Development and Validation of the Role Profile of the Nurse Continence Specialist: A Project of the International Continence Society.

Although nurses have specialized in the management of incontinence, bladder, bowel, and pelvic floor dysfunction for more than 30 years, there is a lack of awareness and underutilization of their role. This article describes a 6-year project to define, characterize, and validate a role profile of the Nurse Continence Specialist. Data collection used a 2-phase, mixed-methods design. Phase 1 of the project resulted in a draft Nurse Continence Specialist role profile and Phase 2 led to validation of the draft profile. The result was a broad consensus about what constitutes the specific skill set for Nurse Continence Specialist specialization within nursing.

The role of nursing best practice champions in diffusing practice guidelines: a mixed methods study.

BACKGROUND: While the importance of nursing best practice champions has been widely promoted in the diffusion of evidence-based practice, there has been little research about their role. By learning more about what champions do in guideline diffusion, the nursing profession can more proactively manage and facilitate the role of champions while capitalizing on their potential to be effective leaders of the health care system. AIM: To determine how nursing best practice champions influence the diffusion of Best Practice Guideline recommendations. METHODS: A mixed method sequential triangulation design was used involving two phases: (1) key informant interviews with 23 champions between February and July 2006 and (2) a survey of champions (N= 191) and administrators (N= 41) from September to October 2007. Qualitative findings informed the development of surveys and were used in interpreting quantitative information collected in phase 2. RESULTS: Most interview and survey participants were female, employed full-time, and had worked in practice for over 20 years. Qualitative and quantitative findings suggest that champions influence the use of Best Practice Guideline recommendations most readily through: (1) dissemination of information about clinical practice guidelines, specifically through education and mentoring; (2) being persuasive practice leaders at interdisciplinary committees; and (3) tailoring the guideline implementation strategies to the organizational context. CONCLUSIONS AND IMPLICATIONS: Our research suggests that nursing best practice champions have a multidimensional role that is well suited to navigating the complexities of a dynamic health system to create positive change. Understanding of this role can help service organizations and the nursing profession more fully capitalize on the potential of champions to influence and implement evidence-based practices to advance positive patient, organizational, and system outcomes.

Implementing nursing best practice guidelines: impact on patient referrals.

BACKGROUND: Although referring patients to community services is important for optimum continuity of care, referrals between hospital and community sectors are often problematic. Nurses are well positioned to inform patients about referral resources. The objective of this study is to describe the impact of implementing six nursing best practice guidelines (BPGs) on nurses' familiarity with patient referral resources and referral practices. METHODS: A prospective before and after design was used. For each BPG topic, referral resources were identified. Information about these resources was presented at education sessions for nurses. Pre- and post-questionnaires were completed by a random sample of 257 nurses at 7 hospitals, 2 home visiting nursing services and 1 public health unit. Average response rates for pre- and post-implementation questionnaires were 71% and 54.2%, respectively. Chart audits were completed for three BPGs (n = 421 pre- and 332 post-implementation). Post-hospital discharge patient interviews were conducted for four BPGs (n = 152 pre- and 124 post-implementation). RESULTS: There were statistically significant increases in nurses' familiarity with resources for all BPGs, and self-reported referrals to specific services for three guidelines. Higher rates of referrals were observed for services that were part of the organization where the nurses worked. There was almost a complete lack of referrals to Internet sources. No significant differences between pre- and post-implementation referrals rates were observed in the chart documentation or in patients' reports of referrals. CONCLUSION: Implementing nursing BPGs, which included recommendations on patient referrals produced mixed results. Nurses' familiarity with referral resources does not necessarily change their referral practices. Nurses can play a vital role in initiating and supporting appropriate patient referrals. BPGs should include specific recommendations on effective referral processes and this information should be tailored to the community setting where implementation is taking place.

Evaluating best practice guidelines.

Clinical practice guidelines are developed with the purpose of improving patient care. The Registered Nurses Association of Ontario (RNAO) Nursing Best Practice Guidelines (BPG) Project was implemented in 1999. It has resulted in the development, implementation and evaluation of 17 BPGs with agencies in different healthcare sectors. This article describes the process, challenges and lessons learned by the team responsible for evaluating the BPGs.

Incontinence Quality of Life Instrument in a survey of primary care physicians.

