Promoting urinary continence with nonpharmacological interventions in Parkinson's disease.

Background: The evidence of nonpharmacological interventions promoting urinary continence in Parkinson's disease is low and rehabilitation nurses do not give it a high priority. Aim: To examine the effects of a urinary incontinence management program on continence and quality of life in persons with Parkinson's disease in inpatient rehabilitation. The acceptance of the intervention and the knowledge of the nurses were also of interest. Methods: A nonrandomized experimental study was conducted. The data collection commenced with a control group followed by an intervention group. A structured urinary incontinence management was performed in the intervention phase. This includes incontinence assessment, care planning, individual interventions, discharge planning, and telephone support at home. Results: Urinary continence and quality of life were enhanced in both groups; however, improvements were higher in the intervention group but the differences were not significant. Knowledge of the nurses about urinary incontinence improved during the study duration. The acceptance of the intervention was high. Conclusions: A structured urinary continence management may improve urinary continence in persons suffering from Parkinson's disease. In clinical practice it is important to perform a detailed assessment to identify problems regarding urinary incontinence.

Facilitators and barriers to implement nurse-led interventions in long-term dementia care: a qualitative interview study with Swiss nursing experts and managers.

BACKGROUND: To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care. METHODS: We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples' perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant's choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants' perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript. RESULTS: Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization¼, «Commitment on several levels¼, «A needs-oriented implementation¼, «The effect and the public perception of the intervention¼, «A structured and guided implementation process¼, «Supporting knowledge and competencies¼, as well as «Resources for implementing the intervention¼. CONCLUSIONS: To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation - and not by the behaviour of the person with dementia.

What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review.

BACKGROUND: The implementation of evidence-based interventions for people with dementia is complex and challenging. However, successful implementation might be a key element to ensure evidence-based practice and high quality of care. There is a need to improve implementation processes in dementia care by better understanding the arising challenges. Thus, the aim of this study was to identify recent knowledge concerning barriers and facilitators to implementing nurse-led interventions in dementia care. METHODS: We performed a scoping review using the methodological framework of Arksey and O'Malley. Studies explicitly reporting on the implementation process and factors influencing the implementation of a nurse-led intervention in dementia care in all settings were included. We searched eight databases from January 2015 until January 2019. Two authors independently selected the studies. For data analysis, we used an inductive approach to build domains and categories. RESULTS: We included 26 studies in the review and identified barriers as well as facilitators in five domains: policy (e.g. financing issues, health insurance), organisation (e.g. organisational culture and vision, resources, management support), intervention/implementation (e.g. complexity of the intervention, perceived value of the intervention), staff (e.g. knowledge, experience and skills, attitude towards the intervention), and person with dementia/family (e.g. nature and stage of dementia, response of persons with dementia and their families). CONCLUSIONS: Besides general influencing factors for implementing nursing interventions, we identified dementia-specific factors reaching beyond already known barriers and facilitators. A pre-existing person-centred culture of care as well as consistent team cultures and attitudes have a facilitating effect on implementation processes. Furthermore, there is a need for interventions that are highly flexible and sensitive to patients' condition, needs and behaviour.

Urinary incontinence in stroke survivors - Development of a programme theory.

AIMS AND OBJECTIVES: To develop, in an inpatient rehabilitation setting, a programme theory that promotes continence in people who have suffered a stroke. BACKGROUND: Urinary incontinence in stroke survivors impacts the quality of life, rehabilitation outcomes and ultimately incurred costs of the patient. Different approaches are available for developing and testing complex interventions. DESIGN: Building a research-based programme theory. METHODS: To elaborate the intervention, a guidance for developing a complex intervention for nursing was chosen and the sources that should be considered were defined. Subsequently, a research-based programme theory was generated that was represented via a theoretical approach logic model. This study was guided by the checklist for reporting theory of change in public health interventions. RESULTS: The intervention consists of six parts with three outcome chains on interconnected levels, which are oriented towards patients and nurses. The important aspects of the programme theory are communication, individually tailored measures and the definition of interdisciplinary objectives. CONCLUSION: Developing a programme theory and representing it via a logic model help clarify the initial intervention and ensure that implementation strategies are well thought out. RELEVANCE TO CLINICAL PRACTICE: By employing detailed reflection and using previous research, it is expected that the intervention can be implemented successfully and its effectiveness can be investigated in more depth.

[The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study]. / Die Betreuung von Menschen mit Demenz im Akutkrankenhaus aus Sicht des Behandlungs- und Betreuungsteams.

