Perceptions and barriers that influence the ability to provide appropriate incontinence care in nursing home residents: Statements from nursing staff

Liv Heidi Skotnes, Ove Hellzen, Esther Kuhry

Department of Medicine, Division of Geriatrics, Nord-Tr?ndelag HealthTrust, Namsos, Norway.
Department of Surgery, St. Olavs Hospital, Trondheim, Norway.
Nord-Tr?ndelag University College, Namsos, Norway.

DOI: 10.4236/ojn.2013.36059                

Abstract

Urinary incontinence is a common medical condition among nursing home residents. Urinary incontinence in older people has a multifactorial etiology and is therefore more difficult to assess and treat than urinary incontinence in younger people. Previous research has shown that incontinence care in nursing home residents often is inadequate and little systematized. The aim of this study was to identify perceptions and barriers that influence the ability of the nursing staff to provide appropriate incontinence care. This was a qualitative study using focus-group methodology. Data were collected from three focus-group interviews with 15 members of the nursing staff from six different units in a nursing home. The focus-group interviews were recorded on tape, transcribed verbatim and analyzed according to qualitative content analysis. Three topics and eight categories were identified. The first topic, Perceptions and barriers associated with residents, consisted of one category: “physical and cognitive problems”. The second topic, Perceptions and barriers associated with nursing staff, consisted of three categories: “lack of knowledge”, “attitudes and beliefs” and “lack of accessibility”. The third topic, Perceptions and barriers associated with organizational culture, consisted of four categories: “rigid routines”, “lack of resource”, “lack of documentation” and “lack of leadership”. The findings from this study show that there are many barriers that might influence the possibilities of nursing staff to provide appropriate incontinence care to residents in nursing homes. However, it can nevertheless seem like opinions and the attitude of nursing staff, together with a lack of knowledge about UI, are the most important barriers to provide appropriate incontinence care.

Keywords

Content Analysis; Focus Groups; Incontinence Care; Nursing Homes; Urinary Incontinence

