Burnout in psychiatric nursing.

INTRODUCTION: Burnout in nursing is of both individual and organizational concern with ramifications for well-being, job performance, absenteeism and turnover. Burnout is rarely assessed as part of a comprehensive model of occupational stress, a short-coming which this paper attempts to redress. METHOD: A randomly selected sample of 510 psychiatric nurses from one Scottish Trust completed a questionnaire based on a psychological model of occupational stress which included the Maslach Burnout Inventory (MBI) as the dependent variable. FINDINGS: The respondents reported average, low and average levels of emotional exhaustion, depersonalization and personal accomplishment, respectively. The study sample had significantly lower scores on emotional exhaustion and depersonalization than normative data but also significantly lower levels of personal accomplishment than a normative group of physicians and nurses. Only 2.0% of the study sample could be categorized as having high burnout overall (i.e. high emotional exhaustion, high depersonalization, low personal accomplishment) and they differed significantly from the rest only in terms of males being over-represented. Hierarchical regression analysis revealed that selected explanatory variables accounted for 41.9% of emotional exhaustion, 16.4% of depersonalization and 25.6% of personal accomplishment in the study sample. IMPLICATIONS: The paper discusses the implications of the findings in terms of a comprehensive approach to intervention aimed at minimizing the risk of burnout in psychiatric nurses. Such an approach will involve interventions at the organizational and individual level.

Addressing urinary incontinence with educational continence-care competencies.

This article is a report of a task force formed from a discussion group hosted by the American Nurses Association on the AHCPR Guidelines on Urinary Incontinence. The need to standardize content related to bladder incontinence to be used in curriculums was identified as an initial step in implementing the guidelines. A task force was formed to develop educational competencies to be used by schools in identifying content that should be addressed at various levels of preparation. Although special training is needed when continence care is a significant part of a nurse's practice, it is expected that by using the educational competencies, schools will produce graduates at the basic level able to provide beginning continence care and graduate nurses able to address advanced incontinence problems.

Urinary outcomes in older adults: research and clinical perspectives.

There is a need for continued collaboration between clinicians and researchers to further improve urinary continence outcomes. This article presents the perspectives of four nurses who conduct continence research or who have independent continence services practices. Each discusses continence outcomes used in long-term care facilities or the community as a researcher or clinician and suggests implications for future nursing development.

Psychological factors associated with urinary incontinence.

This nursing study about women with urinary incontinence was designed to explore (1) the incidence of depression in women with urinary incontinence, (2) the correlation between mastery and depression and/or self-esteem and depression in women with urinary incontinence, and (3) depression as a mediating factor in the quality of life (QOL) in these women. This study found a higher incidence of depression in women with urinary incontinence compared with the general population. Correlational and multiple regression analyses both revealed strong and significant relationships between the independent variables of mastery and self-esteem and the dependent variable of depression. Depression did not emerge as a mediator in QOL. When mastery, depression, and self-esteem were considered together, mastery was the only predictor with a direct effect on QOL in women with urinary incontinence. Nursing interventions aimed at increasing women's sense of mastery may be effective in decreasing depression and improving the QOL.

A digital test for pelvic muscle strength in women with urinary incontinence.

This article reports further experience with a Version 2 digital test performed on 208 community-residing women, 25 to 87 years old. Test-retest (n = 208) and interrater reliability (n = 36) scores for pressure, displacement, and duration were r = .54, .51, and .53 and r = .67, .73, and .55, respectively. Interrater reliability percentage agreement figures were exact for 94% of the women on pressure and 67% on displacement. With duration permitted to vary by 1 second, agreement was 75%. Validity was tested using vaginal electromyography scores with correlation coefficients ranging from .37 to .63. A weak but significant correlation was found between the digital score and the stand-up test pad gain (r = -.12). No significant relationship was found between the digital test and a history of being able to stop the urine stream or other leakage measures. To address limitations in Version 2, a third version of the digital scale is proposed.

Correlations between dynamic urethral profilometry and perivaginal pelvic muscle activity.

