Effective management of urinary incontinence (UI) among older adults, particularly in nursing home residents, depends on the knowledge and practices of nursing staff, who are responsible for their fundamental care. However, nursing staff knowledge and practice gaps remain challenging (1). Therefore, the study aimed to assess the knowledge and practice of nursing staff regarding UI, to explore whether there are differences in knowledge and practice concerning their sociodemographic characteristics, and to determine the correlation between knowledge and practice regarding UI.

A multicentre descriptive, comparative, and correlational cross-sectional study design using a self-assessment survey was utilized to collect data from nursing staff employed in three regional nursing homes. The study followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
The convenience sample comprised N = 171 employees (n = 86 nurses, n = 85 nursing assistants). A general questionnaire for obtaining sociodemographic data and the Urinary Knowledge and Practice Instrument (UKPI) were used as study instruments. Cronbach’s alpha coefficient of the UKPI was 0.89. A higher score on the questionnaires indicates a higher level of knowledge, more positive attitudes, and better practice related to UI. Data were collected using a paper version of the questionnaires during the day shift. All nurses and nursing assistants who met the inclusion criteria (a minimum of six months of working experience) were invited to participate in the study.

The mean score on the UKPI knowledge scale was M = 11.2 out of a maximum of 18. A significant difference (p = 0.00) in the nurses’ (M = 12.2) and nursing assistants’ knowledge levels (M = 10.2) was revealed, where Cohen’s d value of 0.6 indicates a medium effect size. The mean score on the UKPI practice scale for the whole sample was M = 53.2 out of a maximum of 90, which indicates that nursing home employees often implement continence care interventions (Table 1). A statistically significant but weak positive correlation was found between knowledge assessed by the UKPI knowledge scale and the UKPI practice scale.

Nursing staff in evaluated nursing homes showed suboptimal knowledge about UI among older people. Namely, more than 30% of nursing staff did not know that diabetes and some antihypertensive or sleep medications can cause UI and were unaware that certain medications could treat urinary incontinence. The reason for this may be nursing school curricula. Although nurses in Serbia can have a university education, there is still no specialist education such as Nurse Continence Specialist (NCS) or advanced nurse practice program for urotherapists (2).
The gap in nursing staff practice was also evident in all areas, but it was the most prevalent in areas such as the documentation and support in providing continence care interventions.

This study highlights the need for improved education and training on urinary incontinence in nursing homes. Both nurses and nurse assistants must be equipped with the knowledge and skills to provide high-quality continence care. Future research should focus on evaluating the effectiveness of educational interventions and exploring the systemic factors that hinder the implementation of best practices in UI management.

1.	Liao, L.; Feng, H.; Jiao, J.; Zhao, Y.; Ning, H. Nursing assistants' knowledge, attitudes and training needs regarding urinary incontinence in nursing homes: a mixed-methods study. BMC Geriatr. 2023, 23(1), 39. doi:10.1186/s12877-023-03762-z.
2.	Paterson, J.; Ostaszkiewicz, J.; Suyasa, I.G.; Skelly, J.; Bellefeuille, L. Development and Validation of the Role Profile of the Nurse Continence Specialist: A Project of the International Continence Society. J Wound Ostomy Continence Nurs. 2016, 43(6), 641-647. doi:10.1097/WON.0000000000000286