectively, touch all age groups and are particularly prevalent in the older (65+ years) population. However, the quality of continence care is often poor, compromising patient health and well-being, increasing the risk of infection, and is a predisposing factor to nursing and residential home placement. OBJECTIVE: To identify factors that help or hinder good continence care for patients aged 65 years and over in hospital medical ward settings. Medical care, not surgical, was our exclusive focus. METHODS: We conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software. RESULTS: Interviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training. CONCLUSIONS: Findings help explain the persistence of barriers to providing good quality care for patients aged 65 years and over with incontinence. Resolute continence promotion, in hospitals and throughout the National Health Service, would reduce reliance on products and the accompanying risks of patient dependency and catheter-associated gram-negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.
Source: Percival, J. BMJ Open Quality, Apr 2021; 10(2): e001380
A Qualitative Study on the Experience and Training Needs of ICU Nurses for Incontinence-Associated Dermatitis
Abstract: OBJECTIVE: To explore the experience of incontinence-associated dermatitis (IAD) as perceived by nurses, obstacles in the nursing process, and need for IAD training and management. METHODS: This single-setting descriptive qualitative study was conducted from June 5, 2018, to June 22, 2018. Ten nurses working in the respiratory ICU of a local hospital participated in semi structured interviews. The content analysis method was used to analyze, summarize, and refine the interview data. RESULTS: The experience of ICU nurses with IAD can be divided into four types: nursing based on experiential knowledge, seeking self-improvement, disunity of cleaning methods and wiping skills, and postponement of nursing care because of priority allocation. Obstacles in the nursing process include a lack of relevant nursing knowledge and awareness, as well as the medical supplies needed. The goals of training and management include establishing IAD preventive nursing procedures, providing IAD care products, enhancing the practicality of training content and diversifying training methods, and establishing an information system to assist nurses caring for patients with IAD. CONCLUSIONS: The knowledge and behavior of ICU nurses regarding IAD need to be improved. Training and management are imperative. Facilities and nurse managers should actively seek solutions to stated obstacles, formulate training methods suitable for clinical needs, and promote the standardization of nursing for IAD.
Source: Zhang, Y. Advances in Skin Wound Care, Oct 2021; 34(10): 532-537
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Registered nurse's experiences of continence care for older people: A qualitative descriptive study
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.
Source: Borglin, G. International Journal of Older People Nursing, Mar 2020; 15(1): e12275
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A quality improvement programme to reduce hospital-acquired pressure injuries
Abstract: Background At Heart Hospital in Doha, Qatar (HH), 127 pressure injuries (PI) were identified in 2014, corresponding to an incidence of 6.1/1000 patient-days in first 4 months of 2014. Hospital-acquired pressure injury (HAPI) is one of the most common preventable complications of hospitalisation. HAPI significantly increases healthcare costs, including use of resources (dressings, support surfaces, nursing care time and medications). They also have a significant impact on patients in terms of pain, worsened quality of life, psychological trauma and increased length of stay. Working with the Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in all In patient Units at HH with the aim of reducing the number of HAPIs by 60 within 2 years. Methods In collaboration with IHI, our multidisciplinary clinical and risk assessment teams tested several changes and implemented a successful programme. The Surface, Skin inspection, Keep moving, Incontinence and Nutrition bundle was implemented. Signs, turning clocks and PI incidence calendars were used in the units as reminders. Attention was paid to endotracheal tube ties in order to address device-related pressure injuries. Counts of HAPI (incidence) and number of PIs per 100 patient’s surveyed (prevalence) were prominently displayed. Changes were tested using the Plan-Do-Study-Act methodology. Statistical analysis using the independent t-test was applied to detect the significance of any difference in the incidence of HAPI before and after implementation of the changes. Results The incidence of HAPI dropped from 6.1/1000 patient-days to 1.1/1000 patient-days, an 83.5 reduction. The prevalence, based on quarterly survey fell from 9.7/100 patients surveyed to 2.0/100 patients surveyed, a 73.4 decline. Conclusions The interventions proved to be successful, reducing the incidence of PI by >80. The outcomes were sustained over a 4-year period.
Source: Gupta, P. BMJ Open Quality, Jul 2020; 9(3): e000905
Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial
Abstract: OBJECTIVE: To assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women. DESIGN: Parallel group randomised controlled trial. SETTING: 23 community and secondary care centres providing continence care in Scotland and England. PARTICIPANTS: 600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone. INTERVENTIONS: Participants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments. MAIN OUTCOME MEASURES: The primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women's perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years. RESULTS: Mean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference -0.09, 95% confidence interval -0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), -£409 to £651, P=0.64) and quality adjusted life years (-0.04, -0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions. CONCLUSIONS: At 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated. TRIAL REGISTRATION: ISRCTN57756448.
