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.

Burdens and Educational Needs of Informal Caregivers of Older Adults With Urinary Incontinence: An Internet-Based Study.

PURPOSE: The purpose of this study was to describe the burden and educational needs of informal caregivers of care-dependent older adults with urinary incontinence (UI). DESIGN: A cross-sectional, descriptive survey of informal caregivers recruited through Google Ads was performed. METHODS: An online survey, including the Overactive Bladder-Family Impact Measure, was used to assess five areas of the experience of the informal caregiver that may be affected by caring for a person with UI and their educational needs. FINDINGS: Respondents (n = 77) reported a substantial impact of their care recipients' UI on their lives, with concern, travel, and social subscales most affected. However, 42% never sought treatment on behalf of their care recipient. Educational needs included UI treatment strategies and guidance to select appropriate supplies. CONCLUSIONS: Caregivers underreported their care recipient's UI and need substantially more support from healthcare providers to manage the condition. CLINICAL RELEVANCE: Nurses should assess for UI among care-dependent older adults and, if present, provide information and strategies to lessen the impact on caregiver lives.

Fatores inerentes ao surgimento da incontinência urinária no idoso hospitalizado analisados à luz da tríade donabediana / Factores relacionados al surgimiento de la incontinencia urinaria en el anciano hospitalizado analizados a la luz de la tríade donabediana / Factors inherent to the onset of urinary incontinence in the hospitalized elderly patients analyzed in the light of the Donabedian's triad

RESUMO Objetivo Apreender os fatores relacionados ao surgimento e/ou piora da incontinência urinária no idoso hospitalizado, considerando a tríade donabediana. Método Estudo qualitativo, descritivo, realizado com enfermeiros e técnicos de enfermagem de um hospital público universitário. Os dados foram coletados por meio da técnica de grupo focal; para tratamento e análise foi utilizada a análise de conteúdo, com posterior codificação das unidades de registro no software WebQDA, relacionando o corpus obtido com os pilares donabedianos. Resultados Os fatores relacionados ao surgimento e/ou piora da incontinência urinária na pessoa idosa hospitalizada mais relatados estavam interligados ao pilar estrutura, com destaque para o atributo recursos humanos, seguido dos atributos recursos materiais e estrutura física; o segundo pilar donabediano que teve maior associação com os relatos foi o pilar processo e, por último, o pilar resultado. Conclusão A identificação dos fatores relacionados ao desfecho investigado no cenário hospitalar proporcionou a reflexão e sensibilização dos participantes com relação ao problema, sendo possível, assim, propor medidas e intervenções a fim de minimizá-lo e de garantir um cuidado seguro e de qualidade ao idoso hospitalizado.

RESUMEN Objetivo Comprender los factores relacionados al surgimiento y/o agravación de la incontinencia urinaria en el anciano hospitalizado, considerando la tríade donabediana. Método Estudio cualitativo, descriptivo, realizado con enfermeros y técnicos de enfermería de un hospital público universitario. Los datos fueron reunidos por medio de la técnica de grupo focal; para tratamiento y análisis se utilizó el análisis de contenido y, luego, la codificación de las unidades de registro en el software WebQDA, haciendo un puente entre el corpus obtenido con los pilares donabedianos. Resultados Los factores relacionados al surgimiento y/o agravación de la incontinencia urinaria en los ancianos hospitalizados más relatados se refieren al pilar estructura, con énfasis en los recursos humanos; enseguida vienen los recursos materiales y estructura física; el segundo pilar donabediano con mayor relación con los relatos fue el pilar proceso y, finalmente, el pilar resultado. Conclusión La identificación de los factores relacionados al desenlace investigado en el escenario hospitalario, proporcionaron la reflexión y sensibilización de los participantes con relación al problema, por lo que propuso medidas e intervenciones para minimizarlo y garantizar un cuidado seguro y de calidad al anciano hospitalizado.

