The Realities and Needs of Nursing Assistants Caring for Disabled Patients with Fecal Incontinence During Hospitalization: A Qualitative Study.

Objective: To explore the experience, role, and needs of medical nursing assistants during hospitalization in patients with incapacitated fecal incontinence. Methods: Qualitative study using reflexive thematic analysis. Semi-structured interviews were conducted with 21 medical nursing assistants from three hospitals in Southern China. Results: Four themes were constructed from the data: (1) Role perception. All participants described the multiple roles they played during care and knowledge and familiarity with the roles were seen as providing high-quality care to patients. (2) Career cognition. Overall, participants had a positive view of nurse assistants as a career. They believed that nursing experience was more important than training. (3) emotional belonging. The multiple roles of medical nursing assistants give them very mixed emotions. (4) Potential needs. Participants reported that the fatigue of repeatedly scrubbing and cleaning stools, the negative emotions that could not be faced and resolved, and their special status made them overwhelmed, potentially reflecting that they needed more support. Conclusions: This study highlights the roles, experiences, confusions, and needs of nursing assistants in caring for patients with disabling fecal incontinence. Suggested areas for improvement include the development of more intelligent fecal incontinence collection devices and the development of management and training strategies by health managers based on the specific context of medical nursing assistants to emphasize the role of medical nursing assistants and improve the quality of clinical care.

Incontinence: living with a stigmatised health condition.

This article shares the personal account of the author who is living with double incontinence, and the impact this condition can have on the individual and their carers.

Guidance for the provision of absorbent products for adult incontinence.

The Association for Continence Professionals first published their guidance for the provision of absorbent products for adult incontinence in 2017. This consensus document is targeted towards commissioning leads, NHS Trust Boards, Bladder and Bowel leads, among others, and has been updated over the years to ensure that all adults who suffer with continence issues undergo a comprehensive assessment and have access to an equitable service. This article provides an overview of the latest guidelines which were published in February 2023.

Managing incontinence-associated dermatitis in the community: an overview.

Incontinence-associated dermatitis (IAD) is often treated a hygienic challenge, rather than a serious condition with potentially life-threatening consequences. More appropriate education on the management strategies specific to IAD is required, in order for personalised and effective care that reflects the critical nature of this condition to be provided. Francesca Ramadan provides an overview of the key elements of best practice in IAD management and treatment.

Incontinence in people living with dementia.

Dementia and incontinence are both prevalent in older age; yet, neither are an inevitable or normal part of ageing. It has been recognised that there is a skills and knowledge gap in professionals assessing and managing incontinence for people living with dementia. All too often, assumptions are made that incontinence is a symptom of dementia and that nothing can be done if a person living with dementia experiences episodes of incontinence. While dementia may impact on a person's ability to remain continent, it may not be the sole cause, and there may be treatments and strategies that can reduce the incidence in those affected. Therefore, a person-centred continence assessment should be undertaken to promote continence and reduce the impact of incontinence for people living with dementia and those who care for them. This paper will highlight some of the issues that are important for health and social care professionals to explore and identify, assess and manage incontinence to improve outcomes for families affected by dementia.

The Value of Nurses Specialized in Wound, Ostomy, and Continence: A Systematic Review.

OBJECTIVE: To critically appraise peer-reviewed evidence concerning the value, or implied sense of worth or benefit, of nurses specialized in wound, ostomy, and continence (WOC) care. DATA SOURCES: The Preferred Reporting Items for Systematic Reviews and Meta-analyses was used to systematically review current literature in a single database from 2009 to the date of search (July 2019). STUDY SELECTION: The initial search retrieved 2,340 elements; 10 studies were retained following removal of duplicate records, title and abstract reviews, and application of the inclusion/exclusion criteria. DATA EXTRACTION: Literature was graded and critiqued with regard to design and research quality and then synthesized using a narrative approach. DATA SYNTHESIS: Nine values that WOC nurses demonstrate were identified: improved quality of life for patients, teaching and mentoring, cost reduction, improved efficiency, improved wound outcomes, improved incontinence outcomes, advanced treatments, research, and leadership. CONCLUSIONS: Although current studies suggest that there is value in the WOC nurse role, in all areas of the trispecialty, there is a need for high-quality literature with higher-level designs focused on bias reduction.