Source: Hagen, S. BMJ, Oct 2020; 371: m3719
Taking care of continence patients during the COVID-19 pandemic
Abstract: No abstract available
Source: Hillery, S. British Journal of Nursing, Dec 2020; 29(22): 1318-1324
Getting Ready for Certification: Assessing Principles of Continence
Abstract: No abstract available
Source: Kingan, M. Journal of Wound, Ostomy and Continence Nursing, Jul/Aug 2020; 47(4): 407-408
The development and validation of instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: A study protocol
Abstract: Aims: To develop and validate two instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: one instrument to be completed by care recipients and another for healthcare professionals.; Methods: The first phase of the project will involve a review of literature to identify the attributes of "dignity-protective continence care" for older people, which will be used to design the initial drafts of the instruments. Thereafter the Delphi survey technique will be used to establish the face and content validity of the draft instruments with three purposive samples; (a) care recipients (care-dependent older people with decisional capacity), (b) formal carers (nurses and personal care workers from residential aged care facilities, and (c) healthcare professionals with gerontological expertize in the management of incontinence. After instrument development, a large cross-sectional survey of care recipients and formal carers will be conducted to establish the internal consistency and construct validity of the instruments. This will be followed by a series of tests to establish their test-retest reliability.; Conclusion: The completed research will result in two reliable and valid instruments that will support broader efforts to ensure that care practices in residential aged care facilities do not violate the dignity of care-dependent older people with continence care needs, and allow care partners and providers to act upon the results.
Source: Ostaszkiewicz, J. Neurourology and Urodynamics, Jun 2020; 39(5): 1363-1370
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The Effects of Education About Urinary Incontinence on Nurses' and Nursing Assistants' Knowledge, Attitudes, Continence Care Practices, and Patient Outcomes: A Systematic Review
Abstract: The aims of this systematic review were to describe, critique, and summarize research about the effects of education about urinary incontinence on nurses' and nursing assistants' knowledge and attitudes toward urinary incontinence, their continence care practices, and patient outcomes. We searched key electronic databases (PsycINFO, MEDLINE, CINAHL, Web of Science, and Cochrane Library) for full-text primary research articles written in the English language and published between January 1990 and October 2018. Studies were included if they described a controlled or uncontrolled trial of an education program for nurses or nursing assistants about urinary incontinence and evaluated the effects of the program on either knowledge, attitudes, practice, or patient outcomes. Data were extracted about the aim, design, sample and setting, trial methods, intervention, outcomes of interest, and findings. Quality appraisal was conducted using a mixed-methods appraisal tool. Results are presented in tabular format and reported descriptively. Nineteen studies met inclusion criteria; most were set in the United States or the UK. All trials that evaluated the effects on knowledge reported improvements; however, the effects of education on attitudes were mixed as were the effects of education on continence care practices. Eleven of the 19 studies reported the statistical effect of education on patient outcomes. Uncontrolled trials reported improvements in nursing home residents' and community-dwelling patients' continence status, but this effect was not observed in a large controlled trial. Similarly, 2 studies set in inpatient rehabilitation found no significant differences in patient continence outcomes following an educational intervention targeted to nurses.
Source: Ostaszkiewicz, J. Journal of Wound, Ostomy, and Continence Nursing, Jul/Aug 2020; 47(4): 365-380
Implementing a Pressure Injury Prevention Bundle to Decrease Hospital-Acquired Pressure Injuries in an Adult Critical Care Unit: An Evidence-Based, Pilot Initiative
Abstract: Patients in critical care units (CCUs) are at risk of the development of hospital-acquired pressure injuries (HAPIs). Research supports the use of pressure injury prevention (PIP) bundle to standardize PIP strategies and reduce the incidence of HAPIs. PURPOSE: This evidence-based practice initiative was undertaken to implement a PIP bundle to decrease HAPIs in an adult patient CCU. METHODS: A literature review was conducted during the first month of the implementation of the initiative to identify best PIP and bundle implementation practices. Wound, ostomy, and continence nurses conducted educational sessions and mentored registered nurses who became PIP bundle resource nurses. Adoption of the bundle was validated using an audit tool and PIP rounds. The pre- and post-implementation HAPI indices, pressure injuries / patient care days × 1000, were compared. RESULTS: Implementation of the PIP bundle resulted in a notable decrease in HAPIs on the unit. During the pre-intervention period, January 2017 to January 2018, there were 9 HAPIs (HAPI index 3.4). During the 10-month post-intervention period, 1 HAPI developed (HAPI index 0.48). CONCLUSION: An evidence-based PIP bundle initiative was implemented in an adult patient CCU to standardize the process for HAPI prevention and reduce the number of HAPIs. Staff involvement and leadership support were vital to the success of the initiative. Integration of the bundle into practice resulted in a notable decrease in HAPIs.
Source: Rivera, J. Wound Management & Prevention, Oct 2020; 66(10): 20-28
Role of the Wound, Ostomy and Continence Nurse in Continence Care: 2018 Update
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.
