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ABSTRACT
A qualitative, emergent, case study design guided the description of care provided to nursing home residents with urinary incontinence in three Midwestern nursing facilities. Participants included 17 residents and 16 family members or friends of the respective residents. Staff and managers involved in the planning and delivery of care to the participating residents also were included. The three facilities represented variation in size, location, ownership, and Medicare certification. Data were collected via observation, resident record audit, and semi-structured interview. Definitions of incontinence varied among staff. A collectively held expectation that residents would be toileted every 2 hours was not met. Maintaining skin integrity was the primary motivation for keeping residents clean and dry. Medical directors viewed incontinence as a nursing problem. Staff described situations in which incontinence was improved for specific residents, but there was little evidence of formal programs to maintain continence or improve incontinence.
Improvements in care have been achieved in nursing facilities. However, sustaining improvements has proven difficult, and the outcomes of incontinence care illustrate this point Researchers have demonstrated that urinary continence can be improved when appropriate care is provided (Burgio et al., 1994; Colling, Ouslander, Hadley, Eissch, & Campbell, 1992; Ouslander et al., 1995) and that quality improvement technology can support improved continence over time (Schnelle, McNees, Crooks, & Ouslander, 1995; Schnelle, Newman, & Fogarty, 1 990; Schnelle, Newman, et al., 1993). However, the same researchers report a disturbing deterioration in continence after the research ends and nursing facilities reclaim responsibility for the clinical interventions or the quality improvement interventions. Why gains erode so quickly is not clear, and better understanding of the dynamics of care provided to incontinent residents is needed to inform both practitioners and researchers.
This study was designed to describe the care provided to nursing home residents with urinary incontinence. Findings are reported in relation to six elements of care:
* Definitions of incontinence.
* Basic care for incontinence.
* Programs to improve incontinence.
* Preparation of staff to care for incontinent residents.
* Staff attitudes toward care for incontinent residents.
* Medical director attitudes toward care for incontinent residents.
The current study was part of a larger project that also addressed the care planning process (Taunton, Swagerty, Smith, Lassiter, & Lee, 2004) and...