ABSTRACT Objective To apprehend the factors related to the onset and/or worsening of urinary incontinence in the hospitalized elderly patient, considering the Donabedian's triad. Method This is a qualitative, descriptive study, conducted with nurses and nursing technicians from a public university hospital. Data were collected using the focus group technique; content analysis was used for treatment and analysis, with subsequent coding of the registration units in the software WebQDA, relating the corpus obtained with the Donabedian's pillars. Results The most reported factors related to the onset and/or worsening of urinary incontinence in hospitalized elderly patients were linked to the pillar structure, with emphasis on the attribute human resources, followed by the attributes material resources and physical structure; the second Donabedian's pillar with the greatest association with the reports was process and, finally, the pillar outcome. Conclusion The identification of factors related to the outcome investigated in the hospital environment provided the participants with reflection and awareness about the problem, therefore allowing the proposition of measures and interventions to minimize it and ensure safe and quality care to the hospitalized elderly patient.

The Effects of Education About Urinary Incontinence on Nurses' and Nursing Assistants' Knowledge, Attitudes, Continence Care Practices, and Patient Outcomes: A Systematic Review.

The aims of this systematic review were to describe, critique, and summarize research about the effects of education about urinary incontinence on nurses' and nursing assistants' knowledge and attitudes toward urinary incontinence, their continence care practices, and patient outcomes. We searched key electronic databases (PsycINFO, MEDLINE, CINAHL, Web of Science, and Cochrane Library) for full-text primary research articles written in the English language and published between January 1990 and October 2018. Studies were included if they described a controlled or uncontrolled trial of an education program for nurses or nursing assistants about urinary incontinence and evaluated the effects of the program on either knowledge, attitudes, practice, or patient outcomes. Data were extracted about the aim, design, sample and setting, trial methods, intervention, outcomes of interest, and findings. Quality appraisal was conducted using a mixed-methods appraisal tool. Results are presented in tabular format and reported descriptively. Nineteen studies met inclusion criteria; most were set in the United States or the UK. All trials that evaluated the effects on knowledge reported improvements; however, the effects of education on attitudes were mixed as were the effects of education on continence care practices. Eleven of the 19 studies reported the statistical effect of education on patient outcomes. Uncontrolled trials reported improvements in nursing home residents' and community-dwelling patients' continence status, but this effect was not observed in a large controlled trial. Similarly, 2 studies set in inpatient rehabilitation found no significant differences in patient continence outcomes following an educational intervention targeted to nurses.

Psychological nursing intervention on anxiety and depression in patients with urinary incontinence after radical prostatectomy: A randomized controlled study protocol.

BACKGROUND: Prostate cancer (PC) is one of the most familiar disease of the male reproductive system globally. In treating the clinically localized PC, the radical prostatectomy is regarded as a gold standard, but it is associated with syndromes as urinary incontinence (UI), which can have a significant impact on patients' quality of life. Nurse takes responsibility in the management of the UI for their convenience compared with doctors to contact with patients and build better trust relationships with survivals. However, most of the studies focus on the physiological level, the psychological nursing intervention research is less. The purpose of the trial is to introduce a psychological intervention program and to study its effects on anxiety and depression after prostatectomy in IU patients. METHODS: This is a single-center randomized controlled trial that was authorized by Ethics Committee of the First People's Hospital of Chenzhou City (2020054). One hundred participants who undergo radical prostatectomy are analyzed. Inclusion criteria are the following: PC is diagnosed based on histological results; Participants in the study voluntarily sign the informed consent table; Severe UI after extubation; Patients with postoperative UI do not receive any drug treatment. Exclusion criteria are the followings: patients with the history of prostate operation; patients with the history of severe renal and liver malignancy; UI caused by reasons other than prostatectomy. The main outcomes are the degree of anxiety and depression 2 months after urinary catheter is removed. The secondary outcomes are the quality of life 2 months after urinary catheter is removed. All data are collected and analyzed by the Social Science software version 21.0 (SPSS, Inc., Chicago, IL) program. RESULTS: The relevant indexes of severe UI patients are compared in the table. CONCLUSION: Psychological nursing intervention may have a positive effect on depression and anxiety in the UI patients after receiving the radical prostatectomy.