Source: Berke, C. Journal of Wound, Ostomy, and Continence Nursing, May/Jun 2019; 46(3): 221-225
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Review of urinary continence care products using sensor technology to improve effectiveness
Abstract: There have been many treatment and management modalities for urinary incontinence including absorbent products and urine collecting devices, but these modalities are manual in nature, requiring significant time and effort from caregivers. Recently, the application of sensor technology for urine detection in absorbent products and urine collection devices has helped to create new modalities for urinary incontinence and to automate some of the incontinence care processes. In this article, we review the new products and devices for incontinence care which make use of urine detection sensors.
Source: Jeong, G. Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, Jan 2019; 233(1): 91-99
Contamination Risk During Fecal Management Device Removal: An In vitro, Simulated Clinical Use Study
Abstract: Fecal management devices (FMDs) are used to drain and contain fecal matter in incontinent, often acutely or Critically ill patients to protect their skin as well as the environment from contamination. However, there is potential for contamination and resultant infection at various stages of FMD use. PURPOSE: This in vitro study was conducted to compare device removal factors and subsequent splash of simulated fecal matter of 3 different designs of FMDs using a simulated rectum. METHODS: A Universal Test Machine was used to automatically measure removal forces (in newtons N]) and tube extensions as the FMDs were pulled from the simulated rectum by the machine. Splash distance and quantity were measured using a splash-capture cylinder and image analysis software. Each device was tested 3 times. Two-sample t tests were conducted to examine statistical differences in removal forces, removal extensions, and splash areas. RESULTS: The forces required to remove the FMDs from the simulated rectum were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (12.0 ± 0.3 N vs. 32.6 ± 4.3 N and 34.8 ± 3.1 N, respectively; P <.05). The extensions of the catheter tubing were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (32.0 ± 7.5 mm vs. 81.3 ± 9.1 mm and 105.2 ± 10.6 mm, respectively; P <.05). Simulated fecal matter was splashed over mean areas of 25.5 ± 16.1 cm2 and 27.3 ± 13.5 cm2 for the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon, respectively; no splash was observed for the device with a collapsible, donut-shaped retention balloon. CONCLUSION: In vitro observations suggest contamination and potential infection risk during FMD removal from the patient are influenced by FMD design. Future in vitro and clinical studies assessing the infectious nature of effluent and methods for containment are warranted.
Source: Metcalf, D. G. Ostomy Wound Management & Prevention, March 2019; 65(3): 30-37
Nursing Care Guidelines for Reducing Hospital-Acquired Nasogastric Tube-Related Pressure Injuries
Abstract: BACKGROUND: Nurses certified in wound, ostomy, and continence monitored an increasing incidence of hospital-acquired pressure injury of the nares due to medical devices, specifically nasogastric tubes, in a metropolitan hospital. A majority of these pressure injuries occurred in patients in the intensive care unit. The organization lacked formal guidelines for preventing such injuries. OBJECTIVE: To decrease the incidence of nasogastric tube-related hospital-acquired pressure injury. METHODS: The organization's process improvement model, comprising steps to define, measure, analyze, improve, and control, guided the project. The incidence rate of nasogastric tube-related hospital-acquired pressure injury before the intervention was determined for calendar year 2015 and compared with data obtained after the intervention, for calendar year 2016. An interprofessional team created, implemented, and evaluated the effectiveness of evidence-based guidelines and surveillance strategies for preventing nasogastric tube-related hospital-acquired pressure injury. The team implemented guidelines using the simple mnemonic "CLEAN": correct tube position, stabilize tube, evaluate area under/near tube, alleviate pressure, note date and time. RESULTS: The incidence rate of nasogastric tube-related hospital-acquired pressure injury (0.13 per 1000 patient days in 2015) decreased 100% (0.0 per 1000 patient days in 2016) after the guidelines were implemented in the organization. This rate was sustained for a full year, after which it increased slightly because temporary and new staff lacked knowledge of the guidelines. CONCLUSIONS: The creation and implementation of clear and specific guidelines for assessing and securing nasogastric tubes successfully reduced nasogastric tube-related hospital-acquired pressure injury.
Source: Schroeder, J. Critical Care Nurse, Dec 2019; 39(6): 54-63
Preferences for Continence Care Experienced at End of Life: A Qualitative Study
Abstract: CONTEXT: Functional dependence at end of life often leaves individuals requiring help for personal care, including maintaining continence. Current continence guidelines offer little direction for end of life continence care, and little is known of the perspectives of people receiving palliative care. OBJECTIVES: The aim of the study was to examine the continence care preferences of people receiving palliative care to understand what approaches to care and what goals of care are important to them. METHODS: This is a qualitative descriptive exploratory study with data gathered in individual interviews using a semi-structured interview guide. Participants were receiving bladder and/or bowel care on either tertiary or hospice palliative care units. RESULTS: Fourteen Canadian patients (seven female, seven male), six from tertiary and eight from hospice palliative care units, were recruited. From the analysis, three themes were identified: loss of control, finding a way to manage, and caregivers can help and can hinder. Dignity was often lost as a result of having to receive continence care, with most participants following staff recommendations for management approaches as the easiest way. Patients did not recall being asked about their bladder and bowel preferences. CONCLUSIONS: As patients approached end of life they were willing to give up dignity if it was required to address symptoms causing them more distress, like pain. Health care professionals and family have an important role in social interactions around continence care. Health care professionals should incorporate patient preferences as best they can and explain the options when treating incontinence at end of life.
