Prompted Voiding Treatment of Urinary Incontinence in Nursing Home Patients: A Behavior Management Approach for Nursing Home Staff

Middle Tennessee State University, Murfreesboro 37132.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 12/1989; 37(11):1051-7. DOI: 10.1111/j.1532-5415.1989.tb06919.x
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This study evaluated a treatment procedure in which 126 incontinent nursing home patients were checked on an hourly basis, asked if they needed toileting assistance (prompted), and socially reinforced for appropriate toileting. Urodynamic analysis (including cystometrogram), provocative stress test, and behavioral assessment revealed that the nursing home patients were severely debilitated, with 65% demonstrating bladder abnormalities, 87% incapable of independent toileting, and 25% failing to score on the Mini-Mental Status Exam (average score, 8.0). The treatment procedures were evaluated with a multiple baseline design in which subjects were randomly divided into immediate or delayed treatment groups after a baseline observation period. During treatment, the frequency of incontinence per 12 hours changed from a baseline average of 3.85 to a treatment average of 1.91. Three behavioral measures that can be easily collected by nursing staff significantly predicted continence levels during treatment (multiple R, 0.79) and change in incontinence during treatment (multiple R, 0.64). These prognostic criteria offer nursing staff a cost-effective method for selecting the most responsive patients for prompted-voiding treatment.

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    • "Management techniques are largely aimed at hospital or community populations. Research on the management of incontinence in care home populations has been undertaken, predominantly in the United States of America (USA) by designated research teams (for example, Schnelle et al. 1989, Colling et al. 1992, Ouslander et al. 1995) and their findings may not be transferable to other populations or settings where the organization, staffing and delivery of care may vary. Research on long-term follow-up to indicate if practices are sustained is generally unavailable. "
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    ABSTRACT: This is a review of descriptive studies with incontinence as the primary focus in older people in care homes. Incontinence is prevalent among residents of care home populations. MEDLINE and CINAHL were searched from 1996 to 2007 using the highly sensitive search strings of the Cochrane Incontinence Review Group for urinary and faecal incontinence including all research designs. Search strings were modified to enhance selectiveness for care homes and older people and exclude studies involving surgical or pharmacological interventions. Searching of reference sections from identified studies was also used to supplement electronic searches. The Cochrane Library was searched for relevant systematic reviews to locate relevant studies from those included or excluded from reviews. The search was limited to English-language publications. A systematic review of studies on the management of incontinence, promotion of continence or maintenance of continence in care homes was conducted in 2007-2009. This is a report of descriptive studies. Results. Ten studies were identified that reported on prevalence and incidence of incontinence (urinary with or without faecal), policies, assessment, documentation, management or economic evaluation of its management. Use of incontinence pads and toileting programmes comprised the most common management approaches used. No studies were identified that attempted to maintain continence of residents in care homes. Studies on maintaining continence and identifying components of toileting programmes that are successful in managing or preventing incontinence and promoting continence in residents of care home populations along with their economic evaluation are warranted.
    Journal of Advanced Nursing 02/2011; 67(2):228-50. DOI:10.1111/j.1365-2648.2010.05481.x · 1.74 Impact Factor
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    ABSTRACT: Nursing home medicine has moved from guessing, common sense, and hunches to a broader base of knowledge and skills that should be available to and used by all clinicians.
    Journal of General Internal Medicine 05/1992; 7(3):350-62. DOI:10.1007/BF02598095 · 3.45 Impact Factor
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    ABSTRACT: Typescript (photocopy). Thesis (Ph. D. - Nursing)--University of Arizona. Includes bibliographical references (leaves 257-274).
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