Cuidados basados en terapias conductuales aplicados al paciente con incontinencia urinaria / Nursing care for patients with urinary incontinence based on behavioural therapies

La Incontinencia Urinaria es un problema de salud relevante con una prevalencia elevada en ancianos hospitalizados. El aumento de población anciana en la sociedad española justifica la actualización de cuidados y técnicas aplicables a pacientes geriátricos, dependientes y crónicos. Los procedimientos de cuidados de salud basados en la evidencia ayudan a los profesionales en la toma de decisiones y disminuyen la variabilidad en la práctica clínica. En este artículo se describe el procedimiento de cuidados al paciente con incontinencia urinaria del Hospital Guadarrama basado en el uso de terapias conductuales

Urinary Incontinence is a highly prevalent and important health problem in hospitalized elderly people. The increase in the elderly population in Spain requires the care and techniques that apply to geriatric, dependent and chronic patients to be updated. Evidence-based health care procedures assist professionals in decision-making and reduce variability in clinical practice. This article describes the care procedure for patients with urinary incontinence in the Guadarrama Hospital based on the use of behavioural therapies

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.

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.

Development and randomised controlled trial of a Continence Product Patient Decision Aid for men postradical prostatectomy.

AIMS AND OBJECTIVES: To develop and evaluate an evidence-based Continence Product Patient Decision Aid (CP-PDA) to reduce decisional conflict and support continence product choice for men postradical prostatectomy. BACKGROUND: In 2018, 1.3 million men globally were diagnosed with prostate cancer. A common treatment is radical prostatectomy, usually leading to sudden onset of urinary incontinence. For people experiencing incontinence, products to contain leakage are fundamental to health-related quality of life, but many product users and healthcare professionals are unaware of available options. No evidence-based guidance on choosing products exists despite known physical and psychological burdens of poorly managed leakage (e.g. isolation, anxiety, depression, skin damage). DESIGN AND METHODS: 4 phases, underpinned by international decision aid guidance. Evidence/expert opinion: Literature review; consultation with specialist continence clinicians (n = 7) to establish evidence base. Prototype: CP-PDA developed with continence specialist (n = 7) feedback. Alpha testing (stakeholders): CP-PDA materials were provided to expert patients (n = 10) and clinicians (n = 11) to assess content/presentation. Beta testing (field) following CONSORT guidelines, registered NIHR CPMS 31077: Men (n = 50) postradical prostatectomy randomised to evaluate usability and decision-making using the Decisional Conflict Scale compared with usual care. RESULTS: An algorithm differentiating patients by mobility, dependency, cognitive impairment and type/level of leakage, leading to 12 user groups, was developed. For each group, an option table and associated product information sheets guide product choice. Total Decisional Conflict Score for men using the CP-PDA was significantly better than for men without. CP-PDA users reported greater confidence in product knowledge and choice. CONCLUSION: This is the first evidence-based CP-PDA, developed using an internationally recognised method. Compared to usual care, it significantly reduced decisional conflict for men choosing continence products postprostatectomy. RELEVANCE TO CLINICAL PRACTICE: The CP-PDA provides nurses with the first comprehensive, evidence-based intervention to help postprostatectomy men in complex continence product choices. An online version is available: www.continenceproductadvisor.org.

Benchmarking outcomes in maternity care: Peripartum incontinence - a framework for standardised reporting.

