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.

Contra todo pronóstico : Una interpretación de Las tres bodas de Manolita de Almudena Grandes desde la teoría de la resiliencia

Este trabajo analizará a la protagonista de la novela Las tres bodas de Manolita, de laescritora española Almudena Grandes, desde el punto de vista de la teoría psicológica de laresiliencia. Pretendemos comprender qué tipo de mecanismos y factores hacen que se puedaconsiderar a Manolita un personaje resiliente. Al tratarse de una interpretación del texto deGrandes se abordará el estudio siguiendo el método hermenéutico. Se basará el análisisindividual del personaje en los estudios, principalmente de observación, llevados a cabo por elpsicólogo británico Michael Rutter; y el análisis desde el punto de vista social o colectivo enlos estudios realizados por el psicólogo español Juan de Dios Uriarte. Las conclusiones denuestra investigación nos llevarán a confirmar que, siguiendo la teoría que se expone,Manolita presenta las características y actitudes individuales necesarias, además de una redsocial de apoyo, para superar los reveses tan graves que le acontecen durante la novela.