Multiple sclerosis and continence issues : an exploratory study

The study described in this article aimed to identify issues relating to incontinence and assess the impact of referral to a continence adviser on the lives of people with multiple sclerosis (MS). The study design used an in-depth, two-phase anonymous mail survey within a general community as nominated by the participants. Fifty-six people participated in phase 1 and eleven people completed phase 2. The results indicated that incontinence is a problem for the vast majority of participants — people with MS. One-third of the eligible participants took up the option of a consultation, assessment and treatment from a continence nurse. Reasons for not taking up the visit from the continence nurse included ‘managing OK’, ‘didn’t think it would help’, ‘embarrassed’ and ‘too busy’. Increasing awareness of urinary incontinence in the community is important and education needs to focus on at-risk groups in presenting the range of options available to assist people experiencing incontinence.

Bladder continence management in adult acquired brain injury

Purpose: Persistence of urinary incontinence post acquired brain injury (ABI) carries important prognostic significance. We undertook to document the incidence of urinary incontinence, its management and complications in rehabilitation inpatients following ABI and to assess adherence to post ABI bladder management guidelines. 

Method: A retrospective chart survey of a convenience sample of consecutive admissions to two adult neurorehabilitation units Forster Green Hospital, Belfast, and the Scottish Brain Injury Rehabilitation Service, Edinburgh (SBIRSE). Bladder continence and management on transfer to and discharge from rehabilitation, trial removal of catheter, use of bladder drill, ultrasound investigation, anticholinergic medication and complications were recorded. 

Results: One hundred and forty six patients were identified. Seventy-seven (52.7%) were independent and continent of urine at rehabilitation admission and 109 (74.7%) on discharge. In all, 13 patients had urinary tract infection, 7 had urethral stricture and 1 developed haematuria whilst catheterised. Ultrasound of renal tracts was underused. Trial removal of catheter after transfer to rehabilitation occurred at a median of 10 days. 

Conclusions: Urinary continence was achieved in almost half of incontinent ABI patients during rehabilitation. There is potential for increased use of investigation of the renal tracts. Rehabilitation physicians should consider urethral stricture in the management of continence post ABI. 

Implications for Rehabilitation:

- Persisting urinary incontinence post ABI is associated with increased morbidity.

- Urethral stricture is an under-recognised complication after ABI and should be considered as a potential cause of incontinence in this patient group.

- Gains in urinary continence are seen in patients post ABI, managed with various interventions.

- Goal setting offers an opportunity to focus on bladder management rather than simply continence and may allow improvement in rate of appropriate investigation

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.

Development, implementation, and evaluation of a continence education package in acute and subacute care settings

OBJECTIVE: The objective of the study was to trial and evaluate the effect that a discharge Continence Education Package (CEP) had on patients' continence awareness and management preferences.
DESIGN: An exploratory descriptive design was used.
SETTINGS AND SUBJECTS: A total of 631 participants were included in the study: 352 females (55.8%) and 279 males (44.2%) from 4 rural and regional settings in Victoria, Australia.
INSTRUMENTS AND METHODS: A specifically designed questionnaire was used to assess participants' knowledge of incontinence and its management and also to investigate their treatment preferences and intentions if they experienced this type of problem. Data were collected at 2 time periods. Specifically, patients were interviewed before discharge from acute and subacute settings identified as Time 1 (T1). Then the participants were given the CEP and asked to complete a similar questionnaire.
RESULTS: The findings revealed that fewer than 25% of participants had received information on continence before the study being conducted, yet the majority had indicated that they had experienced continence symptoms. The majority of participants found the CEP easy to understand (98.2%) and helpful (95.3%). Most participants said it provided them with information about types of actions to take and/or treatment options for incontinence problems. It also raised their awareness of the signs and symptoms associated with incontinence and provided them with a useful self-administered gauge with which to assess their continence status.
CONCLUSIONS: These findings suggest that the CEP may be a useful educational tool for use in the general population.

The challenge of managing continence care in residential aged care settings : recommendations for research and practice

Incontinence-related problems are a major reason for placement in residential aged care facilities. Data from the Residential Classification Scale indicates that 86% of people in residential aged care facilities in Australia are dependent on others for bladder management, 77% require some support with bowel management and 78% require some support with toileting. In this paper, we present an overview of the literature on the issues that need to be considered for the management of incontinence in residential aged care settings. Based on this literature, we make recommendations for research and practice. Although residential care facilities are mandated to provide continence care, there is little research evidence on which to base care or to evaluate the effectiveness of current practices. Further research is required to address this gap in information to ensure delivery of residential aged care that meets the requirements of the Aged Care Act 1997.

