Attitudes and Knowledge About Urinary Incontinence
Attitudes and Knowledge About Urinary Incontinence
Urinary incontinence (UI) poses challenges for nursing home personnel. The authors of this study explored differences in attitude and knowledge about UI among registered nurses, licensed practical nurses, and certified nursing assistants working in skilled nursing homes before and after study interventions.
The prevalence of urinary incontinence (UI) in the general population of adult women ranges from 25% to 45% (Abrams, Cardozo, Khoury, & Wein, 2009). The prevalence rate of UI has been estimated to be between 45% and 70% for residents in long-term care settings (DuBeau, Simon, & Morris, 2006; Lekan-Rutledge, 2004; McCliment, 2002; Newman, Gaines, & Snare, 2005; Palmer, 2008; Sparks, Boyer, Gambrel, & Lovett, 2004; Yu, Kaltreider, Hu, Igou, & Craighead, 1989). UI has been identified as a pivotal reason for admission to a skilled nursing facility (Abrams et al., 2009; Newman et al., 2005). Addition ally, in terms of mortality, disability, and skilled nursing facility admission, UI has a more severe impact on frail older adults when compared to healthy elders (Abrams et al., 2009).
The findings reported in this article are from a larger study that examined the benefits of using bladder ultrasound scanners in skilled nursing facilities. Skilled nursing facilities are defined as nursing facilities certified to admit Medicare residents (OBRA- 87) and provide room, board, nursing care, and therapies. With the exception of sub-acute settings, skilled nursing facilities provide the highest level of medical care for individuals outside of a hospital. A physician functions as a medical director providing coordination of medical care for residents. Clinical care is supervised 24 hours a day by registered nurses (RNs) or licensed practical nurses (LPNs). Skilled nursing facility payor sources include Medicare, Medicaid, long-term care insurance, and private pay with specific limitations for each source. Education levels of skilled nursing facility nursing staff members vary and can potentially impact the staff attitude and knowledge level related to UI.
A review of the evidencebased practice (EBP) literature has determined that any assessment of UI should include the availability of a bladder ultrasound scanner to determine postvoid residual (PVR) urine amounts (Centers for Medicare and Medicaid Services [CMS], 2006; Lekan-Rutledge, 2004, 2006; McCliment, 2002; Newman et al., 2005; Sparks et al., 2004). In the three years prior to the study in the state where the study took place, seven out of a potential of 506 skilled nursing facilities (1.3%) purchased a bladder ultrasound scanner from a leading patent-holding U.S. manufacturer of bladder ultrasound scanners (Coombes & Millard, 1994; Tubaro, Mariani, De Nunzio, & Miano, 2010). These data are consistent with the findings that bladder ultrasound scanners are rarely found within skilled nursing facilities (Tracey, 2001; Wooldridge, 2000), possibly the result of slow integration of technology in longterm care when compared to acute and primary health care settings (Singh, 2010). Potential barriers preventing widespread adoption of bladder ultrasound scanners in skilled nursing facilities include cost (Altschuler & Diaz, 2006) and lack of clear policies and procedures regarding indications for the use of bladder ultrasound scanners as well as staff knowledge levels pertaining to UI (Ribby, 2006). Despite these obstacles, the adoption of bladder ultrasound scanners in skilled nursing facilities has the potential to improve UI assessment as well as change knowledge and attitude related to UI among skilled nursing facility staff.
The two research questions that guided this study were: a) What are the differences in UI attitude and knowledge between RNs, LPNs, and certified nursing assistants (CNAs); and b) are there changes in attitude and knowledge about UI among nursing care staff after educational inservices and the placement and utilization of a bladder ultrasound scanner in a skilled nursing facility?
Abstract and Introduction
Abstract
Urinary incontinence (UI) poses challenges for nursing home personnel. The authors of this study explored differences in attitude and knowledge about UI among registered nurses, licensed practical nurses, and certified nursing assistants working in skilled nursing homes before and after study interventions.
Introduction
The prevalence of urinary incontinence (UI) in the general population of adult women ranges from 25% to 45% (Abrams, Cardozo, Khoury, & Wein, 2009). The prevalence rate of UI has been estimated to be between 45% and 70% for residents in long-term care settings (DuBeau, Simon, & Morris, 2006; Lekan-Rutledge, 2004; McCliment, 2002; Newman, Gaines, & Snare, 2005; Palmer, 2008; Sparks, Boyer, Gambrel, & Lovett, 2004; Yu, Kaltreider, Hu, Igou, & Craighead, 1989). UI has been identified as a pivotal reason for admission to a skilled nursing facility (Abrams et al., 2009; Newman et al., 2005). Addition ally, in terms of mortality, disability, and skilled nursing facility admission, UI has a more severe impact on frail older adults when compared to healthy elders (Abrams et al., 2009).
The findings reported in this article are from a larger study that examined the benefits of using bladder ultrasound scanners in skilled nursing facilities. Skilled nursing facilities are defined as nursing facilities certified to admit Medicare residents (OBRA- 87) and provide room, board, nursing care, and therapies. With the exception of sub-acute settings, skilled nursing facilities provide the highest level of medical care for individuals outside of a hospital. A physician functions as a medical director providing coordination of medical care for residents. Clinical care is supervised 24 hours a day by registered nurses (RNs) or licensed practical nurses (LPNs). Skilled nursing facility payor sources include Medicare, Medicaid, long-term care insurance, and private pay with specific limitations for each source. Education levels of skilled nursing facility nursing staff members vary and can potentially impact the staff attitude and knowledge level related to UI.
A review of the evidencebased practice (EBP) literature has determined that any assessment of UI should include the availability of a bladder ultrasound scanner to determine postvoid residual (PVR) urine amounts (Centers for Medicare and Medicaid Services [CMS], 2006; Lekan-Rutledge, 2004, 2006; McCliment, 2002; Newman et al., 2005; Sparks et al., 2004). In the three years prior to the study in the state where the study took place, seven out of a potential of 506 skilled nursing facilities (1.3%) purchased a bladder ultrasound scanner from a leading patent-holding U.S. manufacturer of bladder ultrasound scanners (Coombes & Millard, 1994; Tubaro, Mariani, De Nunzio, & Miano, 2010). These data are consistent with the findings that bladder ultrasound scanners are rarely found within skilled nursing facilities (Tracey, 2001; Wooldridge, 2000), possibly the result of slow integration of technology in longterm care when compared to acute and primary health care settings (Singh, 2010). Potential barriers preventing widespread adoption of bladder ultrasound scanners in skilled nursing facilities include cost (Altschuler & Diaz, 2006) and lack of clear policies and procedures regarding indications for the use of bladder ultrasound scanners as well as staff knowledge levels pertaining to UI (Ribby, 2006). Despite these obstacles, the adoption of bladder ultrasound scanners in skilled nursing facilities has the potential to improve UI assessment as well as change knowledge and attitude related to UI among skilled nursing facility staff.
The two research questions that guided this study were: a) What are the differences in UI attitude and knowledge between RNs, LPNs, and certified nursing assistants (CNAs); and b) are there changes in attitude and knowledge about UI among nursing care staff after educational inservices and the placement and utilization of a bladder ultrasound scanner in a skilled nursing facility?
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