NURSING CONTINENCE ASSESSMENT

Nursing Continence assessment

Nursing Continence assessment

Introduction

This article “Effect of Time of Day for Urinary Catheter Romoval on Voiding Behaviors in Stroke Patients” by Gross et al. (2007, pp. 236-8) explains the test results of stroke patients. Basically, the purpose of this article is to compare the effect of urinary catheter removal at 7:00 a.m. with removal at 10:00 p.m. on (a) the length of time to first void after catheter removal, (b) the quantity of the first void, (c) post-void-residual urine, and (d) the number of subjects requiring re-catheterization. In this article, the authors have explained Chi-square methodology to support their evidence.

Overview

According to the Gross et al. (2007, pp. 236-8), behavioral approaches in the nursing home depend on the definition of success used. If decreased wetness is considered the goal, the toileting approaches of prompted voiding and habit training are a success; however, if achievement of continence is the goal, studies have not demonstrated much progress to date. Pinkowski found that prompted voiding is most successful in residents who have lived in the nursing home for a shorter length of time, scored higher on a mental status exam, have more severe incontinence, and are more dependent and less mobile. All of the behavioral interventions except for toileting require the cooperation, involvement, and motivation of the patient for success. This, in turn necessitates a level of orientation that would preclude most demented residents from participating. Various mental status evaluations tools have been recommended to screen for mental ability before initiating extensive behavioral interventions. Schnelle et al43 point out that behavioral programs are well received by families and alert residents, significantly increasing customer satisfaction in the nursing home, but they acknowledge that responsibility for the additional costs involved is less clear.

Improving incontinence care in the nursing home environment is dependent on a care philosophy that involves restoring and maintaining function (Gross et al. 2007, 236-8). Some researchers disclose the presence of conflicting goals over continence programs between administrators, residents, and nursing home staff. Many authors address the conflict between the needs for additional staff to maintain behavioral programs and the financial resources currently available in nursing homes. Schnelle et al note that the only incentive is to care for patients with incontinence. A look at current federal and state reimbursement systems using the MDS 2.0 (Minimum Data Set) and the PRI (Patient Review Instrument in New York state) reveals that the reimbursement score for continent residents, even those on toileting and retraining programs, is lower than that for incontinent residents. Therefore, a disincentive exists for continence programs, as improved continence rates in a facility would negatively impact on the financial bottom line.

Three approaches supporting the enhancement of incontinence care are reflected in the literature. These include assigning leadership of the program to a competent, capable individual; targeting strategies to maximize clinical outcomes and limit costs; and perhaps most importantly, educating all levels of nursing home staff regarding incontinence.

Identifying "program champions" willing to take ownership of the ...