Urinary Incontinence
Download
Report
Transcript Urinary Incontinence
Dealing with Urinary
Incontinence Using Prompted
Voiding – An Overview
Heather Woodbeck,
Best Practice Coordinator - Long Term Care NW. ONT.
December 2007
Objectives
Understand functional incontinence.
Understand factors that contribute to
functional incontinence
Understand prompted voiding as an
intervention for incontinence
What is Incontinence?
Defined by the International
Continence Society as:
“a condition where involuntary
loss of urine is a social or
hygienic problem”
(ICS, 1987)
Why is Incontinence Important?
One of the most common reasons for
admission to LTC.
Negatively affects a person’s dignity.
Causes embarrassment, depression and
social isolation.
Complications cause falls, urinary tract
infections, skin and wound problems.
Myths and Truths
Incontinence is a normal aging process.
Little can be done for incontinent residents.
Toileting residents every 2 hours prevents
incontinence.
Restricting fluids reduces incontinence.
Prompted voiding is an effective method to
use with incontinent patients.
Functional Incontinence
• patient either has
decreased mental
ability (e.g. Alzheimer’s
disease)
• or decreased physical
ability (e.g. arthritis) and
is unable to make it to
the bathroom in time
Incontinence Management
Assess problem.
Develop a care plan.
Address contributing factors.
Implement individualized toileting plan.
Evaluate effectiveness.
Revise as needed.
Assessment: Voiding Record
Time and amount of :
- Fluid intake
- Urine voided
- Incontinence
- Done for 3 or more
days
Assessment: Functional Ability
Access to bathroom
Ambulation (needs
assistance)
Wheelchair
Transfer aids
Adaptive
clothing/environment
Assessment - Cognitive
Capacity
Requirements for Continence
• aware of urge to void
• able to get to the bathroom
• able to suppress the urge until
resident reaches the bathroom
• able to void when resident gets
there
Approaches to Incontinence
Prompted voiding
Habit retraining
Fluid management
Pelvic floor muscle rehabilitation
Lifestyle modifications, and
Urge inhibition techniques
(The Canadian Continence Foundation, 1998).
Prompted Voiding
Changes caregiver’s
response to urine loss
rather than resident’s
response.
Caregiver prevents
undesired urine loss from
occurring before the
resident would be
incontinent.
Prompted Voiding – Target Group
Useful with residents who have physical
or mental impairments or little ability to
determine how best to meet their needs.
Individual voiding patterns rather than
routine toileting (e.g. q2H) can promote
the highest level of success.
Prompted Voiding Intervention
Three main interventions:
Monitoring - Ask the resident at regular
intervals if he/she needs to use the toilet.
Prompting - Remind the resident to use the
toilet and try not to void between prompted
voiding sessions.
Praising - Give positive feedback to resident to
reinforce dryness and appropriate toileting
Before Prompted Voiding
1. Determine the resident’s pattern of incontinence
using a 3-day voiding record.
2. Address constipation and fecal impaction.
2.
Encourage fluid intake of 1500 ml/day.
3.
Minimize caffeinated and alcoholic beverages.
4. Initiate an individualized prompted voiding schedule
based on the resident’s toileting needs, and as indicated
by the 3-day voiding record.
5.
Carefully record and monitor resident’s response.
Trial Run
Collect baseline information about your resident
for at least 3 days.
Review data. Assess responsiveness of your
resident to prompted voiding.
Start slowly, with only one or two residents at
one time.
Try out the intervention for one week with your
resident, carefully track results, then reassess
effectiveness.
Discontinue, if client is not responding.
Monitoring Effectiveness Measures
Decreased # of incontinent episodes per
day and increased the # of continent voids.
Resident will be continent during waking
hours
Bladder irrigation will be discontinued
Full continence will be achieved
Resident will have an individualized toileting
plan
Conclusion
Prompted voiding can work in long term
care BUT you need to start slowly with
residents whom you think will be
successful at achieving continence.
Build on your successes, however large or
small.
References
Anna and Harry Borun Center for Gerontological Research. 2004.
Incontinence Management Training Module. http://borun.medsch.ucla.edu
Lyons, SS & Pringle Specht, JK. 2000. Prompted Voiding Protocol for
Individuals with Urinary Incontinence. Journal of Gerontological Nursing.
26(6). June. pp. 5-13.
Ouslander, JG. et al. 1995. Predictors of Successful Prompted Voiding
among Incontinent Nursing Home Residents. Journal of the American
Medical Association. 273(17), May 3, pp. 1366-1370.
Raiwat, C. & Phillips, D. 2001. A regional approach to continence
management. Canadian Nurse. 97(4): 16-20.
Registered Nurses Association of Ontario (RNAO). 2007.
Continence/Constipation Workshop for RNs in Long Term Care.
http://www.rnao.org/Page.asp?PageID=924&ContentID=813.
Registered Nurses Association of Ontario (RNAO). 2005. Promoting
Continence Using Prompted Voiding. RNAO. Toronto.
http://www.rnao.org/Page.asp?PageID=924&ContentID=813.
Acknowledgements
Part of this presentation were adapted from the IC 3:
Improving Continence Care Collaborative and IC 5 Projects