The geriatric incontinence syndrome: Characterizing geriatric incontinence in older women.

OBJECTIVES: Among older women, the clinical presentation of urinary incontinence (UI) is heterogeneous; presenting as a pelvic floor condition or geriatric syndrome. We aimed to characterize the geriatric incontinence syndrome (GIS) to establish its foundation in clinical practice. DESIGN: Prospective study. SETTING: Geriatric Clinical Research Unit. PARTICIPANTS: Sixty-one community-dwelling women aged 70 and older with bothersome UI symptoms. MEASUREMENTS: UI symptom type and severity were determined by 3-day bladder diary. UI severity was defined; moderate UI defined as <2 UI episodes/day and severe UI defined as ≥2 UI episodes/day. Subjective assessment of physical performance was determined using the Short Physical Performance Battery (SPPB) score. Total SPPB scores >9 define normal physical performance and scores ≤9 defined impaired physical performance. RESULTS: The average age was 77.1 ± 5.8 (mean ± SD) years; 69% of women had severe UI and 31% had moderate UI. Demographic characteristics were similar between groups. Daytime voiding frequency was 7.1 ± 2.9 and nocturia was present equally between groups. The majority of women (59%) with severe UI had SPPB ≤9 compared with 26% among women with moderate UI (p = 0.02); featuring significantly slower chair stand scores (2.3 ± 1.4 vs 3.3 ± 0.9, p = 0.007) and gait speed (0.08 ± 0.2 m/s compared with 1.0 ± 0.2 in women with moderate UI). CONCLUSIONS: A multifactorial GIS may be present in older women evidenced by the co-existence of severe UI, physical disability, slower chair stand pace, and gait speed. Prospective studies are needed to understand how these clinical features may impact the clinical care of older incontinent women.

Organizational and leadership perceptions assessment: opportunities and challenges using the Baldrige companion surveys.

Combining the use of employee perception surveys with sound analytical techniques and models is critical to capturing high quality data from which effective decisions can be made in complex healthcare settings. This study used the Baldrige Award companion surveys with an analysis of variance (ANOVA) framework to identify discordant perceptions of hospital staff and leadership in the areas of customer focus, knowledge management, and results that were significant at the 0.05 and 0.01 levels. Senior leaders in the organization found the ANOVA framework helpful as they interpreted results from the Baldrige companion surveys and planned future improvement activities. During the execution of our study a number of difficulties and challenges arose that are not uncommon to survey administration in smaller settings, such as community hospitals, or in larger hospital settings with no research staff or research staff with relevant psychometric expertise. Our experience suggests that the Baldrige companion survey process would be enhanced by providing organizations with general guidance and protocols for optimal survey administration and data analysis. The purpose of this article is to outline the ANOVA model we used with the Baldrige companion surveys and to provide guidance related to the administration and analysis of these companion surveys for those that use them.

Scales for assessing self-efficacy of nurses and assistants for preventing falls.

AIM: This paper is a report of the development and testing of the Self-Efficacy for Preventing Falls Nurse and Assistant scales. BACKGROUND: Patient falls and fall-related injuries are traumatic ordeals for patients, family members and providers, and carry a toll for hospitals. Self-efficacy is an important factor in determining actions persons take and levels of performance they achieve. Performance of individual caregivers is linked to the overall performance of hospitals. Scales to assess nurses and certified nursing assistants' self-efficacy to prevent patients from falling would allow for targeting resources to increase SE, resulting in improved individual performance and ultimately decreased numbers of patient falls. METHOD: Four phases of instrument development were carried out to (1) generate individual items from eight focus groups (four each nurse and assistant conducted in October 2007), (2) develop prototype scales, (3) determine content validity during a second series of four nurse and assistant focus groups (January 2008) and (4) conduct item analysis, paired t-tests, Student's t-tests and internal consistency reliability to refine and confirm the scales. Data were collected during February-December, 2008. RESULTS: The 11-item Self-Efficacy for Preventing Falls Nurse had an alpha of 0·89 with all items in the range criterion of 0·3-0·7 for item total correlation. The 8-item Self-Efficacy for Preventing Falls Assistant had an alpha of 0·74 and all items had item total correlations in the 0·3-0·7 range. CONCLUSIONS: The Self-Efficacy for Preventing Falls Nurse and Self-Efficacy for Preventing Falls Assistant scales demonstrated psychometric adequacy and are recommended to measure bedside staff's self-efficacy beliefs in preventing patient falls.