The Healthcare Teams' Perspective on Caring for People with Dementia in Acute Hospitals: A Qualitative Study Abstract. Introduction: To deal with the complexity of the situation of people with dementia in acute hospitals, it is necessary to develop tailored interventions. In doing so, it is important to consider the perspectives of all relevant persons, including health care teams. AIM: The aim of this study was to explore the situation of people with dementia in three Swiss acute hospitals from the perspective of health care teams. METHODS: We conducted three focus group interviews with health care teams consisting of medical doctors, nurses and therapists. Data were analysed by means of summarising content analysis according to Mayring. RESULTS: A total of 20 health professionals took part. Three main categories were identified: "People with dementia confront the hospital system", "The hospital system fails to meet the needs of people with dementia" and "Necessary changes take place in the hospital system". The results show a lack of intention in the hospital system to address the specific needs of people with dementia. Health care teams feel forced to intensify their teamwork. This occurs unsystematically and with little organisational support. CONCLUSION: It seems of paramount importance to systematically support the teams' initiatives for enhanced teamwork in caring for people with dementia. Teamwork should be considered as a key aspect when developing interventions.

Prioritäten der Pflegeforschung für das Themenfeld "Dementia Care" im deutschsprachigen Raum - Eine Delphi-Studie.

Priorities of nursing research in dementia care in German-speaking countries - A Delphi study Abstract. Background and objective: To meet the central needs of people with dementia, their relatives and their caregivers in complex living conditions and care situations, a substantive examination of research priorities is required. The aim of this work was the identification and prioritisation of nursing research topics concerning dementia care in German-speaking countries. METHODS: To identify existing research agendas in dementia care, we conducted a systematic literature research. As part of a Delphi process, systematically identified dementia care experts from German-speaking countries supplemented research priorities extracted from existing research agendas and assessed their importance. Subsequently, they prioritized topics of particular importance for nursing research. RESULTS: Fifteen experts supplemented 61 topics previously identified in existing research agendas. They assessed 107 topics in terms of their importance and prioritized 79 topics. CONCLUSIONS: The research priorities developed are a potential framework for nursing science, health policy and research funding in order to structure research activities. To ensure currency, priorities should be regularly updated and re-opened for discussion.

Experiences and needs of relatives of people with dementia in acute hospitals-A meta-synthesis of qualitative studies.

AIMS AND OBJECTIVES: To present an in-depth analysis of existing qualitative literature concerning experiences and needs of the relatives of patients with dementia in hospitals. BACKGROUND: Relatives are an important resource for the care of patients with dementia in hospitals. They provide necessary information about the patient and can support the patient's care. Simultaneously, they are themselves vulnerable, having specific needs and experiences. A number of studies have been conducted that focus on the perspectives of the relatives. The synthesis of qualitative studies contributes to a more comprehensive understanding of recent study findings. DESIGN: A meta-ethnographic synthesis of qualitative research findings was used. METHODS: The synthesis process followed six defined steps. We located relevant studies through searching the CINAHL, PubMed and PsycInfo databases and through searching journals and reference lists by hand. A list of metaphors was created and translated into one another. Identified metaphors were synthesised and interpreted as a new whole. RESULTS: Relatives of patients with dementia frequently experience a negative cycle of specific worries, negative feelings and resulting roles and functions in hospital due to negative care experiences. CONCLUSIONS: Experiences of relatives are strongly influenced by the attitudes, expertise and communication that they receive from health professionals working in the hospital. The results clearly show how health professionals have the potential to break through the negative cycle and contribute to a more positive feeling about a patient's hospital stay. RELEVANCE TO CLINICAL PRACTICE: Structured and individually planned involvement of the relatives during the hospital care seems to be a key aspect for improving the experiences for the relatives and the patients with dementia. Collaboration with the relatives needs to be valued and supported by the organisation. Also a professional and defined frame for this area of responsibility needs to be provided.

Experiences of nurses with the care of patients with dementia in acute hospitals: A secondary analysis.