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Aggozzatti, G., Pesce, F., Grassi, D., Fantuzzi, G., Righi, E., De Vita, D., Santacroce, S. and Artibani, W. (2000) Prevalence of urinary incontinence among institutionalized patients: A cross-sectional epidemiologic study in midsized city in northern Italy. Urology, 56, 245-249. http://dx.doi.org/10.1016/S0090-4295(00)00643-9
[2]	Jumadilova, Z., Zyczynski, T., Paul, B. and Narayanan, S. (2005) Urinary incontinence in the nursing home: Resident characteristics and prevalence of drug treatment. American Journal of Managed Care, 11, 112-132.
[3]	Ko, Y., Lin, S.J., Salmon, J.W. and Bron, M.S. (2005) The impact of urinary incontinence on quality of life on the elderly. American Journal of Managed Care, 11, 103-111.
[4]	Engberg, S., Kincade, J. and Thompson, D. (2004) Future Directions for Incontinence Research with Frail Elders. Nursing Research, 53, 22-29. http://dx.doi.org/10.1097/00006199-200411006-00004
[5]	Skelly, J. and Flint, A.J. (1995) Urinary incontinence associated with dementia. Journal of American Geriatrics Society, 43, 286-294.
[6]	O’Brian J., Austin M., Sethi, P. and O’Boyle, P. (1991) Urinary incontinence: Prevalence, need for treatment and effectiveness of intervention by nurse. British Medical Journal, 303, 1308-1312. http://dx.doi.org/10.1136/bmj.303.6813.1308
[7]	Resnick, N.M. (1992) Urinary incontinence in older adults. Hospital Practice, 15, 139-142,147, 150.
[8]	Milne, J.L. (2008) Behavioural therapies for overactive bladder. Journal of Wound, Ostomy, and Continence Nursing, 35, 93-101. http://dx.doi.org/10.1097/01.WON.0000308624.68582.19
[9]	Schnelle, J.F., Cadogan, M.P., Grbic, D., et al. (2003) A standardized quality assessment system to evaluate incontinence care in the nursing home. Journal of American Geriatrics Society, 51, 1754-1761. http://dx.doi.org/10.1046/j.1532-5415.2003.51560.x
[10]	Watson, N.M., Brink, C.A. and Zimmer, J.G. (2003) Use of the agency for health care policy and research urinary incontinence guideline in nursing homes. Journal of American Geriatrics Society, 51, 1779-1786. http://dx.doi.org/10.1046/j.1532-5415.2003.51564.x
[11]	Morris, J. (2007) Working with older people. Brighton, 11, 35-39.
[12]	MacDonald, C.D. and Butler, L. (2007) Silent no more: Elderly women’s stories of living with urinary incontinence in long-term care. Journal of Gerontology Nursing, 33, 14-20.
[13]	Resnick, B., Keilman, L.J., Calabrese, B., Parmalee, P., Lawhorne, L., Pailet, J. and Ouslander, J. (2006) Nursing staff beliefs and expectations about continence care in nursing homes. Journal of Wound, Ostomy, and Continence Nursing, 33, 610-618. http://dx.doi.org/10.1097/00152192-200611000-00004
[14]	Thomas, S. (2000) Department of health. Good practice in continence services. Nursing Standard, 14, 43-45.
[15]	International Continence Society (2005) Evaluation and treatment of urinary incontinence, pelvic organ prolaps and faecal incontinence. 3rd International Consultation on Incontinence, Monaco, 26-29 June 2005, Health Publication Ltd, Plymouth.
[16]	Thuroff, J., Abrams, P., Andersson, K.E., et al. (2006) Guidelines on urinary incontinence. European Association of Urology, Malmo, 2006.
[17]	Dingwall, L. and Mclafferty, E. (2006) Do nurses promote urinary continence in hospitalized older people people? An exploratory study. Journal of Clinical Nursing, 15, 1276-1286. http://dx.doi.org/10.1111/j.1365-2702.2006.01381.x
[18]	Peet, S.M., Castleden, C.M., McGrother, C.W. and Duffin, N.M. (1996) The management of urinary incontinence in residential and nursing homes for older people. Age and Ageing, 25, 139-143. http://dx.doi.org/10.1093/ageing/25.2.139
[19]	DuBeau, C.E., Ouslander, J.G. and Palmer, M.H. (2007) Knowledge and attitude of nursing home staff and surveyors about the revised federal guidance for incontinence care. Gerontologist, 47, 468-480. http://dx.doi.org/10.1093/geront/47.4.468
[20]	Krueger, R.A. and Casey, M.A. (2009) Focus groups: A practical guide for applied research. 4th Edition, Sage, Los Angeles.
[21]	Kitzinger, J. (1995) Introducing focus groups. British Medical Journal, 311, 299-302. http://dx.doi.org/10.1136/bmj.311.7000.299
[22]	Polit, D.F. and Beck, C.T. (2008) Nursing research: Generating and assign evidence for nursing practice. 8th Edition, Lippincott Williams & Wilkins, Philadelphia.
[23]	Patton, Q. (2002) Qualitative research and evaluation methods. 3rd Edition, Sage Publications, London.
[24]	Baxter, L.A. (1991) Content analysis. In studying interpersonal interaction (Montgomery, B.M. and duck, S., Eds.). Guilford Press, New York, pp. 239-254.
[25]	Krippendorff, K. (2004) Content analysis: An introducetion to its methodology, 2nd Edition. Sage, Thousand Oaks.
[26]	Ouslander, J.G., Schnelle, J.F., Uman, G., Fingold S., Nigam, J.G., Tuico, E. and Jensen, B. (1995) Predictors of successful prompted voiding among incontinent nursing home residents. Journal of the American Medical Association, 3, 1366-1436. http://dx.doi.org/10.1001/jama.1995.03520410060027
[27]	Offermans, M.P., Du Moulin, M.F., Hamers, J.P., et al. (2009) Prevalence of urinary incontinence and associated risk factors in nursing home residents: A systematic review. Neurourology and Urodynamics, 8, 288-294. http://dx.doi.org/10.1002/nau.20668
