Nursing and Midwifery, University of the West of England Faculty of Health and Applied Sciences, Bristol, UK
North Bristol NHS Trust, Bristol, UK.
BMJ Open Qual. 2021 Apr;10(2). doi: 10.1136/bmjoq-2021-001380.
Bladder and bowel control difficulties affect 20% and 10% of the UK population, respectively, touch all age groups and are particularly prevalent in the older (65+ years) population. However, the quality of continence care is often poor, compromising patient health and well-being, increasing the risk of infection, and is a predisposing factor to nursing and residential home placement.
To identify factors that help or hinder good continence care for patients aged 65 years and over in hospital medical ward settings. Medical care, not surgical, was our exclusive focus.
We conducted 27 qualitative interviews with nursing, medical and allied health practitioners in three hospitals. We used a purposive sample and analysed data thematically, both manually and with the aid of NVivo software.
Interviews revealed perspectives on practice promoting or inhibiting good quality continence care, as well as suggestions for improvements. Good continence care was said to be advanced through person-centred care, robust assessment and monitoring, and a proactive approach to encouraging patient independence. Barriers to quality care centred on lack of oversight, automatic use of incontinence products and staffing pressures. Suggested improvements centred on participatory care, open communication and care planning with a higher bladder and bowel health profile. In order to drive such improvements, hospital-based practitioners indicate a need and desire for regular continence care training.
Findings help explain the persistence of barriers to providing good quality care for patients aged 65 years and over with incontinence. Resolute continence promotion, in hospitals and throughout the National Health Service, would reduce reliance on products and the accompanying risks of patient dependency and catheter-associated gram-negative bacteraemia. Robust assessment and care planning, open communication and regular continence care training would assist such promotion and also help mitigate resource limitations by developing safer, time-efficient continence care.
膀胱和肠道控制困难分别影响英国人口的 20%和 10%，涉及所有年龄段，在老年人（65 岁以上）中尤为普遍。然而，控失禁护理的质量往往很差，会影响患者的健康和福祉，增加感染风险，并且是导致患者入住护理院和养老院的一个因素。
确定有助于或阻碍 65 岁及以上住院患者在医院医疗病房获得良好控失禁护理的因素。我们关注的是医疗护理，而非手术。
我们在三家医院对护理、医疗和联合健康从业者进行了 27 次定性访谈。我们采用了目的性抽样，并通过手动和 NVivo 软件进行了主题数据分析。
访谈揭示了促进或阻碍高质量控失禁护理的实践观点，以及改进建议。有人认为，以患者为中心的护理、全面的评估和监测、积极鼓励患者独立，有助于实现良好的控失禁护理。质量护理的障碍主要集中在缺乏监督、自动使用失禁产品和人员配备压力。改进的建议主要集中在参与式护理、开放沟通和护理计划上，提高对膀胱和肠道健康的认识。为了推动这些改进，医院的从业者表示需要并希望定期接受控失禁护理培训。
研究结果有助于解释为 65 岁以上患有失禁症的患者提供高质量护理的持续障碍的原因。在医院和整个国民保健服务体系中坚决促进控失禁，可以减少对产品的依赖，降低患者依赖和与导尿管相关的革兰氏阴性菌血症的风险。全面的评估和护理计划、开放的沟通以及定期的控失禁护理培训将有助于促进这种护理，并通过开发更安全、更高效的控失禁护理来缓解资源限制。