Development and Implementation of a Simple Wound Care Guideline for Minor Skin Lesions: A Quality Improvement Project.

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 postimplementation of The Guideline. OUTCOMES: We conducted wound documentation audits of approximately 491 records that assessed whether patients received appropriate treatment and found an improvement from 45% (104 of 231) to 80% (209 of 260). Nurses' self-rating of their knowledge about which dressings and topical treatment to use improved from 18% (16 of 89) agreement to 57% (55 of 96). Nurses' self-rating of their knowledge about when to change dressings and reapply topical treatments improved from 27% (24 of 89) agreement to 65% (62 of 96). IMPLICATIONS FOR PRACTICE: Although there is evidence for a variety of dressings or products to treat wounds, this quality improvement project demonstrated increased adherence with providing appropriate care when fewer treatment options were recommended to nursing staff through our structured guideline. The Guideline continues to be used at the project site and is now being implemented at affiliate hospitals.

The Prevalence of Incontinence-Associated Dermatitis in Hospitalized Patients in China: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the prevalence and characteristics of incontinence-associated dermatitis (IAD) among hospitalized Chinese patients. DATA SOURCES: Authors searched Chinese (China National Knowledge Infrastructure, Wanfang Data, VIP Data, Chinese Biomedicine) and English (PubMed, Web of Science) electronic databases for articles published from 1987 through February 2019. STUDY SELECTION: The preliminary search identified 558 studies. After removal of duplicates (n = 202), application of exclusion criteria, and screening titles and abstracts (n = 346), 10 studies met the inclusion criteria. DATA EXTRACTION: A standardized form was constructed to extract data from eligible studies, and this information was extracted by two independent authors. DATA SYNTHESIS: A pooled analysis of the 10 studies (total sample size, 40,039) showed the prevalence of IAD in hospitalized Chinese patients was 1.44% (95% confidence interval, 1.10%-1.79%). Subgroup analysis indicated no significant association between sex and IAD. Patients older than 90 years had the highest incidence of IAD (8.64%). The most common type was mild IAD (1.00%). Fecal incontinence (48.02%) led to more cases of IAD than urinary incontinence (11.35%) or both (25.78%). The most common types of IAD were perineal (0.92%) and perianal (0.90%). CONCLUSIONS: Incontinence-associated dermatitis is a global health problem that requires more attention. Understanding the prevalence and characteristics of IAD is helpful in the formulation of IAD prevention and treatment programs in China.

Efficacy of Incontinence-Associated Dermatitis Intervention for Patients in Intensive Care: An Open-Label Pilot Randomized Controlled Trial.

OBJECTIVE: To determine the feasibility of an adequately powered trial testing a long-acting cyanoacrylate skin protectant to prevent incontinence-associated dermatitis in critically ill patients. METHODS: This open-label pilot randomized controlled feasibility study was conducted in the adult ICU of an Australian quaternary referral hospital. Patients were allocated to either an intervention group or a control group (usual care). The intervention was the application of a skin protectant (a durable, ultra-thin, transparent, waterproof, no-removal barrier film). Data collected by trained research nurses included demographic and clinical variables, skin assessment, and incontinence-associated dermatitis presence and severity. Data were analyzed using descriptive and inferential statistics. RESULTS: Of the 799 patients screened, 85% were eliminated because of a short ICU stay or other exclusion criteria. The mean proportion of patients not meeting any of the exclusion criteria was 22% on each screening day. Protocol fidelity was followed for 90% of intervention participant study days. Retention of participants was 86% (31 participants out of 36), 15 in the intervention group and 16 in the control group. Enrolled patients had a mean age of 59 years, 50% were obese, 67% were male, and 36% were smokers. Two patients (11%) in the intervention group developed incontinence-associated dermatitis, compared with three (17%) in the control group. CONCLUSIONS: This study reports no significant findings between the two groups. Difficulty in recruitment and feasibility issues might be overcome with changes to inclusion criteria and study design.