Of 208 ambulatory female subjects evaluated for complaints of urinary incontinence, complete history, physical findings, and urodynamic data were available on 163 patients allowing correlation of measures of perivaginal muscle activity to urethral profilometry measurement of sphincter strength. Perivaginal measures include pelvic digital exam score as well as vaginal electromyography with a modified perinometer. Urethral profilometry was performed at rest and during pelvic muscle contractions in both supine and standing positions. There was a moderate and significant correlation (r = 0.19 to 0.32) between profilometry measures of voluntary sphincter contractions and perivaginal EMG parameters of endurance peak and area, as well as to the digital test parameters of pressure and displacement. The correlation values between the vaginal EMG and the Digital Test scale of perivaginal strength were higher (r = 0.28 to 0.74). When the patients with pure stress incontinence were stratified by degrees of incontinence (mild, moderate, severe), urethral prolfilometry measures were a more accurate indicator of severity of incontinence than measures of perivaginal strength or the degree of bladder neck mobility as measured by the Q-tip test.

Pelvic muscle exercise for stress urinary incontinence in elderly women.

PURPOSE: To compare pelvic muscle exercise to pharmacologic treatment of stress urinary incontinence, the most common cause of urine leakage reported by community-living elderly women. SUBJECTS: Convenience sample of 157 community-living women, aged 55 to 90 years, after completion of a comprehensive diagnostic evaluation. METHODS: Eighty-two subjects were randomly assigned to the exercise protocol (with a 34% attrition rate). Pelvic muscle exercises were taught and monitored for 6 months. Phenylpropanolamine hydrochloride was given to the other group in a dose of 50 mg a day, increasing to 50 mg twice a day. MAIN RESULTS: Treatment outcomes (subjective improvement, self recorded frequency of wetting) were equally satisfactory in both groups. The response to exercises was as good in 5 months as in 6. It was also as good when the minimum recommended number of exercises per day was 80 as when it was 125. CONCLUSIONS: Among those completing the protocol, pelvic exercises were beneficial in reducing stress incontinence, and the benefit was comparable to that produced by phenylpropanolamine.

Urinary incontinence in nursing home residents with dementia: the mobility-cognition paradigm.

The purpose of the study was to evaluate patient factors associated with urinary incontinence in nursing homes to identify the relative importance of these factors in predicting urinary incontinence. Cognitive ability and patient mobility were measured for 61 patients residing in a nursing home. Twenty-nine of the patients were incontinent and 32 continent. Cognitive ability and mobility were found to differ significantly between continent and incontinent patients. When the variables were examined together, mobility emerged as the best predictor of the patient's urine control, followed by cognitive impairment. The findings highlight the importance of addressing patient mobility issues when dealing with urinary incontinence in nursing homes.

A digital test for pelvic muscle strength in older women with urinary incontinence.

A digital test of pelvic muscle strength for evaluation of a pelvic muscle exercise (PME) program was developed with a sample of 338 incontinent women living at home. Factors of perceived pressure, alteration of the vertical plane, and time were combined to form a 7-point scale ranging from 0 to 4. Test-retest for the anteroposterior score was r = .65, p less than .01 with interrater reliability, r = .91, p less than .01. Relationship to other variables and further development of the measure are discussed.

Digital measurement of pelvic muscle strength in childbearing women.

Fourteen primigravidas were evaluated at 32 and 36 weeks antepartum (AP) and 6 weeks postpartum (PP) to test the reliability and validity of a digital measure of pelvic muscle strength using urine control as the criterion. Interrater reliabilities ranged from .67 to .77. Convergent validity was shown by negative correlations between clinical muscle scores and time required to interrupt urine flow at 32 weeks AP (r = -.41), 36 weeks AP (r = -.64) and 6 weeks PP (r = -.71). Validity was also demonstrated in a pattern of lower scores in women who had urine loss during coughing or reported incontinence as compared with those who did not. Women who had cesarean births had higher postpartum pelvic muscle scores with progressively lower scores demonstrated by those who gave birth vaginally without laceration, with episiotomy, and with laceration, F(3, 10) = 5.40, p = .02.

Relationship between drug use and urinary incontinence in elderly women.

Two hundred older women with urinary incontinence were studied to observe the influence of their prescription and nonprescription drug use on symptoms of incontinence. Ninety percent of women reported using medication, with an average use of four drugs. Medications statistically associated with urinary incontinence symptomatology were prostaglandin inhibitors, diuretics, and estrogen therapy. Further studies are needed to clarify the relationship between medication usage and the presence and severity of urinary incontinence.