Booth Jo, Kumlien Suzanne, Zang Yuli, Gustafsson Barbro, Tolson Debbie
Centre for Gerontological Practice, Glasgow Caledonian University, Glasgow, UK.
J Clin Nurs. 2009 Apr;18(7):1049-58. doi: 10.1111/j.1365-2702.2008.02688.x.
To explore nurses' practices and influences in relation to urinary incontinence following stroke, in the UK, Sweden and China.
Urinary incontinence following stroke is common, under-recognised and poorly researched. Before appropriate rehabilitation interventions can be developed, an understanding of nurses' current management approaches and cultural influences is required.
Qualitative.
Semi-structured interviews were undertaken with ten registered nurses from at least four different stroke units in three countries (n = 30). Interviews were carried out in the participants' first language, using an agreed interview guide. Following translation, thematic analysis focusing on manifest meaning was undertaken, using an iterative approach involving electronic and face-to-face discussions.
The consequence of only superficial assessment was no systematic identification of types or causes of urinary incontinence and no individualised plans developed. A process model of practice, common to all three countries, was identified for stroke survivors with urinary incontinence. Routine core activities were followed by the palliative pathway (most frequently), where urinary incontinence was contained to protect the stroke survivors' safety and ensure social continence; or the rehabilitative route (more rarely), where simple continence promoting activities were implemented with the purpose of facilitating recovery of bladder function.
Nurses' reactively manage urinary incontinence following stroke, adopting a routinised approach based on local custom and practice. Promotion of urinary continence is not a priority area of stroke rehabilitation for nurses in western or eastern countries.
The dearth of evidence-based interventions available to rehabilitate bladder function following stroke means that stroke nursing practice is an experience-based endeavour. This study explains the nurses' focus on containment and social continence and highlights the need to systematically assess stroke survivors' bladder rehabilitation needs, identify types of urinary incontinence and adopt appropriate urinary continence promoting practices.
探讨英国、瑞典和中国护士对中风后尿失禁的处理方式及影响。
中风后尿失禁很常见，但未得到充分认识且研究不足。在制定适当的康复干预措施之前，需要了解护士当前的管理方法和文化影响。
定性研究。
对来自三个国家至少四个不同中风单元的十名注册护士进行了半结构式访谈（n = 30）。使用商定的访谈指南，以参与者的母语进行访谈。翻译后，采用聚焦显性意义的主题分析法，通过电子和面对面讨论的迭代方法进行分析。
仅进行表面评估的结果是未系统识别尿失禁的类型或原因，也未制定个性化计划。为中风后尿失禁的幸存者确定了一个三国通用的实践过程模型。常规核心活动之后是姑息治疗途径（最常见），即控制尿失禁以保护中风幸存者的安全并确保社交排尿；或康复途径（较少见），即实施简单的促进排尿活动以促进膀胱功能恢复。
护士对中风后尿失禁采取被动管理方式，采用基于当地习俗和实践的常规方法。促进排尿并非东西方国家护士中风康复的优先领域。
中风后恢复膀胱功能的循证干预措施匮乏，这意味着中风护理实践是基于经验的努力。本研究解释了护士对控制和社交排尿的关注，并强调需要系统评估中风幸存者的膀胱康复需求，识别尿失禁类型并采用适当的促进排尿实践。
