Abstract:
Incontinence and PPS: A New Era
Diane K. Newman,
RNC, MSN, FAAN and Mary H. Palmer, PhD, RNC, FAAN. "Incontinence
and PPS: A New Era." Ostomy/Wound Management 45
(1999) 12: 32-50.
Objectives:
* Newman and Palmer review methods of assessing and
treating urinary incontinence in nursing homes. Dietary
and fluid modification, managing nocturia, bowel management,
toileting assistance programs, and bladder training
are discussed. The authors advocate that nursing home
staffs implement new toileting assistance and bladder
retraining programs modeled upon those that researchers
have shown to be effective in dealing with urinary incontinence.
They argue that "under the Prospective Payment
System [PPS], nursing homes need to change business
as usual and remain abreast of new innovations and research
in different behavioral interventions and continence
technology."
* Newman and Palmer's article is followed by a short
description of an alternative toileting assistance program
incorporating the use of the BladderScan®
to measure bladder volume, written by Leslie Saltzstein
Wooldridge, RN, MSN, APNP.
Conclusions:
* "Urinary incontinence (UI), the involuntary loss
of urine, . . . affects approximately 50% of residents
[in nursing homes], but prevalence varies among individual
nursing home facilities. . . . The prevalence of UI
is considered an indicator of the quality of nursing
home care."
* "Urinary incontinence is costly to nursing homes.
In 1995, UI cost $8.6 in the Medicare part A program.
These costs are directly related to the need for increased
nursing care from secondary problems such as urinary
tract infections (UTIs), skin breakdown and infection,
falls and subsequent injury, psychological distress
and withdrawal."
* "Although UI is common, especially among the
elderly population, it is not a normal part of aging.
Research has shown that when properly assessed and treated,
UI can be corrected in about 30% of nursing home residents
who have this problem and suitably controlled and managed
in the rest."
* "Incorporating research into practice should
improve the quality of care and patient outcomes. With
the implementation of the Prospective Payment System
(PPS), nursing homes cannot afford not to change the
knowledge level and clinical practices of their staffs."
* "Incontinence training must be the goal of the
entire nursing home, staff, and residents . . . . Continence
is a high quality of life goal for most nursing home
residents."
Leslie Saltzstein
Wooldridge, RN, MSN, APNP. "Toileting Assistance
Based on Bladder Volume." Ostomy/Wound Management
45 (1999) 12: 50.
Summary:
* A group of independent long-term care facilities in
Wisconsin decided to design a new bladder retraining
program, based upon the use of the BladderScanTM, as
other programs had been unsuccessful. The program was
successful, as the case of one 84-year-old female illustrates.
Prior to the beginning of the ultrasound program, the
woman had requested assistance to use the toilet every
fifteen minutes; yet when she was taken to the bathroom,
she was unable to void. She feared being incontinent
and not being unable to make it to the bathroom on time,
and in addition to her frequent requests to be taken
to the bathroom, she also stopped drinking liquids.
"The nurses used the [bladder] scanner to show
the resident her increasing bladder volumes and when
those volumes necessitated voiding. Within a couple
of weeks the resident was more comfortable and the staff
did not have to answer the resident's call bell every
15 minutes. The resident's fear of incontinence decreased,
staff use of incontinence products were eliminated,
and her voiding pattern improved to every 3 to 4 hours."
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