What kind of care is provided to patients with incontinence in residential facilities and home care?
II. Diagnostic, treatment and nursing interventions in incontinent persons


Authors: E. Topinková 1,2;  D. Jurásková 3,4;  Z. Kučera 5;  N. Müllerová 6
Authors‘ workplace: Geriatrická klinika 1. LF a VFN, Praha 1;  Subkatedra geriatrie Institutu postgraduálního vzdělávání ve zdravotnictví, Praha 2;  Všeobecná fakultní nemocnice, Praha 3;  Česká asociace sester 4;  IncoForum, Česká společnost podpory zdraví, Praha 5;  Odbor vzdělávání a vědy MZ ČR 6
Published in: Čes Ger Rev 2009; 7(2): 82-89

Overview

Backgro und.
Urinary and fecal incontinence are considered as symptoms worsening significantly pati ent’s qu ality of life and accounting for high costs particularly for nursing care for incontinent in long‑term care faciliti es. We are facing repeated complaints of substandard qu ality of care and nursing practices provided to incontinent persons in these settings. In instituti ons, prevalence of incontinence raise up to 50– 70% of residents and, about a half of home care cli ents suffer from incontinence, too. In the article we present results of the project “Incontinence in the context of nursing care”. Methods. Survey in 34 nursing middle management speci alists was performed in 9 nursing homes, 5 soci al care faciliti es, 10 homes for seni ors and 10 home care agenci es focusing on the current system and qu ality of nursing care. In- depth transversal evalu ati on of di agnostic, therapeutical and nursing interventi ons in 465 incontinent pati ents of the above menti oned providers. Results. In 70% of incontinent pati ents the type has not been di agnosed. In majority of cases severe incontinence was reported (57%) often associ ated with bowel incontinence. The most frequent complicati ons were in decreasing order: dermatitis (20%), urinary tract infecti on (19%) and decubitus ulcer (12%). Urodynamic evalu ati on was performed only in 13% of pati ents, surgical treatment was provided in less than 2% and only 6% received pharmacotherapy. 12,4% of incontinent was catheterized. The most frequently used incontinent aid were bri efs with average 3– 4 daily changes in 60% of incontinent, less frequently in the remaining, followed by incontinence sheets (65%), pads (16%) and di apers (14%). Conclusi ons. Despite significant vari ability in care and nursing practices among individu al providers and types of setting, di agnostic procedures, pharmacotherapy and physi otherapy are insuffici ently offered and used in incontinent residents. Higher prevalence of complicati ons particularly skin lesi ons was reported. Continence training programs are frequently offered, however often without targeting to appropri ate residents and with inappropri ately low frequency of training. These findings reflect poor qu ality of care provided and are caused by both objective (lack of personnel, financi al limits for incontinence aids) and subjective factors (lack of specific standards, insuffici ent knowledge, and low motivati on). It is necessary to introduce health system measures to increase manpower and financi al limits for these faciliti es and, at the same time to modify current guidelines according to the specific needs of this populati on and support targeted educati onal programs for health care workers.

Keywords:
incontinence –  di agnostic, medical and nursing interventi ons –  qu ality of care –  elderly people


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Geriatrics General practitioner for adults
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