Source: Smith, N. Journal of Pain and Symptom Management, Jun 2019; 57(6): 1099-1105.e3
Prevention and management of moisture-associated skin damage
Abstract: The harmful effects of excessive moisture on a patient's skin are well known. While traditionally considered an issue only encountered in continence care and older people, it is now recognised that the harmful effects of excessive moisture can occur across the lifespan and in various patient groups. The term 'moisture-associated skin damage' describes the spectrum of inflammatory damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that moisture-associated skin damage consists of four conditions: incontinence associated dermatitis, intertrigo, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. This article describes the aetiologies of each of the different types of moisture-associated skin damage, and outlines the nursing interventions required for their prevention and management.
Source: Voegeli, D. British Journal of Nursing, Aug 2021; 30(15): S40-S46
Efficacy and Cost-Effectiveness Analysis of Evidence-Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence-Associated Dermatitis
Abstract: Background: A reduction in tissue tolerance promotes the development of pressure ulcers (PUs) and incontinence-associated dermatitis (IAD).
Source: Avsar, P. Worldviews on Evidence-Based Nursing, Feb 2018; 15(1): 54-61
Continence care education: views of students and registered nurses
Abstract: Background: this article reports on a study of continence education and training for students and qualified nurses.; Aims: to understand how nurses and nursing students gain their knowledge in continence education and training, to examine nurses' understanding of bladder and bowel care and to discover to what degree nurses are confident in their knowledge of bladder and bowel care.; Methods: this was a qualitative enquiry and a case study methodology was used to frame the research. The data were captured through a questionnaire and group discussions. Findings: continence education comprised support through self-learning, classroom instruction, skills laboratory sessions and on the wards. Feedback from participants indicated that, although continence education enhanced learning, they thought continence education sessions were either too short or did not go into enough detail. Two key factors that limited learning in the workplace were time and work priorities.; Conclusion: it is recommended that a combination of learning strategies is useful and valuable in developing the nurse's skills and knowledge of continence care, if time and funding are available.
Source: Ferdinand, S. British Journal of Nursing, Aug 2018; 27(15): 852-859
Evaluation of the Efficiency of the Nursing Care Plan Applied Using NANDA, NOC, and NIC Linkages to Elderly Women with Incontinence Living in a Nursing Home: A Randomized Controlled Study
Abstract: PURPOSE: Evaluate the efficiency of the nursing care plan, applied with the use of NANDA‐I, NOC, and NIC (NNN) linkages, for elderly women with incontinence who live in nursing homes. METHODS: A randomized controlled experimental design was applied. NNN linkages were prepared and applied for 12 weeks in an experimental group. NOC scales were evaluated again for two groups. RESULTS: A 0.5 NOC point change targeted in all elderly in the experimental group were provided between pretest–posttest scores. The experimental group had higher life quality and lower incontinence severity/symptoms than the control group. CONCLUSION: It is important that NNN linkages effective for solving the problems are used in different groups and with larger samples to create further evidence linking NNN.
Source: Gencbas, D. International Journal of Nursing Knowledge, Oct 2018; 29(4): 217-226
Be a continence champion: use the CHAMMP tool to individualize the plan of care
Abstract: In June 2005, the U.S. Centers for Medicare and Medicaid Services (CMS) issued revised guidance to surveyors for Section 483.25(d), Urinary Incontinence, Tag F315. Part 1 instructs that an indwelling catheter not be used without valid medical justification. Part 2 requires that a resident receive treatment to restore continence to the extent possible. Identification, assessment, and diagnosis of incontinence are crucial to preparing an individualized plan of care for treatment. Many articles discuss treatment protocols, but they do not focus on identification and assessment of the incontinent resident. The CHAMMP (Continence, History, Assessment, Medications, Mobility, Plan) Tool provides a comprehensive evaluation tool that incorporates information from the resident and provides the documentation necessary for the MDS (Minimum Data Set) and RAP (Resident Assessment Protocol) assessment process. It is used to establish an individualized plan of care.
