Predicting success using individualized scheduled toileting for memory-impaired elders at home.

The purpose of this research was to evaluate the effectiveness of an individualized scheduled toileting (IST) program on incontinent, memory-impaired elders being cared for at home. Using a 2 x 2 mixed design analysis of variance (group by time), 118 patients were randomly assigned to experimental or control groups. Caregivers in the experimental group were taught the IST procedure. Urinary incontinence (UI) was measured at baseline and at 6 months. Weeklong voiding records were kept by caregivers and were used to calculate the percentage of times the incontinence occurred. UI significantly decreased in the experimental group, whereas in the control group it did not. The baseline cognitive ability, mobility, and consistency of implementing IST were entered into a discriminant function equation and significantly predicted patients who would improve with IST. Cognitive ability was the best predictor, with mobility also emerging as a meaningful predictor. Candidates for IST should be selected based on elders' cognitive ability and their ability to cooperate with toileting. Moderately cognitively impaired elders and ones able to cooperate with toileting protocols are prime candidates for IST.

Elderly Mexican women's perceptions of exercise and conflicting role responsibilities.

The purpose of this pilot study was to explore elderly Mexican women's readiness to exercise, and their multiple roles. Fifty older women were sampled from two separate neighborhoods of low socio-economic status. Readiness to exercise was examined using the Stages of Change - Exercise instrument with six categories: precontemplation nonbelievers, precontemplation believers, contemplation, preparation, action, and maintenance. Time devoted to the following functional roles was explored: wife, household, grandmother, personal care, and recreational. Women fell mainly under the first three stages of change both, precontemplation nonbelievers and believers, and the contemplation stage. The stages of change scale and role commitments were not significantly related. Nevertheless, precontemplators devoted less time in all the roles than the women in the other categories of stage of change.

Urine control theory derived from Roy's conceptual framework.

The urine control theory, a middle range theory substructed from Roy's adaptation model, is presented to explicate the phenomenon of urine control. Urine in the bladder is identified as the focal stimulus, and the impact of the cognator subsystem in relation to urine control is described. The role of contextual stimuli related to mobility and the environment is also described. Relationships between concepts are explained and supported with individual case studies. The case findings are used to exemplify the interrelationships in the model. The urine control theory can be used by practitioners to inform practice and by researchers to guide research designs.

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.

The usefulness of the HCFA form 485 in predicting home healthcare costs.

As prospective pay systems are created, many sources of home care information are being considered. This study examines items on the HCFA Form 485 for their ability to accurately predict home healthcare costs. The researchers deduced that the current information available on the HCFA Form 485 was not useful in anticipating, planning for, and, ultimately, controlling costs.

Nursing home residents functional ability and perceptions of choice.

1. Nursing home residents have the right to be involved in decision making relative to their care, which researchers have demonstrated has a positive effect on residents. 2. The authors designed a study to explore discrepancies between residents' perceptions of choice and the amount of choice preferred and their relationship to self-care abilities and functional abilities in nursing home residents. 3. The results indicate that residents desired more choice than they felt they were given, but that this difference was not related to their perceptions of their self-care abilities. As residents' functional abilities increased, actual choice as well as desired choice increased slightly. 4. Nurses should structure the nursing home's approach to residents so that choice is maximized within the constraints of the institution.

The impact of daily exercise on the mobility, balance and urine control of cognitively impaired nursing home residents.

The purpose of this intervention study was to examine the impact of a daily exercise regimen on the mobility, balance, and urine control of a sample of cognitively impaired elderly nursing home residents. A quasi-experimental pretest-posttest design was used with 15 elderly, cognitively impaired, incontinent nursing home residents. Data were collected regarding walking distance, speed of walking, balance ability, ability to rise from a chair unassisted, ability to walk unassisted, and incidence of urinary incontinence before and after a month of daily assisted walking. Subjects were able to walk significantly greater distances before tiring after the exercise regimen. In addition, the incidence of urinary incontinence was significantly decreased.

Self-care agency as a function of patient-environmental factors among nursing home residents.

The relationship between environmental and personal factors on self-appraised self-care agency of nursing home residents was examined. Data were collected from 83 nursing home residents in relation to self-care abilities, environmental constraints, and selected demographic factors. Race and previous occupation were related to self-care agency with residents who were black or previously self-employed evidencing higher scores. In addition, residents who viewed the home as overly restrictive or fostering dependence had lower perceptions of their self-care abilities. The results are discussed in terms of Orem's theory of self-care, social learning theory, and implications for restructuring care within nursing homes.

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.

Nursing assessments in the inpatient geriatric population.

Thorough assessment is essential in caring for the institutionalized elderly who have difficulty with urine control. The assessment should include a physical examination, a functional assessment, and an evaluation of the environment. The physical examination should be completed in a timely fashion after incontinence develops in order to rule out treatable causes of urine loss. The examination includes a health history and physical examination, with special attention being given to the genitourinary system. A urine specimen should be obtained during the examination to rule out bladder infection. The functional assessment of the patient is one of the most important aspects of the patient assessment. This is particularly true for elderly inpatients because much of the incontinence found in nursing homes is attributable to functional deficits. The functional assessment should address the history of the patient's incontinence, the patient's cognitive abilities and potential for participating in continence care, the patient's mobility, and the patient's abilities related to activities of daily living. Deficits in any of these areas may contribute to or cause urinary incontinence. In addition to the physical examination and functional assessment of the patient, the environment should be evaluated. The visibility, location, and structure of the toileting facilities can serve to either promote or impair urine control. In addition to the physical facilities provided, the overall nursing care approach may foster or hinder the patient's ability to maintain urinary continence. Nursing assessment that addresses these three areas will provide information that is needed to develop a nursing care plan that will maximize the patient's potential for urine control.