Nurses’ knowledge and practice about urinary incontinence in nursing home care
Introduction
About 60% of nursing home residents suffer from urinary incontinence (Brandeis et al., 1997, Aggazzotti et al., 2000, Adelmann, 2004, Saxer et al., 2008). Caring for urinary incontinent people is a constant challenge for health care personnel.
Research shows effective interventions for urinary incontinence in older people (Fantl et al. 1996). For example, an important treatment is the use of prompted voiding, especially for older people without or with minor cognitive impairments (Burgio et al., 1994, Fantl et al., 1996, Ouslander et al., 2001, Schnelle et al., 2002). For the cognitively-impaired elderly, routine or scheduled toileting training also shows a positive effect (Colling et al., 1992, Colling et al., 2003). However, an important barrier in the implementation of effective incontinence treatments is the level of knowledge of the nurses concerning assessment and treatment of urinary incontinence (Lekan-Rutledge et al., 1998, Watson et al., 2003). Therefore, it is important to assess current nurses’ knowledge and practice in urinary incontinence care so that nurses can receive adequate training and education.
Only Henderson and Kashka (2000) studied the knowledge and practice of American nurses. American nurses correctly answered 73% of the questions about knowledge and they performed continence-related practice about half the time. No data are available on the subject in Europe. Since the education and practice of nurses differs between America and Europe, transfer of US research findings is not entirely possible. Therefore it was decided to investigate the knowledge and practice of nurses’ and nurse assistants in Swiss nursing homes.
The study was conducted in two phases: (1) new questionnaires about practice and knowledge were systematically developed with content validity analysed by a panel of experts, and (2) validation of the developed scales and exploration of nurses’ and nurse assistants’ knowledge and practice about urinary incontinence.
Section snippets
Design
A cross-sectional design with a written questionnaire was used to measure the knowledge and practice of nurses and nurse assistants from different nursing homes.
Instrument
To measure nurses’ knowledge and practice about urinary incontinence a new instrument had to be developed. In fact there is a questionnaire to measure nurses knowledge and practice, the URINARY INCONTINENCE SCALES© (Henderson 1996). Most questions of the original scale could not be used since they did not address nursing home residents;
Results
The participating registered nurses and nurse assistants were between 18 and 63 years old, with a mean of 28 years. 40% were younger than 33 years, 28% were 33–43 years and 32% were older than 43 years. 39% of the participants had more than 10 years experience in the care of old people, 40% between 3 and 10 years, 21% less than 3 years.
Discussion
This article pursues two goals: the development and testing of a urinary incontinence knowledge and practice instrument as well as reporting on the results on nurses’ knowledge and practice about urinary incontinence.
This study shows that nurses’ knowledge regarding urinary incontinence is satisfactory and that of nurse assistants is somewhat lower than that of nurses. This is seen also in items 13 and 15 about medication. Because nurse assistants are less educated than nurses, this result
Limitations
In this study, a convenience sample was used which may have influenced the result. Another limitation of this study is that we had to develop a new instrument, and future research is needed to show if it is reliable and valid enough. However our results are promising in this respect.
Conclusions
The results show a lack of specific knowledge about urinary incontinent residents, therefore especially nurses have to be re-educated in the specific knowledge and this knowledge has to be integrated in nursing education. Probably nurse assistants do not need the specific knowledge, but nurses do, because they are responsible for the residents and the care planning.
There is a need for improving practice, especially in documentation. Nurses and nurse assistants should receive adequate support in
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