[Using Teamwork to Reduce the Incidence of Incontinence-Associated Dermatitis].

BACKGROUND & PROBLEMS: Dermatitis associated with incontinence was the cause of 55% of the total of 386 skin lesion cases in our unit between July and December 2016 and 40.3% of the skin lesion cases in our unit during March and April 2017, indicating the importance of this issue. Our survey showed that the nurses in our unit scored an average of 78.9% on knowledge related to the prevention of incontinence-associated dermatitis and only 58.2% on knowledge related to incontinence-associated dermatitis care. The main reasons for the high incidence of incontinence-associated dermatitis included: incorrect implementation of care, no discussion with the medical team, no incontinence care standards, no continue education, lack of related equipment for preventing incontinence-associated dermatitis, unit patient characteristics, and drugs used. PURPOSE: To reduce the incidence of incontinence-associated dermatitis from 40.3% to 32.0%. RESOLUTION: A care-bundle in treating incontinence-associated dermatitis was implemented by designing an assessment flow chart for evaluating incontinence-associated dermatitis, by setting standard guidelines for incontinence-associated dermatitis care, by distributing reminder cards, special toolboxes, and by changing how the little diapers were wrapped. In-service education lessons, inter-professional collaborative practice, and regular internal audit were also executed. RESULTS: After project implementation, the knowledge score of nurses increased from 78.9% to 95.7%; the correctness of care score, as retested in November 2017, increased from 58.2% to 91.5%; and the incidence of incontinence-associated dermatitis dropped to 18.5%. These improvements achieved the goals of this project. Furthermore, the sustained effect of the project measures was confirmed, with the incidence of incontinence-associated dermatitis determined as 17.9% at three months after completion of the project. CONCLUSIONS: Formulating care procedures and cooperating with medical team personnel to provide creative care measures were shown to effectively decrease the incidence of incontinence-associated dermatitis and improve overall quality of care. The findings of this project support the revision by hospitals of regulations and procedures related to adult incontinence-associated dermatitis to provide caregivers with basis-of-care standards and uniform care procedures and standards in support of effective patient skin care regimens.

Psychological issues surrounding faecal incontinence: experiences of patients and nurses.

Continence care breaches social norms about privacy, nakedness and bodily functions. Faecal incontinence (FI) is a condition that is associated with a significant emotional impact, which extends to not only the patient but also the nurse or care worker. Patients can experience feelings of guilt and shame and a sense of 'incompetence', which can be connected to childhood experiences. Similarly, nurses and caregivers can encounter feelings of disgust and revulsion, which are often denied, as part of the perceived professional expectation. Nurses can develop self-protective behaviours including emotional detachment and development of a task-orientated approach to physical care. This can, in turn, accentuate the negative feelings experienced by patients with FI. Nurses developing self-awareness through reflection on their own difficult feelings can help to improve communication, which will meet patients' emotional needs and improve the therapeutic relationship. This article aims to encourage nurses and care workers to develop an empathetic understanding of the basic human emotional responses experienced by patients. It also aims to improve nurses' awareness of their own feelings and help them recognise the effect of these emotions on their own behaviours and their patients. Lastly, the importance of providing emotional care to patients with FI is discussed.

Bladder and Bowel Dysfunction in Korean Children with Down Syndrome and Parental Quality of Life.

