Hypothesis / aims of study
To systematically describe, critique, and summarise research about the effects of education about urinary incontinence (UI) on nurses’ and nursing assistants’ knowledge, beliefs, and attitudes about the aetiology and management of UI, their continence care practices and patient outcomes.
Study design, materials and methods
A systematic review was undertaken for full-text experimental research articles in English language about the effects of education about UI for nurses or nursing assistants (NAs). The outcomes of interest were: (i) Knowledge and beliefs about the aetiology/management of UI; (ii) Attitudes about UI; (iii) Continence care practices such as adherence to evidence based recommendations; (iv) Patient continence outcomes such as the frequency or severity of UI, or the presence/absence of UI. Data were extracted on the aim of the study, design, sample and setting, study methods, intervention, outcomes of interest and findings. Quality appraisal was conducted using a mixed methods appraisal tool. The findings are presented in table format, summarised, synthesised and reported descriptively.
The search yielded 4249 unique hits: 17 met the inclusion criteria (see Table 1), totalling 1210 participants (820 nurses, 235 NAs and 155 unclear). The most common practice setting was a nursing home (n=9), followed by community/primary care (n=5) and acute/ subacute care (n=3). Most studies were conducted in the USA (n=8) or the UK (n=5). Of ten uncontrolled studies that provided pre-and post-data about nurses’ and/or NA’s knowledge and beliefs about the aetiology/management of UI, all reported improved knowledge/beliefs.
Eight studies provided data about the effects of education on nurses’/NAs’ continence care practices – showing mixed results. Of these, six uncontrolled studies reported post intervention improvements in nurses/NA’s adherence to evidence-based recommendations, including improved ability to screen/assess UI and plan effective continence care following education about UI, however two controlled studies revealed no differences.
Ten studies reported the effect of education on patient outcomes: uncontrolled studies in nursing homes reported modest improvements in residents’ continence status, one reported no change, and data were insufficient in the only controlled study. In the primary care setting, two uncontrolled studies reported post intervention reductions in patients’ rates of UI, however a large cluster RCT reported a lack of statistically significant difference in patients’ continence outcomes regardless of nurses group assignments.
Two studies evaluated the effects of nurses/NAs education about UI on patient outcomes, i.e. both in an acute/sub-acute context. One study used a controlled design and other did not. Both reported no difference in post stroke patients’ continence status.
Interpretation of results
Existing evidence about the effects of education on nurses/NAs’ knowledge, attitudes, practice and patient outcomes related to UI is largely based on uncontrolled trials. These studies show post educational improvements in nurses/NAs’ knowledge, beliefs and attitudes about UI. Findings about the effect on continence care practices are mixed. Available evidence about changes in patient outcomes is limited to two trials, both of which reported a lack of statistically significant differences between groups.