长期护理机构中工作人员对定时排尿计划的依从性及有效性评级

Remsburg R E, Palmer M H, Langford A M, Mendelson G F

Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

J Wound Ostomy Continence Nurs. 1999 Sep;26(5):261-9. doi: 10.1016/s1071-5754(99)90056-6.

BACKGROUND

Despite findings that prompted voiding is effective in reducing urinary incontinent (UI) episodes, the prevalence of UI in this population has remained unchanged. It is estimated that 50% of all nursing home residents have UI. Staff involvement is considered a critical factor, yet little is known about staff perception of the effectiveness of prompted voiding.

METHODS

This descriptive study of staff perceptions of a prompted voiding intervention was conducted at a university-affiliated 255-bed geriatrics center. A 12-week prompted voiding program was conducted with 17 residents with UI. Baseline continence status was compared with continence status at the end of the program, and a survey was conducted to assess staff perceptions of the program. The aims of the study were: (1) to determine effectiveness of a prompted voiding program, (2) to assess staff perception of overall effectiveness of the prompted voiding program, (3) to assess staff compliance with the prompted voiding program, and (4) to compare staff perception of prompted voiding effectiveness with actual continence outcomes.

RESULTS

Overall UI status improved in 5 residents (31%), remained the same in 6 residents (38%), and declined in 5 residents (31%). Sixty-four (73%) of 88 staff members who participated in the program responded to a survey. Staff members were asked to rate their overall impressions of the prompted voiding program, and to rate improvement in continence status for specific residents who participated in the program. Ninety-five percent of staff members thought drier residents were happier; 80% thought the prompted voiding program should continue. Only 52% of staff thought residents participating in the prompted voiding program were better, and 43% perceived no change. A majority (58%) of staff thought compliance with prompted voiding was 80% to 90%; however, unobtrusive observations during the study revealed only 70% compliance. There was no correlation between staff ratings of improvement in continence and actual continence outcomes for individual residents (r = 0.02, P = .709).

CONCLUSIONS

Staff reports of compliance with a prompted voiding program were inflated, and they were unable to determine which residents had actually improved and which residents had not improved with regard to UI. These findings suggest that nursing home staff, and particularly nursing assistants, need more meaningful definitions of UI and quantifiable evidence that residents benefit from prompted voiding.

背景

尽管有研究发现定时排尿在减少尿失禁（UI）发作方面有效，但该人群中尿失禁的患病率仍未改变。据估计，所有养老院居民中有50%患有尿失禁。工作人员的参与被认为是一个关键因素，但对于工作人员对定时排尿有效性的看法却知之甚少。

方法

这项关于工作人员对定时排尿干预看法的描述性研究在一家隶属于大学的拥有255张床位的老年医学中心进行。对17名尿失禁居民实施了为期12周的定时排尿计划。将基线失禁状况与计划结束时的失禁状况进行比较，并进行了一项调查以评估工作人员对该计划的看法。该研究的目的是：（1）确定定时排尿计划的有效性；（2）评估工作人员对定时排尿计划总体有效性的看法；（3）评估工作人员对定时排尿计划的依从性；（4）比较工作人员对定时排尿有效性的看法与实际失禁结果。

结果

5名居民（31%）的总体尿失禁状况有所改善，6名居民（38%）保持不变，5名居民（31%）有所下降。参与该计划的88名工作人员中有64名（73%）回复了调查。工作人员被要求对他们对定时排尿计划的总体印象进行评分，并对参与该计划的特定居民的失禁状况改善情况进行评分。95%的工作人员认为干爽的居民更快乐；80%的人认为定时排尿计划应该继续。只有52%的工作人员认为参与定时排尿计划的居民情况有所好转，43%的人认为没有变化。大多数（58%）工作人员认为对定时排尿的依从性为80%至90%；然而，研究期间的暗访显示依从性仅为70%。工作人员对失禁改善情况的评分与个别居民的实际失禁结果之间没有相关性（r = 0.02，P = 0.709）。