AIMS AND OBJECTIVES: To describe nurses' experiences in caring for people with dementia in acute hospital settings. BACKGROUND: Recent research suggests that nurses' experience in caring for people with dementia in acute hospitals is characterised by frustration, overall job dissatisfaction and feelings of powerlessness and guilt. Despite a growing body of knowledge concerning the care of people with dementia in acute care settings, it remains unclear how nurses in acute hospitals provide care for people with dementia and what general conditions characterise the nursing care provided to these patients. DESIGN: A qualitative secondary analysis was conducted. METHODS: Data were collected using audio-recorded focus group discussions with nurses in Germany and Austria. Overall, 12 focus group discussions, which were part of two larger research projects in Germany and Austria, were expanded into a qualitative secondary analysis (a content analysis). RESULTS: The findings show that nurses face great uncertainty in caring for people with dementia in acute hospital settings and that each nurse reacts in different ways to address this uncertainty. The results also underline that, even for nurses who provide some form of person-centred care, the hospital environment imposes several contextual constraints. CONCLUSIONS: Hospitals must minimise constraints to give every nurse the chance to perform person-centred care. Furthermore, it is important to sensitise nurses and give them sufficient training and education to enable them to care for people with dementia. RELEVANCE TO CLINICAL PRACTICE: The results may contribute to a better understanding of the factors that support or constrain person-centred nursing care for people with dementia in acute hospitals.

(Can) Not talk about it - Urinary incontinence from the point of view of stroke survivors: a qualitative study.

PURPOSE: The current study intends to gain an in-depth understanding of stroke survivors' lived experience of urinary incontinence and its treatment in an inpatient rehabilitation clinic. METHODS: A qualitative approach was chosen. Semi-structured individual interviews with ten stroke survivors suffering from urinary incontinence were conducted in an inpatient rehabilitation clinic and analysed using qualitative content analysis with an inductive approach. RESULTS: '(Can) not talk about it' was identified as the first main category. The affected persons do not talk about urinary incontinence because they are ashamed. At the same time, no one asks them about this issue. Psychological strain is so high that patients feel the need to talk about incontinence, but from their point of view, conversations with nurses - if they indeed occur - are superficial or nurses do not listen. Therefore, patients' needs and concerns are not properly considered. 'Trying to command incontinence' was also identified as a main category. Participants reported that they try to command incontinence and to develop their own strategies in order to hide urinary incontinence and prevent shameful situations. However, this proved mostly unsuccessful and resulted in resignation to their condition. CONCLUSION: It is important to raise awareness within the treatment team of urinary incontinence in stroke survivors. Team members should be able to communicate about urinary incontinence in an open and empathic way. Obviously, there is great potential for supporting stroke survivors in dealing with incontinence.

Incontinence in nursing home residents with dementia : Influence of an educational program and nursing case conferences.

BACKGROUND: Up to 90 % of nursing home residents with dementia suffer from urinary incontinence with adverse effects on the quality of life. Nurses are often insufficiently prepared for incontinence management and their knowledge is incomplete. Urinary incontinence management for people with dementia is complex due to the multifactorial nature of the disease and cognitive impairment. OBJECTIVE: This study explored the effects of an educational program and subsequent nursing case conferences on urinary incontinence and quality of life of nursing home residents with dementia. METHODS: The stepped-wedge trial design was used and seven nursing homes were included. In total 140 people were included in the study. The intervention consisted of an educational program and six case conferences at each ward. Urinary incontinence and quality of life were measured at baseline, after 2 and 6 months as well as at the end of the study. Univariate analysis of variance (ANOVA), repeated measures ANOVA and linear regression were used to compare the groups and the results at different times of measurement. The responsible ethics committees approved the study. RESULTS: After 6 months urinary incontinence decreased or was approximately equal to the initial measurement. At the end of the study urinary incontinence was slightly but not significantly higher. In the whole sample the quality of life increased in seven out of nine categories up to the end of the study. CONCLUSION: Urinary incontinence management for people with dementia is complex and an educational program and case conferences during 6 months proved to be effective in reducing urinary incontinence and improve the quality of life in nursing home residents with dementia.

Effectiveness of non-pharmacological interventions to promote urinary continence in stroke survivors ­ a systematic literature review / Wirksamkeit von nichtmedikamentösen Interventionen zur Förderung der Urinkontinenz bei Menschen nach einem cerebro-vaskulären Insult - eine systematische Literaturübersicht

Background: Around half of the people who survive a cerebrovascular insult are suffering from urinary incontinence. This is a predictor for functional outcomes and affects the quality of life negatively. Until now, it is not clear, which the optimal method of treatment is. A systematic review of 2008 showed an insufficient data situation and couldn't make a recommendation. Research question: Which non-pharmacological interventions are effective to promote urinary continence in adult persons who have suffered a cerebrovascular insult? Method: To answer the question a systematic literature review was performed. The literature search was conducted in the databases PubMed, CINAHL, CENTRAL and PsycInfo. The period from March 2007 to May 2015 was taken into account. Results: There were a total of six studies included which examined 732 persons. The following interventions were explored for their effectiveness: transcutaneous electrical nerve stimulation, urodynamic assessment with recommendation of bladder emptying method and interventions that consist of several components (e. g. toilet training). All studies showed a positive effect in at least one outcome. Conclusions: There is limited evidence for interventions to promote urinary continence in people suffering a cerebrovascular insult. An intervention consisting of assessment and individual adapted measures currently appear to be the best treatment method.

