Client and clinical staff perceptions of barriers to and enablers of the uptake and delivery of behavioural interventions for urinary incontinence: qualitative evidence synthesis

Patient, Family, and Peer Engagement in Nursing Care as an Effort to Improve the Functional Independence of Post-stroke Urinary Incontinence Patients: A Cross-Sectional Study

Introduction

The engagement of patients, family members, and peers is one approach that can be taken to improve the patient’s health status. This study aimed to investigate the relationship between patient, family, and peer involvement in nursing care to improve the functional independence of post-stroke urinary incontinence (UI) patients.

Methods

This cross-sectional descriptive design study was conducted in three hospitals in Kota Kendari, Sulawesi Tenggara, Indonesia. A total of 104 patients were selected using a simple random sampling method. Data were collected during the research period through a survey and observation. Data were analyzed using descriptive analysis and the Mann-Whitney test.

Results

There was a statistically significant difference in the motor subscale of the Functional Independence Measure (motor-FIM) domain (p<0.05). Based on the results of the analysis, there was a relationship between each motor-FIM domain in the engagement group.

Conclusions

The involvement of patients, families, and peers in patient care needs to be comprehensively improved in an effort to increase patient independence, which in turn can improve the quality of life of post-stroke urinary incontinence patients.

Promoting urinary continence in people suffering a stroke: Effectiveness of a complex intervention-An intervention study

Aim

The study aimed to implement and measure effectiveness of a systematic continence management intervention in people suffering a stroke in undertaking rehabilitation.

Design

An intervention study was conducted.

Methods

In the first part of the study, patients were included in the control group and observed. After the training of the nursing staff, participants were assigned to the intervention group. The intervention consisted of screening, assessment, treatment, communication and evaluation.

Results

Forty‐six patients took part in the study, of which 35 were in the control and 11 in the intervention groups. Within the two groups, significant improvements in outcomes were mostly seen during the study. For the Incontinence Quality of Life Social Embarrassment scale, a significantly higher increase was observed for the intervention group. The improvement between admission and discharge in the intervention group was notably larger for the outcome's incontinence and quality of life.

Home-Care Nurses' Experiences of Caring for Older Adults With Type 2 Diabetes Mellitus and Urinary Incontinence: An Interpretive Description Study

Introduction

A third of older adults with diabetes receiving home-care services have daily urinary incontinence. Despite this high prevalence of urinary incontinence, the condition is typically not recognized as a complication and thereby not detected or treated. Diabetes and urinary incontinence in older adults are associated with poorer functional status and lower quality of life. Home-care nurses have the potential to play an important role in supporting older adults in the management of these conditions. However, very little is known about home-care nurses’ care of this population.

Objective

The objective of this study was to explore how nurses care for older home-care clients with diabetes and incontinence.

Methods

This was an interpretive description study informed by a model of clinical complexity, and part of a convergent, mixed methods research study. Fifteen nurse participants were recruited from home-care programs in southern Ontario, Canada to participate in qualitative interviews. An interpretive description analytical process was used that involved constant comparative analysis and attention to commonalities and variance.

Results

The experiences of home-care nurses caring for this population is described in three themes and associated subthemes: (a) conducting a comprehensive nursing assessment with client and caregiver, (b) providing holistic treatment for multiple chronic conditions, and (c) collaborating with the interprofessional team. The provision of this care was hampered by a task-focused home-care system, limited opportunities to collaborate and communicate with other health-care providers, and the lack of health-care system integration between home care, primary care, and acute care.

Conclusion

The results suggest that nursing interventions for older adults with diabetes and incontinence should not only consider disease management of the individual conditions but pay attention to the broader social determinants of health in the context of multiple chronic conditions. Efforts to enhance health-care system integration would facilitate the provision of person-centred home care.

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.

A meta-ethnography to understand the experience of living with urinary incontinence: 'is it just part and parcel of life?'

BACKGROUND

Urinary incontinence (UI) is highly prevalent and affects the lives of many men and women. We aimed to conduct a qualitative evidence synthesis (QES) to explore the experience of living with UI and to develop a conceptual model that can help us to understand this experience, and the potential barriers to appropriate healthcare.

METHODS

We used the methods of meta-ethnography developed by Noblit and Hare and recently refined for larger studies. Meta-ethnography involves identifying concepts from the studies and abstracting these concepts into a line of argument. We searched for studies that explored the experience of adults with UI. We used the GRADE-CERQual framework to assess confidence in review findings.

RESULTS

We screened 2307 titles, 429 abstracts, 107 full texts and included 41 studies (36 unique samples) in the synthesis. We organised the concepts into 26 conceptual categories, which we further abstracted into 6 themes: (1) Am I ill or is this normal? (2) It effects who I am and how I feel; (3) I feel stigmatised, ashamed and guilty; (4) talking can be difficult but it can help; (5) keeping incontinence under control; (6) have I got to the point that I need help? Our model conceptualises living with UI as navigating antagonists: Is UI normal or am I ill? Do I need help or am I managing? Do I keep UI to myself (and manage alone) or do I tell other people (and get the support that I need)? Do I use control strategies that focus on concealing (avoid risky situations, wear pads) versus, I use strategies that focus on improving the bodily function to improve continence. Our model highlights the experience of stigma, shame and guilt which exert a pull towards concealment.

CONCLUSIONS

The culture of secrecy and profound sense of shame is barrier to seeking help. An environment which reduces the shame and stigma of UI may help people to switch the focus to strategies that will improve continence, rather than conceal incontinence.

User Experience of an App-Based Treatment for Stress Urinary Incontinence: Qualitative Interview Study

Background

Stress urinary incontinence (SUI) affects 10%-39% of women. Its first-line treatment consists of lifestyle interventions and pelvic floor muscle training (PFMT), which can be performed supervised or unsupervised. Health apps are increasing in number and can be used to improve adherence to treatments. We developed the Tät app, which provides a 3-month treatment program with a focus on PFMT for women with SUI. The app treatment was evaluated in a randomized controlled trial, which demonstrated efficacy for improving incontinence symptoms and quality of life. In this qualitative interview study, we investigated participant experiences of the app-based treatment.

Objective

This study aimed to explore women’s experiences of using an app-based treatment program for SUI.

Methods

This qualitative study is based on telephone interviews with 15 selected women, with a mean age of 47 years, who had used the app in the previous randomized controlled trial. A semistructured interview guide with open-ended questions was used, and the interviews were transcribed verbatim. Data were analyzed according to the grounded theory.

Results

The results were grouped into three categories: “Something new!” “Keeping motivation up!” and “Good enough?” A core category, “Enabling my independence,” was identified. The participants appreciated having a new and modern way to access a treatment program for SUI. The use of new technology seemed to make incontinence treatment feel more prioritized and less embarrassing for the subjects. The closeness to their mobile phone and app features like reminders and visual graphs helped support and motivate the women to carry through the PFMT. The participants felt confident that they could perform the treatment program on their own, even though they expressed some uncertainty about whether they were doing the pelvic floor muscle contractions correctly. They felt that the app-based treatment increased their self-confidence and enabled them to take responsibility for their treatment.

Conclusions

Use of the app-based treatment program for SUI empowered the women in this study and helped them self-manage their incontinence treatment. They appreciated the app as a new tool for supporting their motivation to carry through a slightly challenging PFMT program.

Trial Registration

ClinicalTrials.gov NCT01848938; https://clinicaltrials.gov/ct2/show/NCT01848938 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01848938)