Urininkontinens hos kvinnor : Livskvalitet och hjälpsökande

Syftet med denna studie var att undersöka hur kvinnors livskvalitet påverkas vid urininkontinens, om åldern påverkar livskvaliteten samt om kvinnorna sökt hjälp för sina symtom. Metoden var en systematisk litteraturstudie, där vetenskapliga artiklar söktes i flera databaser. Sökordet ”urinary incontinence” ingick i alla sökningar i olika kombinationer med andra sökord. Endast kvantitativa artiklar hittades vid sökningen. Efter att de granskats enligt den mall som författaren sammanställt bedömdes artiklarna vara av god kvalitet. Femton artiklar ingick i resultatredovisningen. Det övergripande resultatet som denna studie kom fram till är att livskvaliteten hos kvinnor påverkas vid urininkontinens. Graden av urininkontinens påverkar upplevelsen av inkontinensen, ju större besvär, desto större negativ påverkan på livskvaliteten beskrevs hos de drabbade. Ju äldre man blir, desto större negativ påverkan på livskvaliteten påvisades. Som mest var det knappt hälften av de kvinnor som deltog i studien som sökt hjälp för sina symtom, det varierade från sex till 42 %. Genom att söka hjälp skulle möjligheten att förbättra livskvaliteten öka för dessa kvinnor.

Individuell utprovning av inkontinenshjälpmedel i kommunala särskilda boenden

The purpose of this study was to examine the extent to which incontinence aids, used in local authority/municipal nursing homes, were adapted to the resident’s urine-leakage volume and to find out how nurses perceived the current situation concerning individual testing of incontinence aids in municipal nursing homes. The study method was a quantitative empirical study and was carried out in two phases. The first phase was a weighing test, carried out in three nursing homes, whereby the incontinence aids used by 25 residents during a 48 hour period were weighed. The second phase was the completion of a questionnaire by the municipal nurses working in the same local authority. The questionnaire covered: the division of responsibilities; routines for testing incontinence aids, and the level of knowledge concerning individual incontinence aid testing. Only 22 % of the pads used during the observation were properly adapted to the patients’ urinary leakage volume, while 76 % of incontinence aids were larger than necessary in relation to the real volume of urinary leakage. The municipal nurses, who have a key role and formal responsibility for individual incontinence aid testing, considered that there was insufficient knowledge within the organisation concerning individual incontinence aid testing, and that the division of responsibilities in this area was unclear. There were great variations relating to the extent of the nurses’ involvement in individual incontinence aid testing, and the nurses stated that increased involvement in individual incontinence aid testing was dependent on more time being made available for this task. Only a minority of the nurses thought that the requisitioning of incontinence aids was preceded by individual testing of the incontinence pads within the organisation. The majority of nurses considered that this was not the case or were unsure of the situation.

Urininkontinens bland kvinnor : ett dolt hälsoproblem

Syftet med denna studie var att undersöka förekomst och svårighetsgrad av urininkontinens hos kvinnor och hur det påverkade deras dagliga liv. Syftet var vidare att studera om kvinnorna sökt hjälp för sin urininkontinens och om de var nöjda med den hjälp de erbjudits. Studien utgjordes av en tvärsnittsstudie med kvantitativ ansats. Populationen i studien omfattade alla de kvinnor över 18 år som under en dag besökte en framlottad vårdcentral i Dalarna. Totalt delades 416 enkäter ut, varav 397 besvarades och 368 inkluderades i studien. Ett validerat mätinstrument ICIQ-UI SF (The International Consultation on Incontinence Modular Questionnaire-Urine Incontinence Short Form) på svenska användes och två tilläggsfrågor konstruerades. Resultatet visar att 54% av kvinnorna besvärades av urininkontinens där ansträngningsinkontinens var den vanligaste typen. Kvinnorna hade urinläckage av mindre omfattning, liten mängd, och påverkan på dagliga livet var låg, dock var de kvinnor med blandinkontinens mera påverkade. En stor andel sökte inte hjälp för sin urininkontinens då de ansåg att besvären inte var så stora. De få kvinnor som sökt hjälp var nöjda med den hjälp de fått. Svårighetsgraden av urininkontinens enligt ICIQ-UI SF visade att övervägande delen av kvinnorna hade obetydliga till måttliga besvär. Resultatet tyder på att urininkontinens är ett dolt hälsoproblem.