Source: Bucci, A. T. Geriatric Nursing, Mar-Apr 2007; 28(2): 120-124; quiz 125
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Source: Borglin, G. International Journal of Older People Nursing, Mar 2020; 15(1): e12275
Contact the library for a copy of this article
A quality improvement programme to reduce hospital-acquired pressure injuries
Abstract: Background At Heart Hospital in Doha, Qatar (HH), 127 pressure injuries (PI) were identified in 2014, corresponding to an incidence of 6.1/1000 patient-days in first 4 months of 2014. Hospital-acquired pressure injury (HAPI) is one of the most common preventable complications of hospitalisation. HAPI significantly increases healthcare costs, including use of resources (dressings, support surfaces, nursing care time and medications). They also have a significant impact on patients in terms of pain, worsened quality of life, psychological trauma and increased length of stay. Working with the Institute for Healthcare Improvement (IHI), we implemented evidence-based practices in all In patient Units at HH with the aim of reducing the number of HAPIs by 60 within 2 years. Methods In collaboration with IHI, our multidisciplinary clinical and risk assessment teams tested several changes and implemented a successful programme. The Surface, Skin inspection, Keep moving, Incontinence and Nutrition bundle was implemented. Signs, turning clocks and PI incidence calendars were used in the units as reminders. Attention was paid to endotracheal tube ties in order to address device-related pressure injuries. Counts of HAPI (incidence) and number of PIs per 100 patient’s surveyed (prevalence) were prominently displayed. Changes were tested using the Plan-Do-Study-Act methodology. Statistical analysis using the independent t-test was applied to detect the significance of any difference in the incidence of HAPI before and after implementation of the changes. Results The incidence of HAPI dropped from 6.1/1000 patient-days to 1.1/1000 patient-days, an 83.5 reduction. The prevalence, based on quarterly survey fell from 9.7/100 patients surveyed to 2.0/100 patients surveyed, a 73.4 decline. Conclusions The interventions proved to be successful, reducing the incidence of PI by >80. The outcomes were sustained over a 4-year period.
Source: Gupta, P. BMJ Open Quality, Jul 2020; 9(3): e000905
Effectiveness of pelvic floor muscle training with and without electromyographic biofeedback for urinary incontinence in women: multicentre randomised controlled trial
Abstract: OBJECTIVE: To assess the effectiveness of pelvic floor muscle training (PFMT) plus electromyographic biofeedback or PFMT alone for stress or mixed urinary incontinence in women. DESIGN: Parallel group randomised controlled trial. SETTING: 23 community and secondary care centres providing continence care in Scotland and England. PARTICIPANTS: 600 women aged 18 and older, newly presenting with stress or mixed urinary incontinence between February 2014 and July 2016: 300 were randomised to PFMT plus electromyographic biofeedback and 300 to PFMT alone. INTERVENTIONS: Participants in both groups were offered six appointments with a continence therapist over 16 weeks. Participants in the biofeedback PFMT group received supervised PFMT and a home PFMT programme, incorporating electromyographic biofeedback during clinic appointments and at home. The PFMT group received supervised PFMT and a home PFMT programme. PFMT programmes were progressed over the appointments. MAIN OUTCOME MEASURES: The primary outcome was self-reported severity of urinary incontinence (International Consultation on Incontinence Questionnaire-urinary incontinence short form (ICIQ-UI SF), range 0 to 21, higher scores indicating greater severity) at 24 months. Secondary outcomes were cure or improvement, other pelvic floor symptoms, condition specific quality of life, women's perception of improvement, pelvic floor muscle function, uptake of other urinary incontinence treatment, PFMT self-efficacy, adherence, intervention costs, and quality adjusted life years. RESULTS: Mean ICIQ-UI SF scores at 24 months were 8.2 (SD 5.1, n=225) in the biofeedback PFMT group and 8.5 (SD 4.9, n=235) in the PFMT group (mean difference -0.09, 95% confidence interval -0.92 to 0.75, P=0.84). Biofeedback PFMT had similar costs (mean difference £121 ($154; €133), -£409 to £651, P=0.64) and quality adjusted life years (-0.04, -0.12 to 0.04, P=0.28) to PFMT. 48 participants reported an adverse event: for 23 this was related or possibly related to the interventions. CONCLUSIONS: At 24 months no evidence was found of any important difference in severity of urinary incontinence between PFMT plus electromyographic biofeedback and PFMT alone groups. Routine use of electromyographic biofeedback with PFMT should not be recommended. Other ways of maximising the effects of PFMT should be investigated. TRIAL REGISTRATION: ISRCTN57756448.
