Caring for continence in stroke care settings: a qualitative study of patients' and staff perspectives on the implementation of a new continence care intervention. (May 2016)

• Record Type: Journal Article
• Authors: Brady, MC; Jamieson, K; Bugge, C; Hagen, S; McClurg, D; Chalmers, C; Langhorne, P
• Is Part Of: Clinical rehabilitation. Volume 30:Number 5(2016)
• Page Start: 481
• Page End: 494
• Publication Date: 2016-05
• Subjects: Incontinence -- rehabilitation -- nursing -- bladder function -- patient-centred care; Medical rehabilitation -- Periodicals; 617.03
• DOI: 10.1177/0269215515589331
• Languages: English
• ISSNs: 0269-2155

Abstract

Objectives: Investigate the perspectives of patients and nursing staff on the implementation of an augmented continence care intervention after stroke. Design: Qualitative data were elicited during semi-structured interviews with patients ( n = 15) and staff (14 nurses; nine nursing assistants) and analysed using thematic analysis. Setting: Mixed acute and rehabilitation stroke ward. Participants: Stroke patients and nursing staff that experienced an enhanced continence care intervention. Results: Four themes emerged from patients' interviews describing: (a) challenges communicating about continence (initiating conversations and information exchange); (b) mixed perceptions of continence care; (c) ambiguity of focus between mobility and continence issues; and (d) inconsistent involvement in continence care decision making. Patients' perceptions reflected the severity of their urinary incontinence. Staff described changes in: (i) knowledge as a consequence of specialist training; (ii) continence interventions (including the development of nurse-led initiatives to reduce the incidence of unnecessary catheterisation among patients admitted to their ward); (iii) changes in attitude towards continence from containment approaches to continence rehabilitation; and (iv) the challenges of providing continence care within a stroke care context including limitations in access to continence care equipment or products, and institutional attitudes towards continence. Conclusion: Patients (particularly those with severe urinary incontinence) described challenges communicating about and involvement in continence care decisions. In contrast, nurses described improved continence knowledge, attitudes and confidence alongside a shift from containment to rehabilitative approaches. Contextual components including care from point of hospital admission, equipment accessibility and interdisciplinary approaches were perceived as important factors to enhancing continence care.