"Fighting an uphill battle": experience with the HCV triple therapy: a qualitative thematic analysis.

BACKGROUND: Hepatitis C virus (HCV) infections are a severe burden on public health worldwide, causing mortality rates triple that of the general population. Since 2011, for both therapy-naive and therapy-experienced genotype 1 patients, the first generation of direct acting antivirals (DAAs), i.e., the protease-inhibitors (PI) telaprevir and boceprevir have been added to existing dual therapies. The therapeutic effect of the resulting triple therapy is striking; however, treatment regimens are complex and commonly cause side effects. Little is known of how patients implement therapy in their daily lives, or of how they deal with these effects.This study aims to describe HCV patients' experiences with protease-inhibitor-based triple therapy and their support needs. METHODS: A qualitative design was used. Patients from three outpatient clinics, with ongoing, completed or discontinued PI treatment experience were recruited using a maximum variation sampling approach. Open-ended interviews were conducted and analyzed using thematic analysis according to Braun & Clarke (Qual Res Psychol 3:77-101, 2006). RESULTS: Thirteen patients participated in the interviews. All described themselves as highly motivated to undergo treatment, since they saw the new therapy as a "real chance" for a cure. However, all later described the therapy period as a struggle. The constitutive theme-"Fighting an uphill battle"- describes the common existential experience of and negative consequences of coping with side effects. The processes that fostered this common experience followed three sub-themes: "encountering surprises", "dealing with disruption" and "reaching the limits of systems". CONCLUSION: HCV patients undergoing outpatient protease-inhibitor-based triple therapy need systematic support in symptom management. This will require specially trained professionals to advise and support them and their families, and to provide rapid responses to their needs throughout this complex course of therapy. As the generation of DAAs for all genotypes, are expected to have less severe side effects, and many HCV patients require treatment, this knowledge can improve treatment support tremendously, especially for patients who are quite difficult to treat. Furthermore, these findings are helpful to illustrate development in HCV treatment.

[Interrater reliability and agreement of the Swiss MDS version 2.0]. / Interrater-Reliabilität und Übereinstimmung der Schweizer RAI-MDS Version 2.0.

Numerous studies have been performed to assess the validity and reliability of the Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI), which was developed and initially implemented in the United States. In general, RAI-MDS 2.0 has been reported to have moderate to high interrater reliability. From the late 1990s onwards the geriatric nursing assessment has been used in nursing homes in Switzerland. The objective of this study was to examine interrater agreement and reliability of the Swiss version of RAI-MDS 2.0 for the first time. For this purpose, 61 nursing home residents were independently assessed by two assessors. The MDS coordinator of the nursing home and an extern expert conducted independent resident assessments by reviewing the chart and asking front line staff about the residents' behaviour. Proportions of exact agreement were calculated and interrater reliability was assessed using kappa and intraclass correlation (ICC) coefficients. For most of the checked items, a high agreement between the two raters was observed. The reliability coefficients for 47 % of the items reached values between 0,81 and 1,0. 29 % of the items achieved values between 0,61 and 0,80. The values of 10 % of the items ranged between 0,41 and 0,60. Two items assessing skin condition obtained a value of 0,25 and 0, respectively. The results of the reliability analysis show that mainly items evaluating pain, mood and behavior, and some items estimating physical function and skin condition are less reliable.

[ Comparison of BESA and RAI: evaluating the outcomes of two assessment instruments for long-term residential care needs]. / Pflegebedarfserfassungsinstrumente BESA und RAI: Vergleich der Outcomes in Minuten.