Source: Hagen, S. BMJ, Oct 2020; 371: m3719
Taking care of continence patients during the COVID-19 pandemic
Abstract: No abstract available
Source: Hillery, S. British Journal of Nursing, Dec 2020; 29(22): 1318-1324
Getting Ready for Certification: Assessing Principles of Continence
Abstract: No abstract available
Source: Kingan, M. Journal of Wound, Ostomy and Continence Nursing, Jul/Aug 2020; 47(4): 407-408
The development and validation of instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: A study protocol
Abstract: Aims: To develop and validate two instruments to measure dignity-protective continence care for care-dependent older people in residential aged care facilities: one instrument to be completed by care recipients and another for healthcare professionals.; Methods: The first phase of the project will involve a review of literature to identify the attributes of "dignity-protective continence care" for older people, which will be used to design the initial drafts of the instruments. Thereafter the Delphi survey technique will be used to establish the face and content validity of the draft instruments with three purposive samples; (a) care recipients (care-dependent older people with decisional capacity), (b) formal carers (nurses and personal care workers from residential aged care facilities, and (c) healthcare professionals with gerontological expertize in the management of incontinence. After instrument development, a large cross-sectional survey of care recipients and formal carers will be conducted to establish the internal consistency and construct validity of the instruments. This will be followed by a series of tests to establish their test-retest reliability.; Conclusion: The completed research will result in two reliable and valid instruments that will support broader efforts to ensure that care practices in residential aged care facilities do not violate the dignity of care-dependent older people with continence care needs, and allow care partners and providers to act upon the results.
Source: Ostaszkiewicz, J. Neurourology and Urodynamics, Jun 2020; 39(5): 1363-1370
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The Effects of Education About Urinary Incontinence on Nurses' and Nursing Assistants' Knowledge, Attitudes, Continence Care Practices, and Patient Outcomes: A Systematic Review
Abstract: The aims of this systematic review were to describe, critique, and summarize research about the effects of education about urinary incontinence on nurses' and nursing assistants' knowledge and attitudes toward urinary incontinence, their continence care practices, and patient outcomes. We searched key electronic databases (PsycINFO, MEDLINE, CINAHL, Web of Science, and Cochrane Library) for full-text primary research articles written in the English language and published between January 1990 and October 2018. Studies were included if they described a controlled or uncontrolled trial of an education program for nurses or nursing assistants about urinary incontinence and evaluated the effects of the program on either knowledge, attitudes, practice, or patient outcomes. Data were extracted about the aim, design, sample and setting, trial methods, intervention, outcomes of interest, and findings. Quality appraisal was conducted using a mixed-methods appraisal tool. Results are presented in tabular format and reported descriptively. Nineteen studies met inclusion criteria; most were set in the United States or the UK. All trials that evaluated the effects on knowledge reported improvements; however, the effects of education on attitudes were mixed as were the effects of education on continence care practices. Eleven of the 19 studies reported the statistical effect of education on patient outcomes. Uncontrolled trials reported improvements in nursing home residents' and community-dwelling patients' continence status, but this effect was not observed in a large controlled trial. Similarly, 2 studies set in inpatient rehabilitation found no significant differences in patient continence outcomes following an educational intervention targeted to nurses.
Source: Ostaszkiewicz, J. Journal of Wound, Ostomy, and Continence Nursing, Jul/Aug 2020; 47(4): 365-380
Implementing a Pressure Injury Prevention Bundle to Decrease Hospital-Acquired Pressure Injuries in an Adult Critical Care Unit: An Evidence-Based, Pilot Initiative
Abstract: Patients in critical care units (CCUs) are at risk of the development of hospital-acquired pressure injuries (HAPIs). Research supports the use of pressure injury prevention (PIP) bundle to standardize PIP strategies and reduce the incidence of HAPIs. PURPOSE: This evidence-based practice initiative was undertaken to implement a PIP bundle to decrease HAPIs in an adult patient CCU. METHODS: A literature review was conducted during the first month of the implementation of the initiative to identify best PIP and bundle implementation practices. Wound, ostomy, and continence nurses conducted educational sessions and mentored registered nurses who became PIP bundle resource nurses. Adoption of the bundle was validated using an audit tool and PIP rounds. The pre- and post-implementation HAPI indices, pressure injuries / patient care days × 1000, were compared. RESULTS: Implementation of the PIP bundle resulted in a notable decrease in HAPIs on the unit. During the pre-intervention period, January 2017 to January 2018, there were 9 HAPIs (HAPI index 3.4). During the 10-month post-intervention period, 1 HAPI developed (HAPI index 0.48). CONCLUSION: An evidence-based PIP bundle initiative was implemented in an adult patient CCU to standardize the process for HAPI prevention and reduce the number of HAPIs. Staff involvement and leadership support were vital to the success of the initiative. Integration of the bundle into practice resulted in a notable decrease in HAPIs.
Source: Rivera, J. Wound Management & Prevention, Oct 2020; 66(10): 20-28
Role of the Wound, Ostomy and Continence Nurse in Continence Care: 2018 Update
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.
Source: Berke, C. Journal of Wound, Ostomy, and Continence Nursing, May/Jun 2019; 46(3): 221-225
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Review of urinary continence care products using sensor technology to improve effectiveness
Abstract: There have been many treatment and management modalities for urinary incontinence including absorbent products and urine collecting devices, but these modalities are manual in nature, requiring significant time and effort from caregivers. Recently, the application of sensor technology for urine detection in absorbent products and urine collection devices has helped to create new modalities for urinary incontinence and to automate some of the incontinence care processes. In this article, we review the new products and devices for incontinence care which make use of urine detection sensors.
