Using a conceptual model for practice in a nursing wellness centre for seniors.

The use of a conceptual model to guide practice is critical to the maturation of the profession. Distinguishing between nursing and other health care professions rests, in part, on nursing's ability to articulate what it offers to clients. The nursing paradigm, comprising the essential components of the individual (client), health, environment, and nursing, provides general rules of thumb for the profession (Fawcett, 1984). Selecting a nursing model for a practice setting contributes to theory development: clinical questions generated from the model can be formulated as testable hypotheses. The Wellness Centre offers a unique opportunity for use of a conceptual model in a nurse-managed practice setting serving seniors. If conceptual models are to be useful, they need to be tested in the settings where nurses practise and for the roles that comprise nursing. Use of the crisis model, in this setting provides reality testing of the model which has evolved to a higher level of internal consistency and external validity as a direct result of practice.

Simple urodynamic evaluation of incontinent elderly female nursing home patients. A descriptive analysis.

We present a descriptive analysis of the functional, mental, and urodynamic status of a population of incontinent elderly female nursing home patients. One hundred fifty-five intermediate care female patients with a mean age of 85.5 years were identified as being incontinent of urine at least once daily. After urologic evaluation, each patient was classified into one of four categories: incontinence with normal cystometrogram 68 (44%), detrusor instability (DI) 52 (34%), stress incontinence (SI) 27 (17%), or overflow incontinence (OI) 7 (4%). Thirteen weeks later, patients were again studied using simple water cystometry. At follow-up evaluation, 45 patients (33%) had urodynamic findings which differed from the initial evaluation. Of these women, 10 with DI, 12 with SI, and 2 with OI were found to have normal cystometric parameters at the time of follow-up study, while 19 (14%) who initially had normal cystometric findings had evidence of DI (11) or SI (3). Strong correlation between urinary incontinence in patients with normal cystometric findings and moderate to severe cognitive impairment was present. Simple urodynamic evaluation did identify patients with SI and OI who might benefit from specific therapy. Urodynamic evaluation of incontinent elderly female nursing home patients is indicated and may provide direction for planning treatment strategies.

Cost effectiveness of training incontinent elderly in nursing homes: a randomized clinical trial.

This study used a randomized clinical trial with 133 incontinent elderly in seven nursing homes to evaluate the effectiveness of a behavioral training therapy and its cost implications. The training program lasted three months, and a 22-week follow-up period examined the durability of the treatment effect. The therapy became effective after six weeks of training. By the final months of training, the treatment participants' wet episodes had been reduced by 0.6 episode per day, or a 26 percent reduction over baseline, and improvement was maintained during the follow-up period. Trainees with a high frequency of incontinence during baseline, relatively more cognitive residents, and residents with a normal bladder capacity responded better to this behavioral program. The cost of training was the equivalent of about one hour of nursing aide time per patient day. The reduction in incontinence during the follow-up period resulted in some small savings in laundry costs and supplies used, and some quantitatively unmeasurable but detectable improvement in psychosocial well-being among the trainees. Since the central figure in implementing this training protocol is the nursing aide, it is important to find an organizational management scheme that will stimulate nursing aides to reduce incontinence among nursing home residents.

Profile of urinary incontinent elderly in long-term care institutions.

This article presents a profile of incontinent elderly in long-term care institutions. One hundred thirty-three frail elderly women were recruited from seven nursing homes in central Pennsylvania for a three-year clinical trial to test the effectiveness of a behavioral therapy on urinary incontinence. All of the patients had more than one medical diagnosis. Eighty percent had cardiorespiratory conditions; the most prevalent diagnoses were cardiovascular diseases. Eighty percent had one or more neurological diseases, including "organic brain syndrome" (47%) and senile dementia (30%); 44% had arthritis/rheumatism. Half of the patients showed severe cognitive impairment; only 12% showed no cognitive impairment. Sixty-three percent were totally dependent; 68% used wheelchairs, 61% were chairbound; 50% had impairments in vision, one-third in hearing, and 14% in speech. Normal bladder capacity, absence of detrusor instability, and satisfactory bladder emptying, as evidenced by low residual urines, was found in 41% of the patients, suggesting that incontinence in this elderly group may not be a primary bladder problem, but rather that mental and physical disabilities may be a more important underlying cause of incontinence in these patients. An important finding in this study is that 34% of the patients had detrusor instability. It is theoretically possible that pharmacologic therapy with anticholinergic agents or imipramine could improve incontinence in this group. Five percent were found to have large residual urine volumes in association with high-capacity bladders suggesting overflow incontinence as the cause of their daily leakage. Pelvic relaxation and stress leakage was far less common in this elderly group of nursing home patients than in young and middle-aged women.

A clinical trial of a behavioral therapy to reduce urinary incontinence in nursing homes. Outcome and implications.

One hundred thirty-three incontinent women in seven nursing homes were assigned randomly to a 13-week behavior therapy program for urinary incontinence or to a control group that received usual incontinence-related care. The therapy became effective after 6 weeks of training. By the final month of training, the treatment women's wet episodes had been reduced by 0.6 episodes per day, a 26% reduction over baseline. This reduction in the number of wet episodes was statistically significant, both with respect to this group's baseline levels of incontinence and in comparison with the performance of the control women. The number of wet episodes in the control group remained about the same throughout training and the 22-week follow-up period. The treatment women improved partly because they learned to request help, a response prompted and reinforced by the program. Trainees with a high frequency of incontinence during baseline, the more cognitively intact residents, and residents with normal bladder capacity responded better to this behavior therapy program.

The ISQ-P tool: measuring stress associated with incontinence.

1. ISQ-P is a useful tool in measuring psychological stress associated with urinary incontinence. 2. ISQ-P can be used in conjunction with bladder training programs. 3. Patients with urinary incontinence show depressive symptoms, have somatic concerns regarding urinary incontinence, and exhibit a feeling of shame.

Medication discharge planning for the elderly.

The purpose of this study was to investigate the status of medication discharge planning for the elderly in relationship to readmission rates to the hospital. Registered nurses were surveyed regarding their practice of medication discharge planning. The study group consisted of 102 medical records for patients 65 years of age and over with congestive heart failure who had been discharged to their homes on one or more medications. A chi-square test showed a significant relationship existed between medication discharge planning and readmission. Patients who received instructions before discharge were less likely to be readmitted.