In Switzerland, the level of nursing care required for residents in nursing homes is either assessed by the BESA Catalogue 2010 or by the Minimum Data Set (MDS) of the Resident Assessment Instrument (RAI). Within both instruments the nursing care need is represented in minutes. According to these minutes, the resident is allocated to a tariff level. The aim of the study was to compare the outcomes of the two assessment instruments BESA Catalogue 2010 and MDS. For this purpose data were collected in two nursing homes. At each facility 60 nursing home residents were assessed with the BESA Catalogue 2010 and the MDS. The assessments were independently performed by nurses of the facility (internal assessment) and by system experts (external assessment). Descriptive data analysis and a comparison of the outcome in minutes and with regard to tariff level were carried out. In average, internal assessments were higher than external assessments. In both nursing homes, half or 54 % of residents were allocated into a higher tariff level by means of internal assessment. Comparing the outcomes in total and within tariff level, significant differences were found. Different classifications may occur, especially for residents with high nursing care needs. As a result, higher or lower costs of nursing care may arise.

[Trapped in the body - lived experience and coping of individuals having Parkinson and their relatives with changed movement pattern caused by the disease]. / Im Körper gefangen sein - Das Erleben und die Bewältigung der krankheitsbedingt veränderten Bewegungsmuster von Menschen mit Parkinson und ihren Angehörigen.

People with Parkinson's disease suffer from various symptoms. Changed movement patterns frequently represent the prevailing symptom experience and influence the everyday life of the affected persons and their relatives. This qualitative study explores how persons with Parkinson's disease and their relatives experience the changed movement patterns and how they manage the consequential problems in their daily life. Eight persons with Parkinson's disease and six partners were interviewed. The interviews were analysed by means of content analysis according to Mayring. The qualitative analysis resulted in two main categories: "effects on the changed movement patterns on everyday life" and "coping skills for dealing with changed movement patterns". The experience of the affected person can be characterised by "being trapped in the body" as well as by a constantly slowing down daily life. The coping strategies are diverse, but all respondents seek to maintain mobility. Partners naturally support the affected persons and take over many tasks. This is associated with elevated distress and the feeling of having to be permanently present. Various coping strategies have to be promoted and included in daily care for people with Parkinson's disease. Consideration of the individual experience of the changed movement patterns is very important in the development of strategies and also the support of the affected persons and relatives that they can keep up with their movements.

A systematic review of physical impairments following radical prostatectomy: effect of psychoeducational interventions.

AIMS: To determine the effect of psychoeducational interventions on urinary and faecal incontinence and erectile dysfunction in men 50 years and older after prostatectomy for prostate cancer in comparison to usual care. BACKGROUND: Prostate cancer is the second most frequently diagnosed cancer in men worldwide. The major complications of radical prostatectomy are urinary and faecal incontinence as well as sexual dysfunction, associated with significantly reduced quality of life. DESIGN: A systematic review of randomized controlled trials was undertaken to provide a narrative synthesis and critical appraisal of included studies. DATA SOURCES: The electronic databases MEDLINE and CINAHL were searched using a systematic search strategy for studies published between January 2001-December 2012. In addition, reference lists of included papers were checked. The Cochrane Database was screened for whether a review on this topic already exists. REVIEW METHODS: The systematic review included randomized controlled trials in men after prostate cancer treatment and psychoeducational interventions to influence urinary or faecal incontinence and erectile dysfunction. The quality of studies was assessed by the reviewers using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. RESULTS: Eight trials met the inclusion criteria. Although these studies are heterogeneous and of varied quality, a descriptive synthesis of results suggests that psychoeducational interventions may improve urinary incontinence, bowel bother, sexual function and sexual bother to some extent. CONCLUSION: The results of this systematic review indicate that it would be worthwhile to implement postprostatectomy psychoeducational interventions into nursing discharge planning. Future research is necessary to corroborate these results and define the most favourable time to implement psychoeducational interventions.

Patient experience with bedpans in acute care: a cross-sectional study.

