'You feel helpless, that's exactly it': parents' and young people's control beliefs about bed-wetting and the implications for practice.

'You feel helpless, that's exactly it': parents' and young people's control beliefs about bed-wetting and the implications for practice Young people wet the bed when they fail to wake up to a full bladder. The causes of bed-wetting are far from certain and this uncertainty is reflected in the diversity of treatments on offer and the lack of any guarantee that treatment will work in a particular case. Most young people are sad and ashamed about the bed-wetting and want it to stop, but they vary widely in their belief in their own capacity to influence the situation, and in their optimism about what the future holds. The problem can persist into adolescence or even adulthood, with far reaching social and emotional consequences, both for the young people and their families. In an ethnographic study involving 19 families 'perceived helplessness' emerged as a key issue permeating the whole system and often activating a downward spiral, leading to abdication of effort and responsibility by the young people themselves, by their parents and sometimes by health care professionals. Informed by the insights gained from this study and an extensive review of the literature on perceived control the Family Perspectives on Bed Wetting Questionnaire has been developed to explore family members' feelings, degree of concern and dimensions of perceived control relating to: effort, ability, luck, important others and the unknown. This questionnaire was used as a basis for structured interviews with family members in a longitudinal survey, involving 40 families attending one of nine community-based, nurse-led enuresis clinics in Greater Glasgow. It was found that only 38% of the young people were entering into treatment with the belief that they had the ability to be dry at night. This became self-fulfilling, with only 33% achieving initial success of 14 consecutive dry nights in a 16-week period (chi-squared test, P=0.029). Seventy per cent of young people felt that luck was important, while most parents felt that luck had little part to play. Implications for practice include the need to assess the families' readiness to engage in treatment, to create opportunities for effective control and to encourage realistic expectations.

Living with a young person who wets the bed: the families' experience.

After allergic disorders, bed-wetting is the most common chronic condition of childhood. It can seriously diminish the quality of life of young people and their families, having an impact on day-to-day activities, family holidays and the young person's willingness and ability to stay away from home with friends and wider family. In this ethnographic study, family members describe the practical and social consequences of bed-wetting, both for themselves and for the family, and the methods that they have employed to encourage the bed-wetting to stop. Most of these methods have little chance of success. Many families' feelings of helplessness and isolation are reinforced by lack of help from healthcare professionals, although the professional's intention to be helpful is rarely questioned. The nature of the families' experiences illustrates the urgent need for adopting a new professional approach to the support of these families, which is based on the principles of 'family nursing'.

Family attitudes to bed-wetting and their influence on treatment.

Bed-wetting can have far-reaching social consequences for the whole family. Seven types of attitude towards bed-wetting have been identified that can be strongly predictive of behaviour, including the readiness to engage in and persist with treatment. Understanding the family's perspective enables a dialogue to be engaged in which takes account of the reality of the family's circumstances.

Promoting the motivation to change. The role of facilitative leadership in quality assurance.

Quality assurance initiatives depend on the motivation of committed clinically-based staff to succeed. A bottom-up approach encourages staff to identify priorities and goals in the knowledge that significant and valid changes can be made.

The Stirling model of nursing audit. Its relationship to standard setting and quality assurance.

Setting up nursing audit can be a daunting prospect. Once done, however, it can provide information about the effectiveness and quality of care. This article describes how audit can be integrated into quality assurance and standard setting initiatives already underway.

Pressure sore management: the patient's role.

Patient education can lead to better healing of pressure sores, but it is essential that education programmes are tailored to the needs of the individual.

Early assessment of pressure sore risk.

If they are to prevent at-risk patients developing pressure sores, and ensure optimum healing time for those already existing, it is vital that nurses understand the aetiology of pressure sores and employ a system of risk assessment.

Delayed pressure sore healing can be prevented.

Delayed pressure sore healing is still a costly problem despite the advances in knowledge on wound healing.