PURPOSE: Children with Down syndrome (DS) are more likely to experience bladder bowel dysfunction (BBD) than typically developing children, which could in turn have a serious effect on children with DS and on their parents and other family members. This study aimed to explore the prevalence of BBD in Korean children with DS and its effect on parental quality of life (QOL). DESIGN AND METHODS: To assess BBD and parental QOL, we used self-administered questionnaires (Dysfunctional Voiding Symptom Score [DVSS], Rome IV criteria, and World Health Organization Quality of Life scale [WHOQOL-BREF]) for parents of children with DS. We collected data from 86 parents between September and October 2017 through an online community website. RESULTS: DVSS was elevated in 26.7% of the children with DS. Specifically, 14% had daytime urinary incontinence, and 33.7% had functional constipation. Moreover, 18.6% of children had BBD according to the DVSS and Rome IV criteria. The sensitivity and specificity of DVSS to functional constipation was 55.17% and 87.72%, respectively. The BBD score and total parental QOL score were statistically correlated (r = 0.291, p = 0.007). CONCLUSIONS: Although children with DS are a high-risk group for BBD, their BBD symptoms are often overlooked because of their intellectual disability. Consequently, this could negatively affect children's and family's health and QOL in the long term. PRACTICE IMPLICATIONS: Health-care providers should reconsider a routine check-up of BBD in children with DS. If a child has BBD, health-care providers should consult a urologist to determine the appropriate diagnosis and intervention.

A Novel Approach to Treating Moderate to Severe Incontinence-Associated Dermatitis and Intertriginous Dermatitis: A Case Series.

BACKGROUND: Patients with moderate to severe incontinence-associated dermatitis (IAD) and intertriginous dermatitis (ITD) often experience pain that negatively affects activities of daily living. While traditional treatments, such as skin protectants including ointment or cream-based products, cyanoacrylate-based monomers, and wicking agents, help some patients, those with moderate to severe cases require more aggressive treatments to accelerate healing. CASE SERIES: This article describes a series of 4 hospitalized patients who presented with moderate to severe IAD and/or ITD with and without fungal infections. These patients were treated with therapies that went beyond routine skin care regimens, which included treatment with a combination of 0.25% acetic acid, a topical steroid agent, or a topical antifungal when necessary. The patients included a 74-year-old woman admitted with hypovolemic shock, an 82-year-old obese woman with pulmonary hypertension and heart failure, an 80-year-old woman with medically complicated obesity, and a 54-year-old morbidly obese woman admitted with sepsis. CONCLUSION: The outcome achieved using this novel approach was successful in treating moderate to severe IAD and ITD in these cases.

Where Do Women With Urinary Incontinence Find Information About Absorbent Products and How Useful Do They Find It?

PURPOSE: This study aimed to determine from what sources women with urinary and dual urinary and fecal incontinence sought and received information about incontinence and absorbent products. We also evaluated source utility. DESIGN: Descriptive, embedded, mixed-methods study with qualitative interviews nested into a survey design in a modified explanatory sequence. SUBJECTS AND SETTING: The target population was community-dwelling women in Canada who used containment products to manage urinary incontinence. Three hundred fifteen women completed the online survey, and 9 participated in interviews. METHOD: Quantitative data were collected using an online survey that was advertised in multiple locations, including continence and urogynecology clinics, non-for-profit health Web sites, and social media. Descriptive statistics were used for analysis. Using initial quantitative data results, a semistructured interview guide was designed to gain further insight. Local survey participants were invited to interviews at the end of the survey. Interview transcripts were coded using content analysis. The codes were then collapsed into categories and finally themes. RESULTS: The most common sources of information (n = 284/315) were retail outlets (43%) and television/radio (42%). The greatest percentages of "useful" or "very useful" resources were healthcare professionals (83%). Content analysis identified 5 themes: (1) using existing knowledge, (2) seeking knowledge, (3) finding the right pad, (4) being safe and secure, and (5) perceptions of healthcare professionals' roles. Product choice was made through trial and error; women drew information from a variety of sources, including product labels. Perceptions of helpfulness of experiences with healthcare professionals varied. CONCLUSION: Although women used multiple sources when selecting containment products, they did not receive information in a manner that suited their needs, resulting in a trial-and-error approach to product selection. Healthcare professionals should actively give information on containment products during their assessment of continence in patient encounters.

Role of the Wound, Ostomy and Continence Nurse in Continence Care: 2018 Update.

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.

A Survey of Turkish Nurses' Knowledge of Incontinence-Associated Dermatitis.