AIMS AND OBJECTIVES: To describe individual experiences of patients using the bedpan in an acute care setting. BACKGROUND: Patients describe the use of the bedpan often as uncomfortable and painful, and nurses mention difficulties using standard-sized bedpans for obese patients or removing a bedpan without soiling the bed. Although the bedpan is still regularly used in hospitals, there are few empirical studies that confirm these experiences. DESIGN: A descriptive quantitative research design. METHODS: A convenience sample of 78 patients was recruited, and data were collected using a standardised questionnaire (German version of the Bedpan Ongemak Schaal). Descriptive statistics were used to analyse frequency (scale A) and extent of inconvenient experiences (scale B). Internal consistency of the scales was tested using Cronbach's alpha. RESULTS: A major finding of the study was that most patients felt dependent on other persons and no autonomous movement was possible on the bedpan. Patients were frequently confronted with pain, inconvenient characteristics of the bedpan (e.g. coldness, hardness), uncomfortable positions and hygiene inconveniences (e.g. wet backside, fear that urination may miss the bedpan). CONCLUSION: As the bedpan is still regularly used in acute care hospitals, innovations in bedpan models are necessary to address the problems. But there are also several courses of action nurses should consider when caring for patients who are dependent on the bedpan. RELEVANCE FOR CLINICAL PRACTICE: The discomfort of the bedpan, the feeling of dependency and embarrassment could lead to undesirable patient reactions, such as avoidance of fluid intake or leaving the bed. If nurses know the reasons for this behaviour, they could meet these problems with empathetic understanding.

[Incontinence--a common issue for people with Parkinson's disease. A systematic literature review]. / Inkontinenz--ein häufiges Problem für Menschen mit einer Parkinsonerkrankung. Eine systematische Literaturübersicht.

Parkinson's disease is among the most common neurological diseases. About 4.1 million people are attected worldwide. The course of Parkinson's disease is chronically progressive. With L-Dopa therapy the life expectancy of people being affected by Parkinon's disease is not shortened compared with people who are not affected. Therefore people with Parkinson's disease often suffer from the serious effects for decades which include motor symptoms as well as vegetative disturbance, which concerns bladder function and functions of the gastrointestinal tract. Urinary and fecal incontinence involve severe impairment of quality of life. In this review the occurence of urinary and fecal incontinence should be determined in order to be able to describe its extent. There are different measures for treatment or improvement. These are reviewed based on the following research question: Which effects do interventions have in improving urinary and fecal incontinence in persons with Parkinson's disease compared to usual care? In order to answer the questions a systematic review was conducted. The literature search occured in the electronic databases Cochrane database, PubMed and CINAHL. Three studies investigating the prevalence with a total sample size of n = 1077 and for the evaluation of interventions four studies with a total sample size of n = 48 have been included. 25 percent of the women with Parkinson's disease suffer from urgency incontinence compared to seven percent of the women without Parkinson's disease (p < 0.01). Among men with Parkison's disease 28 percent are affected and six percent among men without Parkinson's disease (p < 0.01). In respect to stress and fecal incontinence there were no significant differences between people affected and people not affected by Parkinson's disease. With pelvic floor muscle exercises and accompanying measures as well as with injections of botulinum toxin A a reduction of urinary incontinence seems to be possible. Due to methodological insufficiency of these studies, no clear recommendations can be given.

Promoting urinary continence in people suffering a stroke: Effectiveness of a complex intervention-An intervention study.

AIM: The study aimed to implement and measure effectiveness of a systematic continence management intervention in people suffering a stroke in undertaking rehabilitation. DESIGN: An intervention study was conducted. METHODS: In the first part of the study, patients were included in the control group and observed. After the training of the nursing staff, participants were assigned to the intervention group. The intervention consisted of screening, assessment, treatment, communication and evaluation. RESULTS: Forty-six patients took part in the study, of which 35 were in the control and 11 in the intervention groups. Within the two groups, significant improvements in outcomes were mostly seen during the study. For the Incontinence Quality of Life Social Embarrassment scale, a significantly higher increase was observed for the intervention group. The improvement between admission and discharge in the intervention group was notably larger for the outcome's incontinence and quality of life.

[Frequency of using the bedpan in acute care]. / Die Häufigkeit der Bettpfannenbenutzung im Akutspital.

Although the bedpan is a subject of everyday nursing practice, little research was found concerning this issue. Patients often describe that the use of the bedpan is uncomfortable and painful. Studies also underline that using a bedpan is very embarrassing and shameful for the patients. Their privacy is violated considerably. In this quantitative descriptive cross-sectional study, the frequency and duration of use of the bedpan was measured in acute care. 362 women and 367 men were included in the study, 18.2 % of them needed the bedpan for a certain time. It was used more often during the night than during the day, departmental differences were also identified. Women used the bedpan most at the orthopedic and medical wards, followed by the prenatal ward (for urine). Men from surgical wards used the bedpan most (12.3 %), followed by medical wards (8.3 %). Most patients required assistance while using the bedpan. Because of this the resulting workload for nurses should be underestimated. The introduction of alternative urine drainage systems could lead to more autonomy of patients and might reduce the workload for nurses.