ABSTRACT
The authors describe the development, implementation, and evaluation of a continuing education course for nurses. Goals of the program were to help change attitudes toward care of older persons and to help nurses realign value priorities in practice so the concerns, needs, and wishes of patients directed care. Learners engaged in dialogues about aging and were introduced to an alternative nurse-person process in which the patient was leader. Evaluations were positive for nurses and quality of care.
Subject(s)
Education, Nursing, Continuing/methods , Health Knowledge, Attitudes, Practice , Nursing Staff, Hospital/education , Patient-Centered Care/methods , Staff Development/methods , Attitude of Health Personnel , Humans , Nursing Staff, Hospital/psychology , Program Development , Program EvaluationABSTRACT
OBJECTIVE: The York Incontinence Perceptions Scale (YIPS) was developed to measure the psychosocial aspects of urinary incontinence and its management. DESIGN: Testing of internal consistency and validity of the YIPS. SETTING AND PARTICIPANTS: Subjects were 101 female rural community residents (mean age = 67.4 years) diagnosed with urinary incontinence and participating in a 25-week longitudinal randomized control study testing the efficacy of treating incontinence with a behavioral/educational intervention. MEASUREMENTS: Participants completed the YIPS, a bladder chart monitoring daily incontinence episodes, the Aids to Living Scale, the Incontinence Impact Questionnaire, and single-item ratings of self-perceptions of amount of leakage, continence status, and overall health status. MAIN RESULTS: The YIPS had high internal consistency (a = .78). Positive adjustment on the YIPS was correlated with lower frequency of incontinence (r = -.44), and self-ratings of improvement in amount of leakage (r = .60), improved continence status (r = .38), and overall health status (r = .32). At the end of the 25-week treatment period, the participants in the treatment group reported a more positive adjustment on the YIPS than did participants in the control group (t[99] = 4.78, P < .001), which was concordant with a reduction in the incidence of incontinence in the treatment group (F[1,91] = 6.95, P < .01). CONCLUSIONS: The YIPS is a brief, yet reliable, instrument that addresses such psychosocial issues as coping, control, and acceptance of incontinence.
Subject(s)
Urinary Incontinence, Stress/psychology , Aged , Aged, 80 and over , Counseling , Female , Humans , Longitudinal Studies , Middle Aged , Psychometrics , Quality of Life , Reproducibility of Results , Rural Health , Sociology , Surveys and Questionnaires , Urinary Incontinence, Stress/therapyABSTRACT
1. Although a range of factors can contribute to urinary incontinence in long-term care residents, it is more closely associated with a decline in both cognitive and functional status. 2. Although all subjects had to be cognitively impaired to participate in the study, the incontinent group had a significantly lower mean score on the mental status examination than did the continent group. 3. Incontinent subjects were more dependent in activities of daily living and took significantly longer to carry out functional tasks specifically related to toileting. 4. Urinary incontinence was strongly associated with a history of urinary tract infections, positive urine cultures, epididymitis, hematuria, and fecal incontinence. Medical diagnosis, medications, and affective status were not associated with the problem.
Subject(s)
Cognition Disorders/complications , Urinary Incontinence/epidemiology , Case-Control Studies , Hospitals, University , Humans , Long-Term Care , Male , Nursing Assessment , Risk Factors , Urinary Incontinence/complications , Urinary Incontinence/nursingABSTRACT
Sunnybrook Medical Centre, Toronto, has designed a written, multidisciplinary program of care for elderly patients in acute care. The program includes specific community outreach activities that support the in-hospital program and addresses the challenges presented by an increasingly aged population. Some of its objectives are to develop a measurement for length of stay patterns, a reduction in the number of patients waiting for relocation to a long-term care institution (commonly and derogatorily referred to as "placement problems") and an increase in patient, family and staff satisfaction. A method for program evaluation is being designed. The program takes a three-level approach to care: (1) the non-problematic elderly patient, (2) the more complex elderly patient and (3) the care of patients who have finished treatment for their acute illness but who require long-term care institutionalization.