Source: Jeong, G. Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine, Jan 2019; 233(1): 91-99
Contamination Risk During Fecal Management Device Removal: An In vitro, Simulated Clinical Use Study
Abstract: Fecal management devices (FMDs) are used to drain and contain fecal matter in incontinent, often acutely or Critically ill patients to protect their skin as well as the environment from contamination. However, there is potential for contamination and resultant infection at various stages of FMD use. PURPOSE: This in vitro study was conducted to compare device removal factors and subsequent splash of simulated fecal matter of 3 different designs of FMDs using a simulated rectum. METHODS: A Universal Test Machine was used to automatically measure removal forces (in newtons N]) and tube extensions as the FMDs were pulled from the simulated rectum by the machine. Splash distance and quantity were measured using a splash-capture cylinder and image analysis software. Each device was tested 3 times. Two-sample t tests were conducted to examine statistical differences in removal forces, removal extensions, and splash areas. RESULTS: The forces required to remove the FMDs from the simulated rectum were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (12.0 ± 0.3 N vs. 32.6 ± 4.3 N and 34.8 ± 3.1 N, respectively; P <.05). The extensions of the catheter tubing were significantly lower for the device with a collapsible, donut-shaped retention balloon compared with the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon (32.0 ± 7.5 mm vs. 81.3 ± 9.1 mm and 105.2 ± 10.6 mm, respectively; P <.05). Simulated fecal matter was splashed over mean areas of 25.5 ± 16.1 cm2 and 27.3 ± 13.5 cm2 for the devices with a green, foldable, trumpet-shaped retention cuff and a foldable, spherical-shaped retention balloon, respectively; no splash was observed for the device with a collapsible, donut-shaped retention balloon. CONCLUSION: In vitro observations suggest contamination and potential infection risk during FMD removal from the patient are influenced by FMD design. Future in vitro and clinical studies assessing the infectious nature of effluent and methods for containment are warranted.
Source: Metcalf, D. G. Ostomy Wound Management & Prevention, March 2019; 65(3): 30-37
Nursing Care Guidelines for Reducing Hospital-Acquired Nasogastric Tube-Related Pressure Injuries
Abstract: BACKGROUND: Nurses certified in wound, ostomy, and continence monitored an increasing incidence of hospital-acquired pressure injury of the nares due to medical devices, specifically nasogastric tubes, in a metropolitan hospital. A majority of these pressure injuries occurred in patients in the intensive care unit. The organization lacked formal guidelines for preventing such injuries. OBJECTIVE: To decrease the incidence of nasogastric tube-related hospital-acquired pressure injury. METHODS: The organization's process improvement model, comprising steps to define, measure, analyze, improve, and control, guided the project. The incidence rate of nasogastric tube-related hospital-acquired pressure injury before the intervention was determined for calendar year 2015 and compared with data obtained after the intervention, for calendar year 2016. An interprofessional team created, implemented, and evaluated the effectiveness of evidence-based guidelines and surveillance strategies for preventing nasogastric tube-related hospital-acquired pressure injury. The team implemented guidelines using the simple mnemonic "CLEAN": correct tube position, stabilize tube, evaluate area under/near tube, alleviate pressure, note date and time. RESULTS: The incidence rate of nasogastric tube-related hospital-acquired pressure injury (0.13 per 1000 patient days in 2015) decreased 100% (0.0 per 1000 patient days in 2016) after the guidelines were implemented in the organization. This rate was sustained for a full year, after which it increased slightly because temporary and new staff lacked knowledge of the guidelines. CONCLUSIONS: The creation and implementation of clear and specific guidelines for assessing and securing nasogastric tubes successfully reduced nasogastric tube-related hospital-acquired pressure injury.
Source: Schroeder, J. Critical Care Nurse, Dec 2019; 39(6): 54-63
Preferences for Continence Care Experienced at End of Life: A Qualitative Study
Abstract: CONTEXT: Functional dependence at end of life often leaves individuals requiring help for personal care, including maintaining continence. Current continence guidelines offer little direction for end of life continence care, and little is known of the perspectives of people receiving palliative care. OBJECTIVES: The aim of the study was to examine the continence care preferences of people receiving palliative care to understand what approaches to care and what goals of care are important to them. METHODS: This is a qualitative descriptive exploratory study with data gathered in individual interviews using a semi-structured interview guide. Participants were receiving bladder and/or bowel care on either tertiary or hospice palliative care units. RESULTS: Fourteen Canadian patients (seven female, seven male), six from tertiary and eight from hospice palliative care units, were recruited. From the analysis, three themes were identified: loss of control, finding a way to manage, and caregivers can help and can hinder. Dignity was often lost as a result of having to receive continence care, with most participants following staff recommendations for management approaches as the easiest way. Patients did not recall being asked about their bladder and bowel preferences. CONCLUSIONS: As patients approached end of life they were willing to give up dignity if it was required to address symptoms causing them more distress, like pain. Health care professionals and family have an important role in social interactions around continence care. Health care professionals should incorporate patient preferences as best they can and explain the options when treating incontinence at end of life.