Granskning av riktlinjer vid Sveriges förlossningskliniker gällande sfinkterskada i samband med förlossning : Innehållsanalys med en kombination av en deduktiv och induktiv ansats

Background: Sphincter injury is serious complication in connection to vaginal childbirth. Desire to avoid vaginal birth again is seen in women who previously suffered from a sphincter injury. Objective: To identify and evaluate obstetric guidelines in Sweden regarding sphincter injury in relation to childbirth Method: Content analysis with a combination of a deductive and inductive approach. Results: The most frequently occurring risk factors and prevention with help of perineal protection were described in the guidelines. The physician made diagnosis and repaired the sphincter injury at the theatre.  Complications such as coital pain and anal incontinence were described in the guidelines. Paracetamol and diclofenac was most common analgesic regimen given for pain. Prophylaxis such as antibiotic treatment and laxative were common. Information given to women was described. Follow-up by physician, midwife and physiotherapist was recommended after four weeks to six months. For future birth a cesarean section was recommended. Conclusion: The guidelines were constructed in the same way and had to a large extent similar content. The authors of the present work recommend a national guideline.

Improving continence services for older people from the service-providers’ perspective : a qualitative interview study

Objective: To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Design: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. Setting: 3 acute and 13 primary care National Health Service Trusts in England. Participants: 16 continence service leads in England actively treating and managing older people with UI. Results: In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and highquality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Conclusions: Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

Riskfaktorer och förebyggande omvårdnadsåtgärder för UVI hos äldre kvinnor : En litteraturöversikt

Bakgrund: Urinvägsinfektion (UVI) är en av de vanligaste infektionerna hos äldre kvinnor. Escherichia coli (E-coli) är den vanligaste bakterien vid UVI. Äldre kvinnor lider när de är drabbade av UVI och det är sjuksköterskans uppgift att bland annat förebygga sjukdom och lindra lidande. Syfte: Att beskriva riskfaktorer och förebyggande omvårdnadsåtgärder mot UVI hos äldre kvinnor. Metod: Litteraturstudie, med databassökning genom databaser speciellt inriktade på vård och omvårdnad, CINAHL, PubMed, WEB OF SCIENCE och Medline. 15 artiklar har använts till resultatet. Resultat: Recidiverande UVI, diabetes, urininkontinens, smittspridning och förstoppning är riskfaktorer att drabbas av UVI. God hygien och regelbunden tillförsel av vätska ses som god evidensbaserad omvårdnadsåtgärd mot UVI. Ökad tillförsel av vätska förkastas, Tranbärstillägg behöver ytterligare forskning. Slutsats. Hög hygieniskstandard genom de basala hygienrutinerna är en viktig förebyggande åtgärd mot UVI.

The importance of patient involvement in stroke rehabilitation

OBJECTIVE: To investigate the perceived needs for health services by persons with stroke within the first year after rehabilitation, and associations between perceived impact of stroke, involvement in decisions regarding care/treatment, and having health services needs met. METHOD: Data was collected, through a mail survey, from patients with stroke who were admitted to a university hospital in 2012 and had received rehabilitation after discharge from the stroke unit. The rehabilitation lasted an average of 2 to 4.6 months. The Stroke Survivor Needs Survey Questionnaire was used to assess the participants' perceptions of involvement in decisions on care or treatment and needs for health services in 11 problem areas: mobility, falls, incontinence, pain, fatigue, emotion, concentration, memory, speaking, reading, and sight. The perceived impact of stroke in eight areas was assessed using the Stroke Impact Scale (SIS) 3.0. Eleven logistic regression models were created to explore associations between having health services needs met in each problem area respectively (dependent variable) and the independent variables. In all models the independent variables were: age, sex, SIS domain corresponding to the dependent variable, or stroke severity in cases when no corresponding SIS domain was identified, and involvement in decisions on care and treatment. RESULTS: The 63 participants who returned the questionnaires had a mean age of 72 years, 33 were male and 30 were female. Eighty percent had suffered a mild stroke. The number of participants who reported problems varied between 51 (80%, mobility) and 24 (38%, sight). Involvement in decisions on care and treatment was found to be associated with having health services needs met in six problem areas: falls, fatigue, emotion, memory, speaking, and reading. CONCLUSIONS: The results highlight the importance of involving patients in making decisions on stroke rehabilitation, as it appears to be associated with meeting their health services needs.