OBJECTIVE: To evaluate a framework to facilitate standardised reporting of perinatal incontinence. DESIGN: An exploratory, prospective, observational cohort study. SETTING: One Australian tertiary maternity referral centre. PARTICIPANTS: Data from 309 pregnant women collected between August 2017 and January 2019. MEASUREMENTS AND FINDINGS: A framework was developed using consensus-based terminology and definitions, measures and data-collection time-points. The ICIQ-UI SF and the Wexner Scale were administered during pregnancy (<27 and 36-weeks) and postpartum (6- and 26-weeks). Incidence, trajectory and group differences for urinary incontinence subcategories were evaluated. Stress urinary incontinence was the largest contributor of urinary incontinence during pregnancy (39.2%) followed by mixed (11.3%) and urgency incontinence (7.4%). Factors associated with incontinence subcategories during pregnancy were multiparity (stress: RR 1.74), co-existing anal incontinence (mixed: RR 3.51) and early pregnancy urinary incontinence (stress: RR 2.79; mixed: RR 2.85). Factors postpartum included primiparity (urgency), vaginal birth (stress), induction of labour (stress: RR 2.99; urgency: RR 0.2), waterbirth (urgency: RR 2.66), coexisting anal incontinence (urgency: RR 3.55) and late pregnancy urinary incontinence (mixed: RR 3.97). Low numbers of women with anal incontinence prohibited subcategory analysis. KEY CONCLUSIONS: Findings offer preliminary support for the effectiveness of the framework for the measurement and reporting of urinary incontinence in childbearing women. Future research is needed to evaluate the framework in larger and more diverse maternity populations. IMPLICATIONS FOR PRACTICE: A framework for standardised measurement and reporting of perinatal incontinence will facilitate improved synthesis of research findings with the potential to improve the quality of evidence-based clinical guidelines.

Managing Urinary Incontinence.

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series provide simple and useful instructions that nurses should reinforce with family caregivers. This article is the second of two that provide an update on urinary incontinence and its management in older adults. It includes an informational tear sheet-Information for Family Caregivers-that contains links to the instructional videos. To use this series, nurses should read the articles first, so they understand how best to help family caregivers, and then encourage caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

[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.

Non-pharmacologicalinterventions in the control of urinary incontinence and the instruments that allow the diagnosis: integrative review / Intervenções não farmacológicas no controle da incontinência urinária e os instrumentos que permitam o seu diagnóstico: revisão integrativa

Introduction: Urinary incontinence is a major health problem resulting in physical, psychological and social changes with economic repercussions on the health system. Is a multifactorial condition associated with age-related changes and disorders of the genitourinary system, which corroborates the fact that it is the most often recurring geriatric syndrome. Aims: To identify non-pharmacological interventions for adults with urinary incontinence and to identify tools for urinary incontinence diagnosis in adults. Method: An integrative review study design was completed. Two electronic databases was search (MEDLINE and Web of Science). Three independent reviewers searched databases according to a predetermine inclusion and exclusion criteria. Results: Twelve articles were included in the review. Eleven articles mentioned non-pharmacological interventions, such as physical therapies, lifestyle strategies, behavioural therapies and alternative conservative management options. These interventions should be targeted and individualized to the type of incontinence to result in health gains for the population. One article mentioned an assessment tool for urinary incontinence - The Gaudenz-Fragebogen tool. The evaluation tools can help to systematize the diagnostic activity and consequently improve the clinical practice in the field of urinary incontinence. Conclusion: In care conception, nurses should target their interventions to personal data to address individual symptoms and use assessment tools that can help in the differential diagnosis of UI. Then, to advancing the quality and rigor of nursing care, we advocate that providing nurses with skills in attaining a differential diagnosis of UI presents an added value to the improvement of quality of care in a multidisciplinary context

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Registered nurse's experiences of continence care for older people: A qualitative descriptive study.

AIM: This study aimed to illuminate nurses' experience of continence care for older people receiving home care, either in their own home or in an assisted living facility. BACKGROUND: Registered Nurses (RNs) have a major role to play in identifying and establishing appropriate actions regarding continence care for older people. However, the crucial nursing care pathway for continence care is commonly described as poor. METHODS: Interviews were conducted with 11 RNs providing home care, and the transcribed texts were analysed using inductive content analysis. RESULT: The impressions of RNs were categorised according to four themes: perceptions of continence care, an open approach to continence care, the need for personalised aid fittings and the importance of teamwork in continence care. Key findings were the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care; substantiation that evidence-based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care; and the need for nurses to support the right of older persons to receive an assessment of their continence problems, deemed to be the minimum standard of quality care. CONCLUSION: The provision of continence care that is based on key nursing standards, such as evidence-based and person-centred care, as well as individualised continence care that is based on evidenced-based guidelines, would ensure an improvement in the continence care that is presently on offer to older people. IMPLICATIONS FOR PRACTICE: Nurses need to embrace leadership at the point of care and to be more visible with the provision of direct care in order to improve continence care for older people receiving home care.