Source: Smith, N. Journal of Pain and Symptom Management, Jun 2019; 57(6): 1099-1105.e3
Prevention and management of moisture-associated skin damage
Abstract: The harmful effects of excessive moisture on a patient's skin are well known. While traditionally considered an issue only encountered in continence care and older people, it is now recognised that the harmful effects of excessive moisture can occur across the lifespan and in various patient groups. The term 'moisture-associated skin damage' describes the spectrum of inflammatory damage that occurs in response to the prolonged exposure of a patient's skin to perspiration, urine, faeces or wound exudate. It is generally accepted that moisture-associated skin damage consists of four conditions: incontinence associated dermatitis, intertrigo, peristomal moisture-associated dermatitis, and periwound moisture-associated dermatitis. This article describes the aetiologies of each of the different types of moisture-associated skin damage, and outlines the nursing interventions required for their prevention and management.
Source: Voegeli, D. British Journal of Nursing, Aug 2021; 30(15): S40-S46
Efficacy and Cost-Effectiveness Analysis of Evidence-Based Nursing Interventions to Maintain Tissue Integrity to Prevent Pressure Ulcers and Incontinence-Associated Dermatitis
Abstract: Background: A reduction in tissue tolerance promotes the development of pressure ulcers (PUs) and incontinence-associated dermatitis (IAD).
Source: Avsar, P. Worldviews on Evidence-Based Nursing, Feb 2018; 15(1): 54-61
Continence care education: views of students and registered nurses
Abstract: Background: this article reports on a study of continence education and training for students and qualified nurses.; Aims: to understand how nurses and nursing students gain their knowledge in continence education and training, to examine nurses' understanding of bladder and bowel care and to discover to what degree nurses are confident in their knowledge of bladder and bowel care.; Methods: this was a qualitative enquiry and a case study methodology was used to frame the research. The data were captured through a questionnaire and group discussions. Findings: continence education comprised support through self-learning, classroom instruction, skills laboratory sessions and on the wards. Feedback from participants indicated that, although continence education enhanced learning, they thought continence education sessions were either too short or did not go into enough detail. Two key factors that limited learning in the workplace were time and work priorities.; Conclusion: it is recommended that a combination of learning strategies is useful and valuable in developing the nurse's skills and knowledge of continence care, if time and funding are available.
Source: Ferdinand, S. British Journal of Nursing, Aug 2018; 27(15): 852-859
Evaluation of the Efficiency of the Nursing Care Plan Applied Using NANDA, NOC, and NIC Linkages to Elderly Women with Incontinence Living in a Nursing Home: A Randomized Controlled Study
Abstract: PURPOSE: Evaluate the efficiency of the nursing care plan, applied with the use of NANDA‐I, NOC, and NIC (NNN) linkages, for elderly women with incontinence who live in nursing homes. METHODS: A randomized controlled experimental design was applied. NNN linkages were prepared and applied for 12 weeks in an experimental group. NOC scales were evaluated again for two groups. RESULTS: A 0.5 NOC point change targeted in all elderly in the experimental group were provided between pretest–posttest scores. The experimental group had higher life quality and lower incontinence severity/symptoms than the control group. CONCLUSION: It is important that NNN linkages effective for solving the problems are used in different groups and with larger samples to create further evidence linking NNN.
Source: Gencbas, D. International Journal of Nursing Knowledge, Oct 2018; 29(4): 217-226
Be a continence champion: use the CHAMMP tool to individualize the plan of care
Abstract: In June 2005, the U.S. Centers for Medicare and Medicaid Services (CMS) issued revised guidance to surveyors for Section 483.25(d), Urinary Incontinence, Tag F315. Part 1 instructs that an indwelling catheter not be used without valid medical justification. Part 2 requires that a resident receive treatment to restore continence to the extent possible. Identification, assessment, and diagnosis of incontinence are crucial to preparing an individualized plan of care for treatment. Many articles discuss treatment protocols, but they do not focus on identification and assessment of the incontinent resident. The CHAMMP (Continence, History, Assessment, Medications, Mobility, Plan) Tool provides a comprehensive evaluation tool that incorporates information from the resident and provides the documentation necessary for the MDS (Minimum Data Set) and RAP (Resident Assessment Protocol) assessment process. It is used to establish an individualized plan of care.
Source: Bucci, A. T. Geriatric Nursing, Mar-Apr 2007; 28(2): 120-124; quiz 125
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