Promoting the Urinary Continence of Hospitalized Elderly: Limits and Possibilities of Nursing in Brazil

Góes R1, Pedreira L1, Amaral J1, Souza M1, Lorum G1, David R1

Research Type

Basic Science / Translational

Abstract Category

Geriatrics / Gerontology

Abstract 439
Scientific Podium Short Oral Session 20
Thursday 5th September 2019
15:22 - 15:30
Hall G3
Gerontology Incontinence Nursing
1.School of Nursing, Federal University of Bahia

Roberta Pereira Góes



Hypothesis / aims of study
To research how nursing care related to the promotion of urinary continence of hospitalized elderly people occurs, and what are the limits and possibilities for this care to occur.
Study design, materials and methods
A qualitative, descriptive and exploratory study carried out in the medical clinic unit of a university hospital in the northeast of Brazil, with a predominant care profile of elderly people. We used the triangulation of the following data collection techniques: integrative literature review, non-participant observation of the care, (using field diary and script previously elaborated), and focus group workshops with the nursing team. For the review, we searched the Pubmed, Cinahl and Wiley Online Library databases using the descriptors "urinary incontinence", "aged", and "hospitalization" alternated by the boolean operator "AND". The selection of the material complied with the inclusion criteria: original studies in the form of articles published between 2008 and 2018 in any language. It were excluded repeated studies, research protocols still in progress and also those that did not answer the research question: what factors in hospital care predispose the emergence of urinary incontinence in the elderly? In addition to the answer to the research question, we searched for: the title, index base, year of publication and period, authors, language, study design, participants, study site, objectives, and main results. The analysis of the material collected in the review (13 studies) served to support the construction of the script used in the observation and to guide the discussion of the focus group. The observation of care demanded an initial approximation of the researcher with the field by means of the previous presentation of the proposal to the entire nursing team explaining its objectives, justification, and relevance. Subsequently, systematic observation was initiated which totaled 66 hours alternating between the morning, afternoon, and evening shifts for 18 days. The data of this collection were submitted for the summary reading where the relevant information was sought, focusing on the objective and research question. Thus, the observation script was important for a better understanding of the notes contained in the field diary. Finally, the focus group workshops began, which totaled four meetings, with the participation of ten professionals from the nursing team. The meetings previously scheduled with the participants took place in a hospital training room, ensuring a place free of noise and interruptions. The participants were identified by color to preserve their anonymity and the discussions were recorded with their prior authorization. The researcher moderated the discussions, explaining problem situations related to the theme, inciting reports, opinions and narratives of the group, regarding the maintenance of continence and the occurrence of urinary incontinence in hospitalized elderly. For the organization and operationalization of these meetings, given the scientific and methodological rigor required by the focus group technique, the researcher had the assistance of three more members, scholarship students of scientific initiation, who collaborated in the organization of the meetings and the demands during this one. The recordings were transcribed in full and analyzed after skimming reading through the content in the obtained corpus, to meet the research objective, triangulating and relating to the findings of each collection. Thematic categories were discussed based on the literature.
After reading, analyzing, and triangulating the data obtained from the integrative review, non-participant observation and focal group activities, four thematic categories were constructed: 1. Influence of the hospital structure to offer care related to the promotion of urinary incontinence in elderly people; 2. Deficit in the screening, knowledge and recognition of the nursing team regarding urinary incontinence in the elderly; 3. Culture of Brazilian nurses to use urinary control devices in the hospital environment such as geriatric diapers; 4. Nursing actions related to this care and how to extend them. Regarding the first category, the findings revealed aspects related to the availability and disposition of human resources, material resources and physical structure as influencers to offer this care. Among the reported situations are: insufficient human resources to meet the demand of the hospitalized elderly person for the use of the bathroom or placement of manual continence aids in the bed (such as urinals); lack of material resources such as wheelchairs, urinals among other manual continence help materials, of support bars in the unit to facilitate the displacement of the person to the toilet; adverse hospital physical structure for promotion urinary continence of such persons as inadequate lighting; and distance from the toilets in relation to the bed. Regarding the second category, the data showed that the majority of the nursing team considers urinary incontinence as a consequence of aging and can not be treated or prevented and that, in addition, measures in hospital settings focus more on reversal of the main cause of hospitalization, so secondary conditions such as urinary incontinence are not perceived. The third category revealed the indiscriminate use of urinary control devices such as geriatric diapers and permanent bladder catheter in hospitalized elderly people, sometimes without indication. The fourth category showed that there are few actions to promote continence and rehabilitation of urinary incontinence in hospitalized elderly people. Among the few actions carried out were those related to the prevention of falls and delirium, with environmental adaptations, education of family members and stimulation of functional independence and mobility, which indirectly help promote continence.
Interpretation of results
The results allowed us to identify aspects of the hospital structure that influence the care under investigation and should be reconsidered to meet the demand of elderly people at risk or with urinary incontinence. It is known that the adequacy of such aspects requires costs that are above the governance of the care team, and studies like this are necessary to alert managers and authorities to investment priorities. Regarding the lack of screening, knowledge, and recognition of the problem by the nursing team, it is necessary to raise awareness and permanent education that addresses this issue with the nursing team in the hospital settings. Related to the culture of the use of urinary control devices such as geriatric diapers and bladder catheters, we observe the need for instruments that standardize and establish criteria for its use in care practice, avoiding its consequences. Considering the last category, it is emphasized that mitigation of risk is already established in the hospital environment, such as the risk of falls, are incorporated into clinical practice, but the elderly person needs other care, mainly for the screening, prevention and rehabilitation of geriatric syndromes, with urinary incontinence being one of them and hospitalization is a unique opportunity for this approach.
Concluding message
It is clear that nursing care related to urinary incontinence of hospitalized elderly still occurs in a punctual, non-systematized manner, and it is necessary to raise the awareness of the roles involved and the instruments that standardize and guide this practice. Found as limitations for this care factors such as hospital structure; the culture of the indiscriminate use of urinary control devices and the deficit in the screening, knowledge, and recognition of the problem by the nursing team. And an opportunity to increase this care is to emphasize the importance of educational interventions, dissemination of studies based on evidences related to the theme, and the strengthening of the multiprofessional work.
Funding Federal University of Bahia, Brazil Clinical Trial No Subjects Human Ethics Committee Ethics Committee of the Nursing School of the Federal University of Bahia Helsinki Yes Informed Consent Yes