[28]	Jirovec, M.M. (1991) The impact of daily exercise on the mobility, balance and urine of cognitively impaired nursing home residents. International journal of nursing studies, 28, 145-151. http://dx.doi.org/10.1016/0020-7489(91)90004-M
[29]	Han, D.S. and Wang, Y.H. (2008) Urinary incontinence in dementia. Incontinence & Pelvic Floor Dysfunction, 2, 63-66.
[30]	Ostaszkiewicz, J., Johnston, L. and Roe, B. (2004) Time voiding for the management of urinary incontinence in adults. Cochrane Database of Systematic Reviews, 1, CD00280.
[31]	Freundl, M. and Dugan, J. (1992) Urinary incontinence in the elderly: Knowledge and attitude of long-term care staff. Geriatrics Nursing, 13, 70-75. http://dx.doi.org/10.1016/S0197-4572(05)80111-9
[32]	Swedish Council on Technology & Assessment in Healthcare (2000) Evidence Based Treatment of Urinary Incontinence. Stockholm, Report No. 143.
[33]	McLafferty, I. and Morrison, F. (2004) Attitudes towards hospitalized older adults. Journal of Advanced Nursing, 47, 446-453. http://dx.doi.org/10.1111/j.1365-2648.2004.03122.x
[34]	Mellor, P., Chew, D. and Greenhill, J. (2007) Nurses’ attitudes toward elderly people and knowledge of gerontic care in a multi-purpose health service (MPHS). The Australian Journal of Advanced Nursing, 24, 37-41.
[35]	Lovell, M. (2006) Caring for the elderly: Changing perceptions and attitudes. Journal of vascular nursing, 24, 22-26. http://dx.doi.org/10.1016/j.jvn.2005.11.001
[36]	Henderson, J.S. and Kashka, M.S. (2000) Effect of knowledge, attitude and belief on nurses’ practice regarding urinary incontinence in adults. Urological Nursing, 20, 291-293,297-305.
[37]	Wyman, J.F. (2003) Treatment of urinary incontinence in man and woman. The American Journal of Nursing, 103, 26-35. http://dx.doi.org/10.1097/00000446-200303001-00005
[38]	Smith, D.B. (1998) The culture of long-term care: Impact on a continence care program. Urologic Nursing, 18, 291-296.
[39]	Schein, E. (2004) Organizational culture and leadership. John Wiley & Sons, San Francisco.
[40]	Eide, T. and Aadland, E. (2010) Etikkhandboka (Ethics Handbook) Kommuneforlaget AS, Oslo.
[41]	Campell, E.B., Knight, J., Benson, M., et al. (1991) Effect of an incontinence training program on nursing home staff’s knowledge, attitudes, and behavior. Gerontologist, 31, 788-794. http://dx.doi.org/10.1093/geront/31.6.788
[42]	Tanaka, Y., Nagata, K., Tanaka, T., et al. (2009) Can an individualized and comprehensive care strategy improve urinary incontinence (UI) among nursing home residents? Archives of Gerontology and Geriatrics, 49, 278-283. http://dx.doi.org/10.1016/j.archger.2008.10.006
[43]	Hindl, A. and Coates, A. (2011) Nursing care of older people. A textbook for students and nurses. Oxford University Press, Oxford.
[44]	Anger, S., Pace, J., Rodriguez, L.V., et al. (2006) The urologic diseases of America project. True prevalence of urinary incontinence among female nursing home residents. Urology, 67, 281-287. http://dx.doi.org/10.1016/j.urology.2005.08.062
[45]	Minichiello, V., Browne, J. and Kendig, H. (2000) Perceptions and consequences of ageism: Views of older people. Ageing and Society, 20, 253-278. “ http://dx.doi.org/10.1017/S0144686X99007710
[46]	Lekan-Rutledge, D., Palmer, M.H. and Belyea, M. (1998) In their own words: Nursing assistants’ perceptions of barriers to implementation of prompted voiding in longterm care. Gerontologist, 38, 370-378. http://dx.doi.org/10.1093/geront/38.3.370
[47]	Mueller, C. and Cain, H. (2002) Comprehensive management of urinary incontinence through quality improvement efforts. Geriatric Nursing, 23, 82-87. http://dx.doi.org/10.1067/mgn.2002.123790
[48]	Manghall, J., Taylor, P., Thomas, S. and Watterson, L. (2006) Continence problems in care hones: Auditing assessment and treatment. Nursing Older People, 18, 20-22.
[49]	Saxer, S., de Bie, R.A., Dassen, T. and Halfens, R.J. (2008) Nurses’ knowledge and practice about urinary incontinence in nursing home care. Nurse Education Today, 28, 926-934. http://dx.doi.org/10.1016/j.nedt.2008.05.009
[50]	McElroy, A., Corben, V. and McLeish, K. (1995) Developing care plan documentation: An action research project. Journal of Nursing Management, 3, 193-202. http://dx.doi.org/10.1111/j.1365-2834.1995.tb00076.x
[51]	Lawhorne, L.W., Ouslander, J.G., Parmelee, P.A., Resnick, B. and Calabrese, B. (2008) Urinary incontinence: A neglected geriatric syndrome in nursing facilities. Journal of the American Medical Association, 9, 29-35.
[52]	Wright, J., McCormack, B., Coffey, A. and McCarthy, G. (2007) Evaluating the context within which continence care is provided in rehabilitation units for older people. International Journal of Older People Nursing, 2, 9-19. http://dx.doi.org/10.1111/j.1748-3743.2007.00046.x
[53]	Smith, D.B. (1998) A continence care approach for longterm care facilities. Geriatric Nursing, 19, 81-87. http://dx.doi.org/10.1016/S0197-4572(98)90043-X
[54]	Palmer, M.H. (2008) Urinary incontinence quality improvement in nursing homes: Where have we been? Where are we going? Urologic Nursing, 28, 439-453.