Does a continence educational brochure promote health-seeking behavior?

OBJECTIVE: This study reviewed whether participants who were given a continence education package, which included a Continence Educational Brochure (CEB), and who indicated that they were bothered by incontinence symptoms changed health-seeking behaviors about their incontinence problem because of being given the brochure.
METHOD: This study used a descriptive and exploratory design. Participants were given the CEB and asked to read the information. They were also asked to complete a continence questionnaire and mail this back to the research team. Participants who indicated that they were bothered by a continence problem and consented to being interviewed were telephoned 2 to 3 months later. They were asked questions to determine their actions and progress in relation to managing their continence problem and whether the CEB had influenced their behavior.
SETTING AND SUBJECT: A total of 631 participants (352 females, 55.8%; 279 males, 44.2%) from 4 rural and regional settings in Victoria, Australia, participated. Of this sample, 111 participants (78 females, 70.3%; 33 males, 29.7%) who reported that they were bothered by a continence problem were interviewed 3 months after being given the CEB.
RESULTS: Two thirds of the total sample of participants (n = 111) sought help for their continence problem. Approximately 70.3% (n = 78) continued to have a continence problem. Of this group, 84.6% were still bothered by the continence problem and 65.4% had taken action to treat their incontinence. Forty-nine participants (44.1%) indicated that they had discussed the issue of bladder or bowel problems with someone directly because of this study or the information contained in the brochure. More than 94% of participants who remembered the CEB indicated that they believed the brochure would be helpful if given to other people.
CONCLUSIONS: These findings suggest that the CEB prompted individuals to discuss their continence problem and in fewer cases to seek professional help. Given these findings, distribution of a continence education package is advocated as a continence health promotion strategy.

A clinical nursing leadership model for enhancing continence care for older adults in a subacute inpatient care setting

This article describes the application and evaluation of a clinical nursing leadership model to enhance continence care in an inpatient rehabilitation setting for older adults. Multiple strategies were employed to optimize the uptake and sustainability of 3 practice initiatives: (1)  establishment of an enhanced role for wardbased nurses to provide clinical support to patients and other staff for the management of incontinence, (2) a new method for nursing assessment and management of bowel elimination, and (3) a framework for improved discharge care of patients with incontinence. Evaluation data indicated a high level of acceptance of the role of the ward-based continence resource nurses, improved assessment and management of bowel elimination, and enhanced discharge care for patients with incontinence. These initiatives were sustainable during a 2-year period after their introduction, despite the gradual withdrawal of the clinical leader.

The construct validity of brief continence self-assessment awareness questionnaires

The aim of this study was to develop brief versions of the continence self-assessment awareness questionnaire (CSAAQ), sensitive to gender-specific experiences of incontinence, and to evaluate their construct validity. Recruitment took place at four Victorian healthcare settings during 2001 and 2002. A total of 431 participants completed the CSAAQ following an appointment or hospital discharge. Factor analyses performed on CSAAQ items demonstrated there were three factors (urinary incontinence symptoms, faecal incontinence symptoms, lifestyle adjustment behaviours) for both women and men. The urinary and faecal items that loaded on their respective factors were different for women and men. Consequently two versions of the CSAAQ were developed; one for males and one for females. Analyses supported the construct validity and internal consistency reliability of the gender specific questionnaires. The brief gender specific CSAAQs could be produced as a single questionnaire with separate sections for female and male specific items. The brief CSAAQs are suitable for use as an incontinence self-assessment questionnaire to increase awareness of individual incontinence issues and to encourage health-seeking behaviours.

The challenges encountered with developing a valid and reliable urinary continence assessment form

The purpose of this study was to develop and validate a concise continence assessment form that can be completed by patients.
A prospective, descriptive, multi-site study was conducted at three major teaching hospitals over a 6 month period utilising a repeated measure design. The study was conducted over two stages: Stage One
consisted of developing the face validity and user friendliness of the instrument; Stage Two consisted of establishing the test-retest reliability of the instrument.
This paper discusses the process and results of the instrument development project. It highlights the clinical and statistical difficulties experienced in the development of the continence assessment form.