PURPOSE: The purpose of this study was to determine the knowledge of incontinence-associated dermatitis (IAD) among nurses working in intensive care units. DESIGN: Descriptive study. SUBJECTS AND SETTING: The study was conducted in 6 intensive care units of a 550-bed academic research hospital in Turkey. Licensed practical and registered nurses with a minimum of a Bachelor of Science in Nursing degree employed full-time on these units were invited to participate. METHODS: The survey consisted of statements that examined the demographic characteristics (14 questions) and knowledge levels (59 statements) of the nurses. For each statement, nurses were required to mark only one of the following options: "correct," "incorrect," or "no knowledge." Data were collected from July to September 2016. The Shapiro-Wilk test, Mann-Whitney U test, Kruskal-Wallis H test, post hoc multiple comparison test, and Spearman's correlation coefficient were used to analyze the data. RESULTS: Of the 126 RNs who participated in the study, 46.83% (n = 59) had an undergraduate degree in nursing. The majority (29.37%) practiced in gastroenterology surgery and urology intensive care units. The mean knowledge score was 33.05 ± 10.16 (min = 0, max = 59). The most correctly answered statement (94.44%; n = 119) was "The pH of the skin plays a role in skin barrier function." The statement with the most incorrect or "no knowledge" answers (96.03%; n = 120) was "The natural moisturizing factor found in the structure of corneocytes helps the skin to maintain its oil levels." Based on correctly answered statements, we found knowledge levels of the prevention and treatment of IAD were higher among nurses with a master of science degree in nursing (40.67 ± 4.32) and lower among licensed practical nursing (29.12 ± 10.08) (P < .05). CONCLUSION: In this study, knowledge of the nurses on identification, prevention, and treatment of IAD was low. Comprehensive basic nursing education and in-service training programs on IAD are recommended.

Factors influencing changing bowel habits in patients undergoing sphincter-saving surgery for rectal cancer.

A research survey research was conducted to identify factors affecting changes in bowel habits of rectal cancer patients undergoing sphincter-saving surgery and to provide basic information useful in nursing interventions supporting treatment for rectal cancer patients. The subjects were rectal cancer patients who had undergone sphincter-saving surgery over 2 years ago. The final analysis included 107 patients who had made outpatient visits to the colorectal surgery from 12th to 31st May, 2014. Collected data were processed with SPSS Version 21.0. Changes in bowel habits in the subjects were observed: frequent bowel movement in 74 patients (69.2%) and faecal incontinence in 48 (44.9%). Most of the patients used self-care to improve their bowel function including dietary modification (78.5%), regular exercise (72.0%) and pelvic floor exercise (34.6%). Frequent defecation was associated with adjuvant chemoradiation therapy (P < 0.001) and faecal incontinence was associated with age of ≥65 years (P = 0.019) and a group who underwent adjuvant radiation therapy (P < 0.001). It is necessary to give sufficient information about possible postoperative changes in bowel habits to patients with the risk factors before surgery.

Design and psychometric testing of the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD).

Despite the availability of a range of skin care products for the prevention of incontinence-associated dermatitis (IAD), prevalence remains high. Nurses' attitude is an important determinant to take into account in quality improvement projects. This study aimed to design a psychometrically test the attitude towards the prevention of incontinence-associated dermatitis instrument (APrIAD). A prospective psychometric instrument validation study was performed in a convenience sample of 217 Belgian nurses. Construct validity and reliability (internal consistency, stability) were tested. The exploratory factor analysis demonstrated a model consisting of four factors and 14 items: (a) beliefs about the impact of IAD on patients, (b) beliefs about team responsibility to prevent IAD, (c) beliefs about personal responsibility to prevent IAD, and (d) beliefs about the effectiveness of IAD prevention products and procedures. Cronbach's α was 0.72 for factor 1, 0.65 for factor 2, 0.63 for factor 3, and 0.47 for factor 4. The intra-class correlation coefficient was 0.689 (95% confidence interval [CI] 0.477-0.825) for the total instrument, 0.591 (95% CI 0.388-0.764) for factor 1, 0.387 (95% CI 0.080-0.626) for factor 2, 0.640 (95% CI 0.406-0.795) for factor 3, and 0.768 (95% CI 0.597-0.872) for factor 4. Psychometric testing of the APrIAD demonstrated adequate validity and reliability measures.