OBJECTIVE: To assess the performance of the Incontinence Quality of Life (I-QOL) Instrument in measuring the impact of urinary incontinence on the quality of life of family medicine patients. STUDY DESIGN: Postal survey. Multiple imputations of missing answers. Linear regression analysis of I-QOL predictors. Comparison by receiver operating characteristic of the I-QOL and the Short Form 12 (SF-12). POPULATION: Women 45 years or older attending either of 2 family medicine clinics. Response rate was 605 (61%) of 992. OUTCOMES MEASURED: Prevalence of stress, urge, and mixed incontinence. Scores on the I-QOL and SF-12 instruments. RESULTS: Of the 605 respondents, 310 (51%) reported urinary incontinence in the month before the survey. One or more items were missing on 19% of the I-QOL scales and scores were imputed. The relation between I-QOL and the number of leakage episodes was nonlinear. I-QOL scores decreased with the number of episodes, the amount of leakage, and poorer general health. There was no association between the I-QOL and age, education, or type of incontinence. The I-QOL was more sensitive than the SF-12 to the statement, "urinary incontinence is a problem." CONCLUSIONS: The I-QOL is a useful instrument for the investigation of incontinence-related quality of life in the community setting.

Urinary incontinence: common problem among women over 45.

OBJECTIVE: To examine age-specific prevalence and correlates of urinary incontinence (UI) among community-dwelling women. DESIGN: A questionnaire survey used a modified Dillman method. SETTING: Two family practice clinics in Hamilton, Ont. PARTICIPANTS: Questionnaires were mailed to 1082 women 45 years old and older. Ninety women were disqualified; 606 recipients responded. MAIN OUTCOME MEASURES: Self-reported prevalence of UI and potential risk factors. RESULTS: Overall response rate was 61% (606/992); 51% (311/606; 95% confidence interval 47.3% to 55.3%) reported an episode of UI during the last month. Of the 311 women reporting UI, 35.7% perceived it as a problem, 27% had had it for less than a year, 41.9% had had it for 1 to 4 years, and 31.1% had had it for 5 years or longer. Three kinds of UI were reported: 34% (106/311) reported stress UI, 14.5% (45/311) reported urge UI, and 51.4% (160/311) reported a mixed pattern. In multivariate analysis, the overall prevalence of incontinence increased significantly with "usually having a cough," "being troubled by swollen ankles," "giving birth," "ever smoking cigarettes," and "being troubled by headaches." Stress UI was associated with "usually having a cough" and "ever smoking cigarettes." Urge UI was associated with "having troubles with constipation" and "swollen ankles." Mixed incontinence was associated with "get sick more than other people," "usually having a cough," "taken hormones for menopause," and body mass index in the 50th to 75th percentile or greater. Age was not significantly associated with prevalence of UI or any of its subtypes. Only 40% of incontinent women indicated they had discussed urine loss with their physicians; 70% of these women felt satisfied with physicians' responses. CONCLUSION: Incontinence occurs in more than half of community-dwelling women 45 years old and older. Almost one of five women in the community reported UI that affected normal activities. Treating the effect of incontinence will require further understanding of women's coping skills and self-perceptions. Prevalence does not appear to increase with age.

Urinary incontinence in Canada. National survey of family physicians' knowledge, attitudes, and practices.

OBJECTIVE: To determine current knowledge, attitudes, and management of urinary incontinence among family physicians in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Family physicians in Canada. PARTICIPANTS: A random sample of 1500 members of the College of Family Physicians of Canada. MAIN OUTCOME MEASURES: Self-assessed knowledge, self-reported attitudes, and rating of various tests and treatments in the investigation and management of incontinence. RESULTS: The overall unadjusted response rate was 43.3% (650/1500). Although most respondents reported that urinary incontinence was common in their practices, less than half (46.0%, 284/617) indicated that they clearly understood incontinence and just 37.9% (232/612) had an organized plan for incontinence problems. Only 35.0% (214/612) of respondents felt very comfortable dealing with incontinence. Physical examination, urodynamic studies, urinalysis, and testing blood sugar levels were all considered important investigations by more than 90% of respondents. CONCLUSION: There are wide variations in knowledge, attitudes, practices, and comfort level among family physicians dealing with urinary incontinence.